Endometriosis & Infertility – How it Causes Infertility and Treatment Options

The American Society for Reproductive Medicine (ASRM) reports that around 11% of reproductive-aged women in the United States (6.7 million) struggle to achieve pregnancy or carry a baby to term.  30-50% of women suffering from infertility have endometriosis .  Endometriosis is one of the most common causes of infertility, but still, many women suffer from endometriosis for years before they are properly diagnosed.  In addition to causing infertility, endometriosis symptoms include painful menstrual cramps, chronic pain in the lower back, and intestinal pain.  In this article, we will discuss all things related to endometriosis and infertility, including; diagnosing endometriosis, treatment options, getting pregnant with endometriosis, and more.  We all also discuss some natural remedies and treatments to reduce the symptoms of endometriosis, especially inflammation and pain.  

Fast Facts about Endometriosis and Infertility

  • 30-50% of women who suffer from infertility have endometriosis.  
  • Endometriosis affects 10–15% of all women of reproductive age
  • Women with infertility are about eight times more likely to have endometriosis than women that have been pregnant.
  • Fertility treatment has been shown to increase the probability of pregnancy in endometriosis patients by up to 60% .
  • In one study, women with endometriosis experienced similar live birth rates after IVF treatment to control groups .
  • Different studies have produced conflicting results when trying to explain how endometriosis affects fertility.
  • Research suggests tendometriosis can cause; distorted anatomy of the pelvis, adhesions, scarred fallopian tubes, inflammation of the pelvic structures, altered immune system functioning, changes in the hormonal environment of the eggs, impaired implantation of a pregnancy, and altered egg quality

What is Endometriosis?

In addition to being one of the leading causes of infertility, endometriosis is one of the most common gynecological diseases.  Endometriosis is an inflammatory disease defined as the presence of endometrial-like tissue (glands and stroma) outside the uterus.  During a normal menstrual cycle, endometrial tissue grows inside the uterus and the endometrial lining fills up with blood and prepares the womb for ovulation.  When an embryo does not implant, the lining sheds and is released through the vagina, and a women’s period occurs.

In women with endometriosis, abnormal tissue grows outside the uterus on their ovaries, intestines, and the tissue that lines the pelvis.  Over time, this tissue breaks down and bleeds.  Unlike the normal tissue that grows in the uterus, this broken-down tissue and blood have nowhere to go.  The buildup of broken-down blood and tissue causes chronic inflammatory reactions, scar tissue, and adhesions that may distort a woman’s pelvic anatomy .  Endometriosis patients can present with a wide-range of symptoms.  For most women, endometriosis causes pain and infertility, but 20-25% of patients are asymptomatic.  

Symptoms of endometriosis include:

  • Pain – The most common symptom of endometriosis.  Examples include; painful menstrual cramps, chronic lower back and pelvic pain, pain during or after sex, intestinal pain, painful bowel movements 
  • Bleeding or spotting
  • Infertility
  • Digestive problems and stomach issues
  • Other symptoms – fatigue, diarrhea, constipation, bloating or nausea

Does Endometriosis Affect Fertility?

Impaired fertility is the main complication of endometriosis.  Research indicates that about 25 to 50% of infertile women have endometriosis, and 30 to 50% of women with endometriosis are infertile.  Infertile women are 6 to 8 times more likely to have endometriosis than fertile women .  Although research has established a strong association between endometriosis and infertility, the exact mechanism of how it affects fertility is not definitively known.  Many large endometriosis studies have published conflicting reports and conclusions as to how the disease affects fertility.  Rather than debating the results of these studies, below, we will explore some of the leading theories of how endometriosis causes infertility.

How Does Endometriosis Affect Fertility?

Fertility specialists believe that the inflammation and irritation caused by endometriosis affect fertility in more ways than one.  In order for pregnancy to occur, a woman’s ovary must release an egg.  After the egg is released, it is picked up by the fimbria and is transported to the fallopian tube where it is fertilized by a sperm cell.  The egg and sperm attach to the uterine wall and development begins. 

