How Does Endometriosis Affect Fertility?
Lizzie Alexander
Video
21 min
00:00:00 All too often, we aren't able to or we don't take the time out to give ourselves rest and true rest from, you know, the fast paced world that we really live in. And actually, I think COVID has really shown how fast paced our world was before it happened and that there are some benefits because it's actually shown us just, you know, how actually nice it is just to slow down that pace sometimes. now the break by having that breakaway it had a massive effect on my cycle um afterwards which now the break by having that breakaway it had a massive effect on my cycle um afterwards which was really interesting and it was just real testament to me that to me and also those you know my clients that i teach that the huge importance of rest especially when so many of you suffer from chronic stress now remember rest is free um and it is literally the most powerful healer but it's the thing that actually um i find my clients find is one of the things that we
00:00:54 actually struggle with the most because it's the thing that when you're short of time you steal time from sleep but you know it's it's what we shouldn't do sleep really is is the power to heal time from sleep but you know it's it's what we shouldn't do sleep really is is the power to heal when we're sleeping um i really am starting to feel the benefits of my energy level starting to go up. My cycle and period have dramatically improved since I had that break and I've really been focusing on my sleep, which is a key sign that my body's getting stronger, my chi's getting stronger. I'm going to first start with a little bit of general information about endometriosis stronger. I'm going to first start with a little bit of general information about endometriosis
00:01:30 and then discuss the ways in which endometriosis can directly and indirectly affect your fertility. I don't have enough time to go into the really detailed actions you can take to optimize your fertility in this episode though I will mention one or two where appropriate but I will be covering that in episode two next week as there are plenty of things that you can do. Now believe it or not endometriosis is common and often debilitating condition for women during their reproductive years and I don't need to really tell you that. Now according to Diane Stefferson-Mills years and I don't need to really tell you that. Now according to Diane Stefferson-Mills reproductive gynecologists recognize it as the second most common gynecological complaint in
00:02:09 women which is crazy. Now here are some more crazy statistics I'm sure you might be aware of and if you're not then it's really important to know them. It's understood that one in every 10 women have endometriosis that's somewhere between 6 and 10 percent of the general female population but up to 50 percent in sub or infertile women. Now this equates to about one and a half million but up to 50 percent in sub or infertile women. Now this equates to about one and a half million in the UK and over 176 million worldwide based on 2017 figures. Now what I find really hard to take is on average it takes seven and a half years for women to get a diagnosis and for many it's far longer than that. I mean for me it took almost 25 years to get to the bottom of it. Now those
00:02:54 statistics are immense and frankly shocking and it's why we need to be talking about this more statistics are immense and frankly shocking and it's why we need to be talking about this more so that women know about this before they're trying to get pregnant. It can affect anyone, regardless of where you live in the world, your body type, race, colour, social status, etc. Now, I could spend the whole podcast talking about this, but I'm not going to. Now, the word endometriosis means that some of our body's cells are basically growing in the wrong place.
00:03:25 They are similar cells to those that grow inside the womb lining, but instead they're outside the womb and can grow anywhere though more commonly around the ovaries but instead they're outside the womb and can grow anywhere though more commonly around the ovaries and in the peritoneal cavity which is commonly known as the abdomen. The problem occurs when these cells act in the same way that they do in the womb in that they're nutrient-rich tissues that build up blood and then break down and bleed in conjunction with a woman's menstrual cycle. Now this is where one of the key problems lie because there's nowhere for this blood to go like there is with a period exiting from the womb. Instead it can cause inflammation, pain
00:03:55 like there is with a period exiting from the womb. Instead it can cause inflammation, pain and scar tissue. So scar tissue or fibrous connective tissue is formed as the body tries to isolate the endometrial growths by putting a plaster type growth over the top of them. Now this tissue then thickens and goes hard over it as you can see when you have scar tissue on your skin after a cut. Now this kind of makes sense doesn't it? But the problem is that this scar tissue can then stick or glue tissues together nearby whilst it's still soft and scar tissue can then stick or glue tissues together nearby whilst it's still soft and this is where real problems occur as organs can get stuck to the wrong places and cause distortion,
00:04:40 further pain and functional problems such as poor gut motility, cerebral infertility. Right I want to go straight into how endometriosis can affect fertility rather than go into more detail about how endometriosis affects the body overall. Our fertility can be affected in a number of ways, some directly and some indirectly. Here are the key seven I've found in my research, some directly and some indirectly. Here are the key seven I've found in my research, though it should be noted that the precise mechanism is still unknown. Three direct inways include number one, fallopian tube blockages. Now the fallopian tubes are the width of a hair which is really tiny and when ovulation occurs they swell in response to an estrogen surge.
