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March 3, 2023, marks the beginning of endometriosis awareness week. A week during which we should all be informed and educated about that common but often unrecognized condition. In this article, we will shed some light on the causes, implications, and on how endometriosis affects fertility levels and possible pregnancies.

What is endometriosis? 

Endometriosis is defined as the presence of endometrial-like tissue (glands and stroma) outside the uterus, which induces a chronic inflammatory reaction, scar tissue, and adhesions that may distort a woman’s pelvic anatomy. It is primarily found in young women, but its occurrence is not related to ethnic or social group distinctions. Patients with endometriosis mainly complain of pelvic pain, dysmenorrhea, and dyspareunia. 

It is a very common condition with 6 to 10% of the world population suffering from it, and the percentage rises up to 50%  in women with pain and infertility problems. About 25 to 50% of infertile women have endometriosis, and 30 to 50% of women with endometriosis are infertile, so there is a clear connection between those two conditions. 

Symptoms of endometriosis: Most common symptoms appear to be dysmenorrhea, chronic pelvic pain, deep dyspareunia, severe menstrual pain and irregular flow. Others might be nausea, lethargy, and chronic fatigue. The severity of the symptoms increases with the woman’s age.

A woman reproductive system made of flowers in a pink and yellow background.

Treatment of endometriosis:

It basically needs the female hormone estrogen to develop and grow. Birth control pills and other drugs that lower or block estrogen can be effective in improving pain symptoms. For patients who wish to become pregnant, medical therapy may be considered prior to attempts at conception. 

While hormonal treatments such as birth control or gonadotropin-releasing hormones (GnRH) can temper symptoms, there is often a high recurrence rate after stopping the treatment. Because of this, it’s a good idea to explore multiple options when looking to treat your endometriosis, and it doesn’t have to be medical treatments. 

Research has found that things like inflammation, estrogen regulation and menstruation can all impact the severity of endometriosis and they are all aspects that can be affected by the food we eat. There is no universal diet plan for endometriosis but through trial and error, you can discover foods to avoid that trigger endo symptoms, and ones to add to your diet that soothe them. The most important thing you should do while choosing a new diet is to consult a nutritionist or a dietician to correctly consult you.

Anti-inflammatory diet:

A diet that includes fibrous foods that have been proven to decrease estrogen levels, which can have a positive effect on endo symptoms caused by inflammation from high estrogen levels. It also includes iron-rich foods, like leafy greens, broccoli, nuts and seeds, as well as foods rich in fatty acids: fatty fish such as salmon and sardines, or walnuts, chia and flax seeds. Some studies have shown that consuming omega-3 fats can discourage endometrial cells from attaching to the endometrium, thus alleviating pain. 

Antioxidant-rich foods are another key part of an anti-inflammatory diet, as antioxidants such as vitamin C and E carry inflammation-reducing properties. These can be found in berries, spinach, dark chocolate and beets. On the flipside, certain foods contribute to greater inflammation, thus having the potential to trigger endo symptoms. One study found that people with endo experienced a significant decrease in pain after eliminating gluten from their diet. Gluten, red meat, trans fat, caffeine and alcohol have all been proven to increase inflammation, thus intensifying symptoms.

What about exercise?

The act of exercising helps regulate estrogen levels, thus targeting the very thing that is contributing to that pain, bloat and discomfort. Walking can reduce inflammation, leading to a reduction in pain, as well as release endorphins, which can lessen your body’s sensitivity to pain. Another great benefit of exercising and specifically walking is that it boosts mental health, due to the endorphins release. Dealing with endometriosis can have a negative effect on your psychology, having to deal with all this pain, anxiety, discomfort, and not being able to talk about how you feel.

And while we talk about feelings you should know that there are several endometriosis communities you can talk to, and the most important thing is to be brave enough to talk about your condition to your workplace. As many of us spend so many hours a day in the office, and office is our second home, we should feel comfortable at that home. Nowadays, fertility struggles and health conditions in general are receiving more and more awareness in the workplace, and managers want to do more and take action.

Don’t suffer in silence, make people aware of the situation, and let them help you.

