Endometriosis Awareness Month: Let’s talk about endometriosis and conception

34-year-old Camilla Fellas Arnold has been trying to conceive for three years. “It’s been really tough,” she says. “It’s been lonely and brings up all sorts of doubts, fear, and internal blame.”

Camilla was also diagnosed with endometriosis (defined by the NHS as ‘a condition where tissue similar to the lining of the womb grows in other places, such as the ovaries and fallopian tubes’) by a consultant in November 2023. She was put on the waiting list for a diagnostic laparoscopy (a procedure carried out under general anaesthetic, where a small telescope is inserted into the abdomen to assess the internal tissue) – intended to officially confirm her diagnosis once and for all, and to establish the severity of her condition – with an 80-week wait.

Crucially, Camilla doesn’t know if endometriosis has impacted her fertility journey – “I don’t really know enough about what stage of endo I have” – but suspects it has. “I didn’t know about endo when we started trying to conceive, although now it does explain why it’s probably been difficult,” she says. “As a result of being put on the waiting list for the laparoscopy, I’ve been advised to undergo fertility testing to see if/what can be done to help that side of things, but this is still in progress.”

As you’re no doubt aware, March is Endometriosis Awareness Month. Every March, we can (quite rightly) expect to see swathes of endometriosis-related articles nudging their way to the top of our search engines – from the ever-shocking and horrifying diagnosis wait times to whether changing your diet can relieve your symptoms. But a certain facet of patriarchy known as the gender health gap (isn’t it great to be a woman in pain?) means there’s still a lot for us all to learn about endometriosis; including the extent to which endometriosis can impact someone’s journey to conceiving a baby.

That’s where we come in. We’ve taken a deep dive into the possible (we repeat, possible) link between endometriosis and conception; speaking to an expert and endeavouring to answer all your endometriosis-and-conception-related questions. Remember, though, everyone’s endometriosis (and fertility) journey is different, and journeys to conception will differ depending on how the condition manifests for each individual. Read and learn, by all means; but always speak to your healthcare provider first and foremost.

Without further ado…

I have endometriosis and I’m trying to conceive. What’s the first thing I should know?

If you have endometriosis, that does not automatically mean you won’t be able to conceive. Take 45-year-old Merrisha Gordon, for example, who had Stage IV endometriosis (the most severe form) and had a lot of surgery after being misdiagnosed for 20 years. She was told she’d never conceive naturally; but, contrary to what she was told, conceived naturally six years ago.

Ems Rae Searle is another example. The 27-year-old didn’t have any endo surgery, but private consultations with an endometriosis specialist confirmed her diagnosis. Ems tried for a baby for years – and, after a full spectrum of fertility tests which came back all clear, she concluded that the only way to explain the delay in conceiving was her endometriosis.

Last summer, Ems and her husband were approved for IVF on the NHS – and got pregnant naturally in the same week they got the IVF approval letter through. They’re now expecting their baby in a few weeks.

So, endometriosis certainly doesn’t equate to infertility. It might, though, lead to complications you wouldn’t necessarily encounter otherwise.

“First thing to do is not to panic but to think optimistically,” says OVUM’s Co-Chief Medical Officer, Dr. Phoebe Howells. “Endometriosis is a common condition affecting around 1:10 women of reproductive age. It does not automatically cause infertility, but there may be an association with fertility problems. That said, it is thought that 60-70% of patients with endometriosis will conceive naturally.

“If you do have concerns, it is best to get advice early as there may be ways that your fertility can be optimised,” she adds.

So, in short: The first thing to do is take a deep breath (or ten) and make an appointment with a healthcare professional.

What role does ovulation play in preconception and conception?

Okay, this may not have been one of your burning questions about endometriosis and conceiving a child, but it’s an important one to know the answer to nonetheless. The answer is that, while you can still get pregnant when you’re not ovulating, ovulation plays a crucial role in conception. It’s known as the ‘the fertile window’:

“Ovulation is the process whereby your ovary releases an egg,” Howells explains. “This is usually midcycle, which, in a 28-day cycle, would usually be around day 14; in a 35-day cycle, this would be around day 21.

“This egg will be swept up by the end of the fallopian tube and will then migrate down the tube into the uterus, meeting sperm in the fallopian tube along the way, if present, which fertilise [the egg].”

So…does endometriosis impact ovulation?

Current evidence suggests that women with endometriosis can have altered egg production in the ovaries,” answers Howells. This may be because of a higher level of inflammatory cells in the pelvic fluid that surrounds the ovaries, potentially making it a hostile environment.

“Some women also have cysts on the ovaries, called Endometriomas, that are filled with old blood”, Howells continues. “It is thought that these can also alter the environment in the ovary, which could affect the production of the egg and even ovulation.”

And speaking of eggs – if you’re some way on your fertility journey, you may have heard the term ‘egg quality’ bandied about a fair bit. “It is difficult to know the exact mechanisms of why endometriosis can cause poorer egg quality,” says Howells. “One theory is that the scar tissue that endometriosis forms can compromise normal blood flow to the ovaries, which could hinder the eggs' maturation. Another is that the inflammatory chemicals can alter the quality of the developing egg.”

If you’re concerned that endometriosis could be impacting your ovulation and/or egg quality, it’s important to speak to a healthcare provider to establish whether this is the case and, if so, what steps might be available to you.

I have endometriosis, and I’m worried about my chances of conceiving. What lifestyle steps can I take…

Well, you’ll be happy to know that – while there are no guarantees of pregnancy – you can take some natural steps to prepare your body as best as possible for getting pregnant.

Some people advise cutting down on inflammatory foods, such as sugar, alcohol, and meat,” says Howells. “Eat plenty of foods which are rich in antioxidants such as vegetables, which can counteract the inflammatory chemicals.”

Next, of course, there are supplements, which, if you’re already familiar with OVUM, you may have some experience with. “Taking preconception supplements which have multiple antioxidants, such as OVUM, will also create a healthier environment for egg development,” adds Howells. “Antioxidants neutralise chemicals called free radicals which can cause damage to the DNA in eggs.”

…And what medical routes might be available to me?

“Investigations to help diagnose the reason for fertility issues in women with endometriosis include a dye test [...] or a laparoscopy and dye test,” says Howells. “The dye test is to evaluate whether the fallopian tubes are open, as endometriosis can cause [...] a potential blockage.”

Howells adds that the best way to diagnose the stage of the endometriosis is via a laparoscopy; but emphasises that laparoscopies aren’t suitable for everyone. It is essential to speak to your healthcare provider about your condition, symptoms, and fertility journey thus far to establish which test is best for you. 

And, when it comes to fertility treatments that might be available to you, Endometriosis UK has a handy explainer on some options, Including ovulation induction, intrauterine insemination, and ovarian stimulation with IUI, among others. You can read more about these options here.

Final key takeaways…

“You may be struggling with endometriosis along with infertility, and this can feel very isolating and demotivating, especially if it has been years without success,” Howells concludes. “Know that you are not alone and there are many support groups who specifically want to help women in these situations.”

And Camilla’s final thought for anyone struggling with endometriosis, fertility, or both at the same time, is to “do whatever you can to support your mental state.” We can’t say fairer than that.

Written by Izzie Price. 
Izzie Price is a freelance journalist and health writer, often specialising in women's health (though she also writes about love and relationships). She's written for Refinery29, Glamour, Cosmopolitan, Stylist, the Independent, the Telegraph, the i, HuffPost, Metro, Dazed, Vice and Reader's Digest, among others.

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