00:05:28 Now fertilization takes place in the upper third so sperm have a really long way to swim Now fertilization takes place in the upper third so sperm have a really long way to swim and a woman's orgasm can actually really help this because it helps propel the sperm up further into the fallopian tube. Now unfortunately the fallopian tubes can be easily blocked by endometriosis lesions and scar tissue along or over these tubes which can then either either prevent the sperm from reaching the egg or the fertilized egg from reaching the womb. Another way is that chocolate cysts, which are fluid-filled ovarian cysts that occur Another way is that chocolate cysts, which are fluid-filled ovarian cysts that occur
00:06:01 deep within the ovary, can actually result in distorting the fallopian tubes so that these finger-like projections cannot reach the ovary, meaning the egg cannot then pass into the fallopian tubes. One thing that can really help with blockages, depending on the extent and why it is blocked is abdominal massage and therapy. Now there is a really really good podcast episode by Lisa Hendricks and Jack on the Fertility Friday podcast with Larry and Belinda Worm. Lisa Hendricks and Jack on the Fertility Friday podcast with Larry and Belinda Worm. I'll pop it in the show notes but I absolutely loved it and as a massage therapist it really connected with me and the positive results that these two have actually found with abdominal
00:06:44 therapy. Now it's especially uplifting for any of you that have blocked tubes and if you want to know how to do self abdominal massage I have a video tutorial available which I'll also pop into the show notes. Two is poor egg quality and count. Now cysts or ovarian endometriomas as they're the show notes. Two is poor egg quality and count. Now cysts or ovarian endometriomas as they're known occur in about 17 to 44 percent of women with endometriosis and are often associated with more severe forms of the disease. Now when cysts, lesions or scar tissues grow on, over or in the ovaries it can result in fewer eggs and poor maturation of eggs resulting in sub-optimal quality and its ability to be fertilized. Now this would explain why studies have found women
00:07:26 quality and its ability to be fertilized. Now this would explain why studies have found women with endometriosis experiencing a higher rate of early miscarriage i.e. in the first six weeks and often you may not even be aware that you might have actually got pregnant. Now there are several reasons why poor egg quality can happen. The first is due to chemical secretions that come from the endometriotic tissues. Now these secretions not only contain blood but many things including cytokines which are inflammatory immune cells that are toxic to eggs and pre-implantation embryos. cytokines which are inflammatory immune cells that are toxic to eggs and pre-implantation embryos. Now research has shown that over an egg quality improves after cysts are removed
00:08:10 though there is still research needed on this. Second reason is other chemicals such as prostaglandins and excess estrogen which I'll come on to in a minute whether that's natural or external can be damaging to conception. And then the third reason, repeated surgery involving work external can be damaging to conception. And then the third reason, repeated surgery involving work on the ovaries has unfortunately been shown to have a negative effect on ovarian reserve despite it improving the quality of the eggs themselves. This is why it's really important to consider your options if you have cysts as to whether you want surgery
00:08:46 if you want a family. Or it might not be that you want surgery whether you actually just want them to leave the eggs alone whilst you have surgery and elsewhere within your abdomen. Now there are pros and cons and this is a huge subject and I cannot cover it here and I cannot cover it here but you do need to do your research before your surgery
00:09:03 and advise your skilled excision surgeon of your desire to have a family and discuss it with them in detail. Now, the third direct way that endometriosis can affect your fertility is that it can reduce blood flow. Now, ovaries require blood with fresh oxygen and nutrients to mature healthy eggs. Scar tissue can compromise blood getting to and within the ovaries, meaning less oxygen and Scar tissue can compromise blood getting to and within the ovaries, meaning less oxygen and nutrients and more toxins or less toxins that can be taken away. Now lower oxygen levels may mean the eggs do not mature as well making them less likely to be able to be fertilized or implant
00:09:45 very well. Now one study found that surgery to remove scar tissue and surgery improved uterine blood flow to the ovaries. Now this is another reason why abdominal massage or therapy is really good because it can really help break down scar tissue and increase blood flow to the pelvic area. good because it can really help break down scar tissue and increase blood flow to the pelvic area. There are five indirect ways yet all interrelated in some way that I've found that endometriosis affects fertility. I hope I've explained them clearly as it can be difficult without diagrams and pictures. Now number one is a dysregulated immune system. Endometriosis is associated with a dysregulated or as I call it a discombobulated immune system. Our immune system is there to
00:10:25 a dysregulated or as I call it a discombobulated immune system. Our immune system is there to protect us from foreign or abnormal cells in our body. Now you may have heard of autoimmune diseases this is when our body mistakenly attacks the body's own healthy tissues. In contrast with endometriosis the body fails to recognize the endometrial lesions that are growing in the wrong place as being foreign and this results in a poorly coordinated immune response which is why some consider endometriosis an immune disease that is still not fully understood. Unfortunately some consider endometriosis an immune disease that is still not fully understood. Unfortunately there is lowered natural killer activity natural killer cell activity and yet increased inflammation