Endometriosis can disrupt this process in several ways.  Firstly, it can create inflammation in the fimbria which causes swelling and scarring keeping the egg from ever reaching the fallopian tube.  If the egg does reach the fallopian tube, endometriosis can cause obstruction and inflammation in the tube which can keep the sperm from reaching the egg.  Endometriosis can cause; distorted anatomy of the pelvis, adhesions, scarred fallopian tubes, inflammation of the pelvic structures, altered immune system functioning, changes in the hormonal environment of the eggs, impaired implantation of a pregnancy, and altered egg quality .

Inflammation and Adhesions

One of the main characteristics of endometriosis is inflammation and subsequent formation of adhesions in the pelvis .  These changes distort a woman’s pelvic anatomy which can hurt her fertility in numerous ways.  Specific to a woman’s fertility, adhesions can cause a disturbance in the structural alignment of the ovaries and fallopian tubes.  Endometriosis can also cause tubal blockages and the formation of hydrosalpinges, which are known to cause infertility.

Endometriosis causes several chronic inflammatory environments, particularly in the peritoneal cavity, ovaries, and uterus .   However, endometriosis does not always affect patients in an anatomical manner.  Endometriosis can affect fertility in several other ways.

Inflammation in The Peritoneal Cavity

Endometriosis is known to alter the composition of the peritoneal fluid and peritoneal environment, causing a chronic inflammatory state  .  Research has shown that the volume of peritoneal fluid is significantly higher in infertile women with endometriosis than in those without the disease .   Changes in peritoneal fluid composition directly influences the fertilization process and can lead to poorer quality oocytes with reduced fertilization rates and poorer embryonic development and implantation .  For example, endometriosis can affect sperm motility and function, reducing the chance of fertilization

Inflammation in the Ovaries

Inflammatory cells in the peritoneal fluid have been associated with altered ovulation and oocyte production.  Peritoneal fluid and the resulting inflammatory environment can influence the endometriotic tissue and cause endometriomas to grow.  Endometriomas cause inflammation in the ovaries which has been shown to impair both oocyte production and ovulation in the affected ovary .  

Numerous past studies have indicated that endometriosis causes damage to the ovarian tissue which impairs ovarian function.  Endometriosis can cause a physiological disturbance in the female reproductive system that can alter ovulation patterns . A cyst in the ovaries may cause damage to the ovarian tissue, including the follicle.  It can impede blood flow and cause compression in the ovarian cortex which alters the make-up and vascularization of ovarian tissue .  When follicles begin to grow, they do not have their own vascular network.  As such, they rely on the ovarian tissue cells surrounding them for nutrient supply .  Inflammation caused by endometriosis can damage this ovarian tissue causing follicles to develop improperly.  

Endometriosis’ Affect on Ovarian Reserve

Research indicates that endometriosis and the abnormal structural tissue growth that it causes in and around the ovaries may also contribute to diminished ovarian reserve .  Endometriosis causes a sustained reduction of ovarian reserve through both physical mechanisms and inflammatory reactions, which result in the production of reactive oxygen species and tissue fibrosis.  The severity of endometriosis is related to ovarian reserve .  The ovarian reserve of endometriosis patients can be measured by AMH (Anti-Mullerian Hormone) or pre-antral follicle count (number of early eggs that are present in the early part of the menstrual cycle) testing.  At baseline, women with endometriomas have signifcantly lower AMH levels than healthy women .  

Impaired Implantation

Even if the oocyte and is successfully picked up by the fallopian tube and is fertilized, women with endometriosis have functional alterations in eutopic endometrium which can reduce the chances of implantation .  Research has shown that women with endometriosis have lower implantation rates compared to patients with tubal infertility .  Endometriosis appears to impair the relationship between the embryo and the endometrium, but the exact mechanism behind the disruption is unknown.  Some researchers believe that endometriosis causes disruption of progeserone receptors which leads to progesterone resitance.  Progesterone resistance may cause decreased endometrial receptivity

It is unclear if endometriosis causes reduced implantation or if there is one pathological process that produces both endometriosis and decreased implantation.  IVF studies have suggested that women with more advanced endometriosis have poor ovarian reserve, low oocyte and embryo quality, and poor implantation .  Some researchers believe that damage caused to the oocytes by endometriosis may be responsible for the lower implantation rates. 