If endometriosis is found at the time of surgery, the doctor will surgically remove the scar tissue. This treatment will restore the normal anatomy and will allow the reproductive organs to function more normally. 

The best way to tell for certain if you have endometriosis is through a surgical procedure called laparoscopy.

There is a staging system for evaluating endometriosis:

  • 1. Stage I endometriosis (minimal disease): There are a few small implants (specs) of endometriosis, with no scar tissue seen.
  • 2. Stage II endometriosis (mild disease): There are more implants of endometriosis, but less than 2 inches of the abdomen is involved and there is no scar tissue.
  • 3. Stage III endometriosis (moderate disease): There is quite a bit of endometriosis in the abdomen which may be deep and may create pockets of endometriotic fluid (chocolate cysts, or endometriomas) in the ovaries. There may be scar tissue around the tubes or ovaries.
  • 4. Stage IV endometriosis: A great deal of endometriotic implants, possibly large endometriotic cysts in the ovaries, possible scar tissue between the uterus and the rectum (lower part of the intestines), and around the ovaries or fallopian tubes.

In general, when women are younger (below the age of 35)  it is reasonable to remove any visible endometriosis to increase chances of pregnancy. If women are 35 or older, other fertility treatments are recommended instead of laparoscopy. If Stage III or IV endometriosis is present, pregnancy rates are higher after surgery is performed to remove scar tissue or large endometriotic cysts. If pregnancy does not occur within 6 months after surgical treatment of endometriosis, other fertility treatments should be discussed, such as IVF. 

According to a research study, the correct management of infertile women with endometriosis is a combination of surgery and, in the absence of a spontaneous post-surgery pregnancy, IVF-ET. This integrated approach (surgery-IVF-ET) produced a pregnancy rate of 56.1% compared to a significantly lower pregnancy rate of only 37.4% after surgery alone. 

What is IVF-ET exactly?

It is a two-part assisted reproductive technology procedure. It requires the female partner to receive a series of injections of potent fertility drugs, which induce ovulation. These fertility medications cause her ovaries to produce several mature eggs (oocytes) at the same time as opposed to just one in a normal, unmedicated menstrual cycle. This gives the woman an increased chance of conceiving, and the ability to select the most viable embryos. Egg retrieval proceeds by removing the oocytes from the ovaries under light sedation using an intravaginal aspiration process that takes just a few minutes to perform. A semen specimen is obtained from the male partner, and eggs and sperm are combined in the IVF laboratory. Within three to six days, embryos developing from this process are evaluated, and some are selected for embryo transfer (ET). 

So, if you have endometriosis and want to get pregnant, the doctor will evaluate your situation using the endometriosis fertility index (EFI). The EFI is a 10-point scale that can tell a doctor how likely a person is to get pregnant without medical intervention. Some of the scale considers factors are:

  • age
  • endometriosis stage
  • least function score (measures fallopian tube and ovarian function)
  • length of infertility
  • medical history
  • prior pregnancies

Although one size doesn’t fit all, a 2021 study concluded that people with a score of 5 or higher might be able to try conceiving naturally for 24 months before medical intervention. The authors said that those with scores of 4 or lower should be referred for artificial reproductive treatments more quickly.

Interesting scientific facts you may need to keep in mind, is that if you have endometriosis the risk of a miscarriage rises to 1 in 4, when for healthy women is 1 in 5. Also, although ectopic pregnancies are less common than miscarriages, with around 1 in 80 to 100 pregnancies ending up as ectopic, but research has shown that in those with endometriosis, the risk is more than doubled.

Bottom line is that although endometriosis will most likely cause infertility issues, that is not the end of your story! Trust your body and science, give time, and hope for the best. Assisted reproductive technology does wonders nowadays, but there is also a chance of you conceiving naturally if you treat endometriosis at an early stage.

And because we are on the endometriosis awareness week, there are a few associations/communities worth “visiting”!


MEDIPASS is by your side through your fertility journey, offering you the best fertility clinics , always according to your wants and needs. Together we will transform your fertility journey.

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