00:11:06 and this is a phenomenon referred to as counter inflammation. Now counter inflammation means inflammation that contributes to less coordination in the immune response to control growth of irregular cells. Now in relation to fertility the rise in progesterone during the luteal phase or in other words the second half of your cycle it acts to down regulate the immune system so that in other words the second half of your cycle it acts to down regulate the immune system so that our bodies do not reject sperm and the egg or even the developing embryo. Therefore if you have low progesterone as a result of hormonal imbalances and increased inappropriately placed inflammation it can result in the rejection of all three. Now there are many steps you can take to improve your
00:11:51 immune system but one key thing is improving your gut health where 70% of your immunity occurs. So the second indirect way is through inflammation. As I just mentioned the immune system is more So the second indirect way is through inflammation. As I just mentioned the immune system is more often than not dysregulated and results in inflammation in the peritoneal cavity that's in the abdomen and the peritoneal fluid containing an increased number of immune cells including macrophages, mast, natural killer and T cells as well as elevated growth factors, chemokines and inflammatory cytokines. So that's a lot of things and you're probably thinking my god I've no idea what you're talking about there and I'm not going to go into the individual sort
00:12:28 god I've no idea what you're talking about there and I'm not going to go into the individual sort of chemistry of all of those things but just be aware that as a result the peritoneal fluid that coats the outside of the womb and the pelvic area becomes toxic effectively and it can then affect the ovarian reserve, egg and embryo quality and even make it difficult for the embryo to implant into the uterine lining. This is why reducing inflammation is a really important step in improving your overall health and improving your fertility. Number three is hormone imbalance. Now improving your overall health and improving your fertility. Number three is hormone imbalance. Now endometriosis increases your oestrogen and this then causes an imbalance with progesterone.
00:13:10 The endocrine system is a finely tuned machine and any part that is out of balance will have a knock-on effect as other endocrine glands step in to help and pick up the imbalances which cause further imbalance. This is why for some women an imbalance in their estrogen and progesterone especially combined with an elevated stress can have a knock-on effect on the thyroid progesterone especially combined with an elevated stress can have a knock-on effect on the thyroid function which then affects egg health and ovulation. Now number four is elevated prostaglandins. So prostaglandins are hormones that are involved in many functions around the body but are strongest associated with our reproductive health. Specifically they're involved in ovulation,
00:13:51 the breakdown of the corpus luteum which occurs if you do not get pregnant and signals the end of the cycle and therefore the start of your period. Immune interactions, the motility of of the cycle and therefore the start of your period. Immune interactions, the motility of sperm and contractions. They are secreted by normal endometrial tissues in the uterus as well as endometrial growth outside the uterus in women with endometriosis. Now if they're elevated at the wrong time in the wrong place due to endometriosis they can interfere with the fertilization of the embryo and many other elements of reproduction. Now prostaglandins released by growth outside the uterus have been shown to do it out of sync with the release inside
00:14:26 released by growth outside the uterus have been shown to do it out of sync with the release inside the uterus which then sends the wrong messages and can have dire consequences. Now interestingly fats from dairy and meat can raise certain prostaglandins and PGE2 specifically so excessive consumption can actually cause an issue. So this is one of the reasons why people say you know not to have an excessive consumption of both dairy and meat and also to be careful of the sources which you get them from. Now finally number five is something that's far less understood it's the which you get them from. Now finally number five is something that's far less understood it's the micro is microbiome dysbiosis. Now it's not that it's not less understood it's just that the link
00:15:12 with fertility is less understood. So our body is host to trillions of bacteria and they are continually being discovered in unique communities present in their own microbiome such as the gut, reproductive system, skin, nasal, mouth. I mean every pocket within your body has its own reproductive system, skin, nasal, mouth. I mean every pocket within your body has its own microbiome that's slightly different from the next one. So essentially we are bacteria and we wouldn't be here if we didn't have bacteria living on and within us. What's been discovered is that there is a link between our gut bacteria and endometriosis and even some mention of our reproductive bacteria and endometriosis. Though which way round they affect each other is yet to
00:15:52 be discovered as this really is an evolving science. Now the status of our gut microbiome is so so important as it's involved in so many incredible things from nutrient absorption, is so so important as it's involved in so many incredible things from nutrient absorption, maintaining the integrity of our gut lining and thus the systemic overall inflammation within our body, gut brain signaling, gut liver detoxification interactions, sleep, stress and so many other things. Now, the clearest connection between gut and fertility is the regulation of sex hormones, specifically estrogen. The gut microbiome has its own estrobilone. I love that word, estrobilone, which is a subset of the gut microbiome associated with estrogen metabolism.