Affect on Gametes and Embryos

As previously mentioned, endometriosis causes an alteration in the composition of the peritoneal fluid.  The inflammatory/toxic effects of the altered peritoneal fluid can cause a decrease in sperm quality or function.  The increased number of inflammatory cells in the peritoneal fluid not only damages the oocytes and sperm, but they also have been shown to negatively affect the embryo .  

Studies have shown that women with endometriosis experience fairly high pregnancy rates when they undergo IVF with donor eggs from a woman without endometriosis.  When women without endometriosis undergo IVF and use donor eggs from women with endometriosis, success rates are significantly reduced .  Other studies have shown that embryos created from the eggs of endometriosis patients during IVF have lower fertilization and development rates than embryos from women without endometriosis .  Since women with endometriosis have higher levels of inflammatory substances and lower pregnancy rates, toxicity as a result of endometriosis may result in impaired embryos.  Impaired embryos as a result of poor quality eggs may explain the lower implantation rates and higher early spontaneous abortion rates in endometriosis patients.    .  

So what about endometriosis causes a decrease in egg quality?  Unfortunately, there is not a concrete answer to that question, but there are several theories that aim to explain the relationship between endometriosis and egg quality.  One theory is that the inflammation in the reproductive system caused by endometriosis may be toxic to eggs .  Egg development and egg quality could also be affected by hormonal imbalances in the ovary.  These hormonal imbalances, especially estrogen and progesterone, are believed to be caused by endometriomas. 
Another potential explanation for poor egg quality caused by endometriosis is the resulting scar tissue in the reproductive system.  Scar tissue can impede blood flow to the ovaries causing a reduction in oxygen and nutrient levels.  Low oxygen and nutrient levels can cause eggs to mature improperly.  If eggs mature improperly they may not be able to fertilize, implant, or develop into a viable embryo .  

Gamete transport is also affected by endometriosis.  The inflammatory environment caused by endometriosis disrupts tubal function and tubal motility.  Impaired tubes can affect oocyte release or pick-up, alter sperm motility, and hinder fertilization and embryo transport .  

Endometriosis, Infertility, and Age

As women get older, their fertility decreases naturally.  The severity of endometriosis symptoms and the probability of a diagnosis also increase with age .  Research has found that endometriosis is significantly related to age, and that its symptoms peak at ages 40-44 .  As such, doctors advise those diagnosed with endometriosis to seek treatment sooner rather than later and not to delay having children. 

Endometriosis patients can benefit from early treatment in many ways.  Research has shown that early identification of endometriosis and treatment can help to mitigate pain and prevent disease progression which can preserve fertility .

Silent Endometriosis

Typically, endometriosis causes pain and other symptoms, although 20–25% of patients are asymptomatic .  That may lead you to ask, how can a chronic inflammatory disease that produces all of the complications discussed in this article have no symptoms?  For some women, the only apparent symptom of endometriosis is impaired fertility.  Many women do not discover they have endometriosis until they experience difficulty conceiving naturally or they go for a fertility evaluation.  

Endometriosis is often misdiagnosed.  The only true way to diagnose endometriosis is through laparoscopy.  Endometriosis can also be detected, although less effectively and definitively, by:

  • Anti-Mullerian Hormone (AMH) testing, as lower ovarian reserve is a symptom of endometriosis
  • High levels of Follicle-Stimulating Hormone (FSH)
  • Elevated levels of cytokines (inflammatory markers)
  • An internal ultrasound

Diagnosing Endometriosis for Infertility 

Endometriosis can be identified through common symptoms or ultrasound, but a true diagnosis cannot be made until a laparoscopy is performed.  Laparoscopy can be used to identity endometriosis, uterine fibroids, abnormal growths, and scar tissue.  Laparoscopy is a minimally invasive outpatient surgery that can provide an accurate diagnosis and sometimes even offer improved pregnancy rates if scar tissue or endometriosis is found and treated at the time of surgery.  During a laparoscopy, two small incisions are made in the patient’s abdomen.  A small telescope-like camera is inserted into the incision near the belly button.  The camera enables the surgeon to visualize the abdominal and pelvic organs including the uterus, fallopian tubes, and ovaries.  Surgeons can then identify even small areas of endometrial tissues and adhesions.  Treatment of endometriosis by laparoscopy can reduce pain and improve fertility.    

