Endometriosis and Pregnancy: Is it Possible?

endometriosis and pregnancy

Endometriosis affects 6 to 10% of women of childbearing age. Endometriosis in the context of infertility is difficult to evaluate and often depends on the severity of this inflammatory disease. However, each woman has her own variability of disease. It is difficult to evaluate the chances of spontaneous pregnancy in cases of endometriosis versus MAP. Nevertheless, the joint management of allopathic medicine and naturopathy can make the difference in hoping for a pregnancy, despite endometriosis.

What is endometriosis?

It is a pathology of the endometrium with uterine cells that migrate either into the pelvic cavity, the myometrium or the abdomen. It is a disease at the crossroads of complex interactions of genetic, hormonal, environmental and immunological factors leading to:

  • Pelvic pain,
  • Dysmenorrhea,
  • Dyspareunia,
  • sometimes dyschezia (anal and urinary incontinence).

Symptoms can be expressed from the first menstruations and sometimes until the menopause, which makes it a hormone-dependent disease.

There are 3 specificities:

  • The most frequent is superficial peritoneal endometriosis,
  • Subperitoneal endometriosis, known as deep endometriosis, the lesions migrate to the wall of the pelvic organs;
  • endometriotic ovarian cyst.

Adenomyosis or Endometriosis, what are the differences?

Adenomyosis is specific, as seen above, by the location of the lesions in the myometrium, hence its name of internal endometriosis.

Endometriosis, known as external endometriosis, is characterized by lesions found outside the uterine cavity.

Endometriosis and Adenomyosis, what are the causes?

There are several theories, but the most recognized and validated is that of Sampson dating from 1927. The regurgitation of menstrual flow through the fallopian tubes would result in the transport of endometrial cells. These cells could then develop under chronic inflammation on the surface of the organs of the abdomen or pelvis. It should be noted that this reflux is physiological. Thus, if the immune system is efficient, these cells are destroyed. This raises the hypotheses:

  • of a degradation of the immune system,
  • a hormonal imbalance and,
  • a genetic predisposition.

Infertility and Endometriosis: Is it possible to get pregnant when you have endometriosis?

It is now established that the chances of natural conception are lower in women with severe forms of the disease. This means that in the case of superficial to moderate endometriosis, spontaneous pregnancies are quite possible. Many of my clients with endometriosis have not encountered any problems when they wanted to get pregnant or conceive a child.

However, before any treatment for infertility in the context of endometriosis, the medical team will propose a complete fertility assessment. This thorough analysis includes hormone levels (FSH, LH, estrogen, progesterone at least), an ovarian reserve assessment, a spermogram, as well as a mapping of the endometriotic lesions.

Complete surgery of the endometriosis lesions may be envisaged in order to restore fertility. It is also possible to consider surgery for lesions complicating natural fertility or management within the framework of medically assisted procreation (MAP) or assisted reproductive technology (ART).

It should be noted that in young women, if the endometriosis is superficial or moderate with good tubular permeability, ovarian stimulation possibly associated with intrauterine inseminations gives good results. However, it seems important to specify that it is necessary to ensure that there are no unfavourable male factors. For this reason, the future father must also be accompanied in a comprehensive manner.

Endometriosis, MAP and Pregnancy: what are the options?

Ovarian stimulation

Ovarian stimulation can be done either orally with clomiphene tablets that increase FSH secretion and LH peak or, in case of insufficient response, daily injections can be considered. During this ovarian stimulation, pelvic ultrasound and hormonal assays will be necessary to monitor ovulation. The objective of ovarian stimulation is to promote the production of oocytes, in order to multiply the number of oocytes in the cycle, and to increase the chances of fertilization.

Artificial insemination

Sperm is injected directly into the woman’s uterus at the time of ovulation. Ovarian stimulation can be considered beforehand to allow the development of several oocytes.

In vitro fertilization

In Vitro Fertilization is a technique that consists of fertilizing the egg with a spermatozoon in the laboratory, after it has been collected from the couple. The transfer of the embryos is then performed in the uterus of the future mother. IVF-ISCI consists of injecting the sperm directly into the egg.

What are the solutions for getting pregnant naturally when suffering from endometriosis?

Reduce the inflammation

The best thing to do in this case is to use common sense, so avoid as much as possible the dietary factors that cause inflammation and oxidation. Alcohol, coffee, red meat and dairy products should be avoided as much as possible, as should excess saturated fatty acids. Even more important, it is the quality that will have the most influence, it is essential to favor organic products and small farms for meat and dairy products. However, it is prudent to remember that proteins, especially those contained in dairy products, act on an increase in the synthesis of endogenous growth factors (IGF1 in particular).

Reduce oxidative stress

Even if it is impossible to neutralize because it is natural, it is the excesses that are deleterious. This is why working on one’s vulnerability and adaptation to stress must be part of naturopathic care (never a substitute for medicine). A massive dose of anti-oxidants must also be provided by the diet every day.

Facilitate the work of hepatic detox

The catabolism of endogenous and exogenous estrogens is carried out by the liver in 3 phases. It is thus a question of facilitating the ways of elimination of the estrogens via specific enzymes, in particular by:

  • Phase 1 (oxidation) by in particular the enzymatic complex cytochrome P450;
  • Phase 2 (methylation, glucuronidation, sulfation) which is the conjugation step with conjugation molecules by amino acids, sulfate groups, glutathione …;
  • Phase 3 (elimination), the metabolites are excreted in the urine and feces in the form of glucuronates and sulfates.

The normal functioning of the different phases of hepatic detoxification allows to secure the transformation and the elimination of estrogens. Any deficiency in these phases leads to cell damage.

Regulating the microbiota

In inflammatory imbalances, a dysbiosis of the intestinal microbiota is often highlighted.

The estrobolome is the microbiota responsible for metabolizing estrogens.

Certain intestinal bacteria, particularly E.Coli, Bacteroides fragilis or Clostridium perfringens, synthesize an enzyme (beta-glucuronidase) which allows the deconjugation of conjugated molecules by the liver. Thus, deconjugated, the molecules will be reabsorbed by the small intestine and put back into circulation exposing the organism to the toxic effects of hormonal imbalances.

It is therefore advisable to add fermented foods to your diet. The use of intestinal permeability regulators and certain strains of probiotics can be very helpful. Other strategies should also be part of the naturopathic protocol to promote and enhance fertility. To do this, it is necessary to reduce exposure to endocrine disruptors as much as possible, decongest the pelvic area, make up for deficiencies and revitalize the body through micronutrition. Regulating the hormonal sphere and relieving pain through natural methods will of course complete the program.

Endometriosis, Pregnancy and Natural Support with a Naturopath specialized in Fertility

Pregnancy with endometriosis is possible either naturally or with the help of assisted reproduction.

Calling on a naturopath specialized in this field (in addition to medical support, of course) is one of the first actions to take. A naturopath specialized in fertility and pregnancy support will be able to establish a personalized and customized support.

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