00:16:36 And this is where, if it's out of kilter, it can cause endometriosis progression, which then is you know going to affect and impact our fertility as I've just mentioned. Now studies are still going on for this but they have been done as well in relation to vaginal and cervical microbiomes and endometriosis and though it's still in its infancy and has shown vaginal and cervical microbiomes and endometriosis and though it's still in its infancy and has shown it has shown that there are differences in the microbiomes between someone who is healthy and say someone's got stage three or four endometriosis in the fact that those with endo have far more diversity which is not desired in fact for your vaginal microbiome
00:17:18 we want as least diversity as possible dominated by a lactobacillus species and this diversity is known to affect fertility it's still a very new area of research and something I'll be discussing is known to affect fertility it's still a very new area of research and something I'll be discussing in more detail in future podcasts. I actually have an interview with an amazing lady all about the astrobalone for example and this is why looking after your gut health is actually really really key and one thing I've not mentioned actually is there is a link between your gut health and your vaginal microbiome so the gut and the vaginal microbiome are also really linked so by looking after your gut you have a knock-on effect on your vaginal microbiome also. So that was all rather
00:17:55 after your gut you have a knock-on effect on your vaginal microbiome also. So that was all rather complicated as complex as the miracle that is reproductive process in humans this is why it's important to enhance immune and reproductive systems and get the right hormonal messages working and going to the right places so it means that the body is then less tolerant of endometriosis it's really important to note that you may have other things that are related to your endometriosis that affect other important things that are required for you to be in optimal fertility that affect other important things that are required for you to be in optimal fertility function. Now one really common thing for example and I've already mentioned about gut health is
00:18:37 well-functioning digestive system because it has a big impact on your optimal nutrient stores. If you're depleted in certain areas it's going to have a knock-on effect in what you need to both grow a baby but also for certain systems to function whether it's your liver whether it's your thyroid so that's what is really really important and I will always harp on about our digestive health. What I do want to finish off with is that not all women with endos suffer digestive health. What I do want to finish off with is that not all women with endos suffer with infertility. For some it just may take longer than the average so it's really good to be aware of this. Also that there is a lot you can do to manage your endometriosis and optimize your
00:19:16 fertility using a variety of modalities including surgical intervention, natural lifestyle and nutritional changes and assisted reproductive technology. Now if I were to share one thing with you today it would be that knowledge is power as if you understand more about your with you today it would be that knowledge is power as if you understand more about your endometriosis you're more likely to ask questions and take action so you can empower yourself and understand how you can personally improve your health in conjunction with a well-qualified team of specialists around you whether this is surgeons pelvic floor therapists acupuncturists nutritionists and fertility specialists don't be embarrassed to speak out and tell your story now i do understand
00:19:56 And if you don't want to talk about your fertility, this can be a really sensitive area. So you don't have to. So you don't have to. But just share your story about your endo, whether it's how long it took you to get diagnosed, whether, you know, it's how you feel. It's, you know, how it makes you feel in your private life, how it affects your work. You know, you may find that close friends and family are actually suffering in silence and they've not mentioned it and you've never realized. So it can make, you know, you can end up making some real connections there. So thank you for listening.
00:20:24 I hope you found this informative and not too overwhelming I find that knowledge is power and I hope you do too and it's better to know what you're dealing with so that you can then make I hope you do too and it's better to know what you're dealing with so that you can then make informed choices to help grow your family so that you so deeply desire so have a great week I look forward to chatting to you next week all about the things that you can do to help improve your health and optimize your fertility