Laparoscopy allows fertility doctors to diagnose and correct known causes of infertility that would otherwise be missed by other less invasive testing like an HSG, ultrasound, or blood work.  If a patient has scar tissue that is preventing the egg from reaching the fallopian tubes, laparoscopy can help identify and treat it.  By performing a laparoscopy, fertility specialists can grade the level of severity to determine the appropriate treatment. Endometriosis treatment is highly individualized to each patient so several mechanisms are considered when designing medication protocols and deciding which reproductive technologies will be used.  

Laparoscopy is usually recommended after male and female fertility testing is completed and a patient shows a history of impaired fertility.  Other times, laparoscopy is recommended after a patient fails a few Letrozole, Clomid, or IUI cycles.  Recently, laparoscopy has been dubbed as a cost-effective treatment for improving pregnancy rates/outcomes based upon many factors including the potential impact of endometriosis.  Undergoing diagnostic surgery is associated with a lower rate of patients “dropping out” of fertility treatment prior to achieving pregnancy.  

For more information on using laparoscopy to diagnose endometriosis and infertility, check out Dr. Kiltz’s support webinar.  

As discussed, laparoscopy is the only way to definitively diagnose endometriosis.  Depending on the severity of the condition, laparoscopic surgery can be used to remove scar tissue or large endometriotic cysts to restore the normal pelvic anatomy .  In less severe cases, fertility specialists may recommend other fertility treatments like intrauterine insemination (IUI).  Commonly, a combination of laparoscopy and fertility treatments like in vitro fertilization (IVF) are used to give patients with endometriosis the best chance of getting pregnant.  A large, randomized meta-analysis of the available research found that treating endometriosis was associated with about a 60% increase in the chance for a successful pregnancy

IUI

Intrauterine insemination (IUI) is a minimally invasive reproductive procedure in which sperm is collected, concentrated, and deposited into a woman’s uterus.  IUI is most commonly used in conjunction with ovulation induction medications for endometriosis patients.  Medication protocols are specific to each patient and are designed by fertility specialists after reviewing a patent’s medical history, fertility history, the results of fertility testing, and other factors.  Research has shown that IUI can be an effective first-line strategy for infertile endometriosis patients with moderate to severe symptoms .    

During IUI, sperm are inserted directly inside the uterus.  This makes the journey sperm must travel to reach the egg shorter and less difficult.  As you know, endometriosis can cause inflammation all throughout the reproductive tract, which can impede sperm from reaching the egg.  IUI increases sperm’s chances of reaching the egg and for successful fertilization to occur.  

IVF

In vitro fertilization is known as the gold standard in fertility treatment and is currently the most effective treatment of endometriosis-associated infertility .  IVF treatment offers the highest success rates and quickest time to pregnancy of any assisted reproductive technology.  For a full breakdown, check out our article on the IVF process.   Women with mild to moderate endometriosis may undergo IVF as a first or second treatment option after IUI.  Women with more severe endometriosis may undergo laparoscopic surgery to remove extra tissue or blockages prior to IVF treatment.  Research has shown that laparoscopic surgery prior to IVF can increase the pregnancy rate for endometriosis patients .  

IVF can be beneficial for endometriosis patients because it eliminates several mechanisms required for a natural pregnancy that the disease affects.  For example, during IVF the woman’s eggs are fertilized by sperm in an embryology lab.  This eliminates the risk of sperm being damaged or not reaching the egg due to changes in the woman’s reproductive environment caused by endometriosis.  Eggs can be fertilized by normal IVF procedures or through intracytoplasmic sperm injection (ICSI).  

In a recent report on the Society of Assisted Reproductive Technology data, researchers showed that endometriosis patients may experience better results with IVF when compared to patients with other causes of infertility.  The average delivery rate per retrieval of patients undergoing IVF was 39.1% for women with endometriosis.  Patients with all other causes of infertility only saw a 33.2% success rate .  These results suggest that women with endometriosis have similar or increased success with IVF treatment compared to women with other causes of infertility.

Frozen Embryo Transfer

Frozen embryo transfer (FET) is a cycle in which frozen embryos from a previous IVF or donor egg cycle are thawed and then transferred into a woman’s uterus.  Freezing embryos is one of those convenient and effective ways of preserving fertility for women with endometriosis. Keep reading below for information on preserving your fertility for endometriosis patients.  When patients undergo a frozen embryo transfer, their bodies have more time to recover from the ovarian stimulation phase leading up to their retrieval.  This allows time for progesterone and estrogen levels to balance out and the endometrial lining to become more receptive.  Research has indicated that that frozen embryo transfers may result in higher cumulative live birth rates compared to fresh transfers .

Laparoscopic Surgery

Depending on the severity of a patient’s endometriosis, their age, and other factors, laparoscopic surgery may be used as a first-line treatment or after one or more failed IVF cycles.   If a patient is undergoing a diagnostic laparoscopy and endometriosis is detected, then laparoscopic surgery should be the first choice of treatment .  During laparoscopic surgery, the doctor will surgically destroy or remove implants and endometriomas to reduce inflammation .  The goal of surgery is to restore your normal anatomy and to improve the function of your reproductive organs.  

In one study, researchers conducted a controlled trial to determine whether laparoscopic surgery enhanced fecundity in infertile women with minimal or mild endometriosis.  During the study, 30.7% of women who underwent laparoscopic surgery were able to achieve pregnancy.  Only 17.7% of the women who did not undergo corrective laparoscopic surgery got pregnant.  Researchers concluded that laparoscopic surgery can enhance fecundity in infertile women with mild endometriosis .  Laparoscopic surgery can improve the chances of spontaneous pregnancy by reducing pelvic inflammation.      

ASRM also notes that your chances of becoming pregnant are improved after surgical treatment.  In addition to improving chances of spontaneous pregnancy, laparoscopic surgery can be beneficial for patients trying to conceive via IVF .  Laparoscopic surgery prior to IVF treatment can help to identify and remove peritoneal endometriosis, adhesions, and tubal pathologies.  

Donor Egg IVF

Donor egg IVF is an IVF cycle that uses another woman’s eggs (usually from a young and fertile donor) which are then fertilized and implanted into the recipient’s uterus.  Donor egg IVF is a wonderful option for endometriosis patients who are unable to conceive with their own eggs.  As previously discussed, endometriosis can significantly damage eggs and can also cause them to develop abnormally.  Abnormal eggs increase the chances of failed implantation and miscarriage. 

One study produced evidence that patients with endometriosis experience reduced pregnancy rates per cycle, reduced pregnancy rates per transfer, and reduced implantation rates when undergoing IVF treatment compared to women with tubal infertility.  These results suggest that infertility in endometriosis patients may be related to alterations within the oocyte, which in turn results in embryos with decreased ability to implant .  Donor egg IVF helps to eliminate oocyte quality concerns because egg donors are screened for conditions like endometriosis.  This helps to increase the chances that the resulting embryos produced by IVF or ICSI are healthy and are more likely to implant successfully.  

A different study focused on whether endometriosis affects implantation and pregnancy rates in donor egg recipients.  Researchers compared the results of patients whose endometriosis diagnosis had been confirmed by laparoscopy to a control group without endometriosis.  In the study, endometriosis patients experienced similar pregnancy and implantation rates to the control group.  Researchers concluded that endometriosis does not have a significant effect on implantation, but it more likely affects oocyte and embryo quality.  

Preserving your Fertility with Endometriosis

Endometriosis is a common condition that affects many young women and is known to harm their reproductive organs.  As mentioned above, endometriosis negatively impacts ovarian reserve and the severity of symptoms that affect fertility increase with age.  Ovulation induction, oocyte retrieval, IVF, and embryo cryopreservation are recognized as the most effective fertility preservation techniques. 

Embryo Freezing

The first step in the embryo freezing process is ovarian stimulation, which involves taking hormone-based medications to improve the number and quality of eggs produced that cycle.  Next, the oocytes are removed through the egg retrieval process.  The mature oocytes are then fertilized in the IVF/ embryology lab using the partner or a sperm donor’s sperm.  The resulting embryos are then cryopreserved or frozen and sent for genetic testing

Researchers have concluded that freezing embryos is one of those convenient and effective ways of preserving fertility for women with endometriosis.  The process does not have a significant effect on ovarian reserve and it offers a real chance of future pregnancy if a good number of quality embryos are created .  Embryo freezing has also shown effective in providing good chances for future fertility in cancer patients .  As previously mentioned, women with endometriosis commonly experience diminished ovarian reserve, so by freezing their embryos, they can increase their chances for successful pregnancy at a later time. Some endometriosis patients undergo embryo freezing prior to completing endometriosis surgery in order to improve their chances of successful implantation via frozen embryo transfer

Egg Freezing

Research has shown that cryopreservation of mature oocytes also presents as a viable fertility preservation method, especially for young women with endometriosis .  Egg freezing is recommended for young endometriosis patients because it is minimally invasive and has no effect on future ovarian reserve .  Egg freezing provides an option for single women who would like to preserve their fertility.  Depending on the severity of the patient’s condition and her ovarian reserve level, it may take multiple cycles to produce adequate embryos.  Research has shown that egg freezing success rates significantly decline after the age of 36 .  Like all treatments for patients with endometriosis, the exact protocols are highly individualized based on many factors including age, fertility testing results, and the extent to which the ovaries are affected .  

Naturally Improving Endometriosis Symptoms

At CNY Fertility, we believe in a holistic approach to fertility treatment, especially for endometriosis patients.  Research has shown that making diet and lifestyle changes along with medical therapies can help to combat endometriosis symptoms .  Combining both eastern and western modalities of healing can help endometriosis patients feel better while also improving their chances of having a baby.  When you are trying to get pregnant, it is important to focus on healing and improving your overall and fertility health prior to treatment, because a healthy body is a fertile body.  

Diet and Inflammation

As previously mentioned, endometriosis is an estrogen-dependent inflammatory disease.  Inflammation from endometriosis can cause discomfort, pain, and negatively impact fertility.  One of the best ways to reduce inflammation in the body is by making changes to your diet.  To combat inflammation, we recommend eating a diet high in fat and low in carbohydrates.  

Dietary fat provides our bodies with energy and essential fatty acids that we can’t produce on our own.  Research has shown that consuming omega-3 fatty acids and saturated fat can help to reduce inflammation .  Fat is believed to reduce inflammation by hindering the activity of harmful cells that trigger an immune response.  In one population-based case-control study, researchers evaluated if diet has an effect on endometriosis patients.  They concluded that certain dietary components may be associated with a higher endometriosis risk and that increased total fat consumption is associated with a decreased risk .  Fat also supports fertility by enabling the body to absorb essential vitamins like A, D, and E.

In another study, women who reported primarily using butter while cooking were also at a decreased risk of endometriosis .  High-fat butter contains high levels of cholesterol.  Cholesterol is needed to produce numerous essential fertiltiy hormones and to fight inflammation.  Butter is a key ingredient to Dr. Kiltz’s Keto diet.  At CNY Fertility, we recommend our endometriosis patients eat a high fat, moderate protein, and low to no carbohydrate diet, nicknamed the B.E.B.B.I. Diet; Bacon, Eggs, Butter, Beef, and Ice cream made from full-fat heavy cream (with little sugar).  

Yoga

Yoga can help to improve the fertility of endometriosis patients in three main ways; 1. improving circulation, 2. balancing the immune system, and 3. reducing stress. As mentioned above, endometriosis is known to cause blockages, especially in the fallopian tubes.  The blockages impede blood flow and prevent nutrients from reaching the reproductive organs.  Yoga is known to improve blood circulation and nourishing blood flow.  Increased blood flow provides the reproductive organs with more oxygen and other vital nutrients that can help to improve fertility.  Practicing yoga has also been shown to support the immune system and to increase the number of white blood cells in the body .  Balancing the immune system can help to reduce the body’s inflammatory responses and improve the symptoms of endometriosis.  One randomized control trial found that yoga was associated with a reduction in levels of chronic pelvic pain and an improvement in the quality of life in women with endometriosis .  Women in the study who practiced yoga experienced significantly lower degrees of daily pain compared with the non-yoga group.  

Getting diagnosed with endometriosis can cause stress and numerous studies have established a link between heightened stress levels and lowered pregnancy chances .  Stress levels can also increase after a diagnosis of infertility or failed fertility treatments .  Yoga is a highly-touted stress-reduction technique that can help to reduce concentrations of cortisol, the stress hormone, and overall stress in the body.  Several studies have concluded that yoga helps couples boost their natural fertility and increases the success rate of assisted reproductive technologies (ART) .

Abdominal Massage

Massage offers many physical and psychological benefits.  Fertility massages can help to improve circulation, reduce muscle tension, reduce stress hormones, and help you to relax.  The massage techniques are designed to manipulate the muscles and connective tissue that hold the pelvic organs in place.  For endometriosis patients, abdominal massages are specifically focused on correcting any blockages, restoring blood and lymphatic flow, and optimizing reproductive physiology.  

Research has shown that abdominal massages can help to increase fertility in women that have been diagnosed as infertile.  The massages help to reduce adhesions and increase the function of reproductive organs .  In a large study of patients who were diagnosed with various causes of infertility, massage was shown to help clear the fallopian tubes of 60.85% of participants .  42.81% of the patients who were diagnosed with endometriosis were also able to achieve pregnancy after receiving massage treatment.  

In addition to improving fertility and the chances of success with reproductive treatments, massage can also help to significantly reduce the pain caused by endometriosis, especially menstrual pain .  Researchers have dubbed massage as an effective complementary therapy to reduce the pain in patients suffering from endometriosis that has no side effects.    

Acupuncture

Research has shown that acupuncture for fertility can help to give positive results and serve as a non-surgical infertility treatment option for women with endometriosis.  Acupuncture can help treat endometriosis-related infertility by increasing nourishing blood flow and balancing hormones to improve the uterus’ health.  In one study, researchers concluded that acupuncture can help women with endometriosis to achieve pregnancy and also to decrease the dimensions of their ovarian endometrioma .  

As noted earlier in this article, endometriosis can have a significant negative effect on ovarian reserve.  Research has also shown that acupuncture can help patients with poor ovarian reserve to achieve pregnancy.   In one study, researchers studied the effects of acupuncture in 60 cases accepting IVF treatment.  They found that acupuncture therapy can improve oocyte quality and pregnancy outcome in patients with poor ovarian reserve .  As with the other natural treatments discussed in this article, acupuncture is known to reduce the symptoms associated with endometriosis, especially pain .

The Bottom Line of Endometriosis and Infertility

Endometriosis is a complicated inflammatory disease that is strongly associated with infertility.  Science has not yet concluded exactly why endometriosis causes infertility, but many patients with endometriosis have infertility and many infertility patients have endometriosis.  The only definitive way to diagnose endometriosis is via laparoscopy and an endometriosis diagnosis can be stressful.  It is important to manage endometriosis-related stress as it can further contribute to infertility.  The good news is that there are several natural ways you can improve endometriosis and its resulting symptoms.  There are also assisted reproductive treatments and surgical interventions available to improve endometriosis symptoms and combat infertility.  

 

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