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Guide to Endometriosis and Fertility

Endometriosis and fertility

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Endometriosis is a condition that impacts 1 in 10 women and people with periods, but it is so often misdiagnosed and misunderstood. Whilst many women with endometriosis can conceive naturally, there is a chance the condition could impact a fertility journey. If someone you know and love is living with the condition, understanding its complexities, its symptoms and how it can be managed will help you be a more supportive partner.  

What is Endometriosis?

Endometriosis is a complicated and nuanced condition, but we will do our best to explain it in a digestible way. 

The condition is a full-body inflammatory disease and one that also has connections to the autoimmune system. However, one of its biggest characteristics is that it causes tissue similar to the lining of the womb to grow in places where it’s not meant to. This could be in other areas of the female reproductive system, like the ovaries and fallopian tubes, but it can also appear in other places  – like the bladder or the bowel. 

This tissue acts as the lining of the uterus does during a period. This means that it becomes inflamed and attempts to ‘shed’. However, whilst the lining of the womb sheds and bleeds – which is what a period is – endometriosis cannot escape the body in this way. Instead, these areas form adhesions – scar tissue – that can be incredibly painful.

Endometriosis is categorised into 4 stages by the American Reproductive Society, and this is generally to do with how many adhesions you have and how deep they go. However, the stage of endometriosis doesn’t always correlate to the severity of the pain, so even if you are classed as having Stage 1, you could be experiencing debilitating pelvic pain that causes you to miss work or school and has a massive impact on your quality of life. 

What are the main symptoms of endometriosis? 

Pain is definitely one of the biggest symptoms of endometriosis, but unfortunately, it is often dismissed as ‘just a painful, heavy period’. This is why so many people with the condition suffer in silence and it takes an average of 8 years for someone living with endo to receive a formal diagnosis. 

The symptoms of the condition can actually be very far-reaching and include: 

  • Pelvic pain 
  • Aches and pains in the lower stomach, legs back
  • Debilitating period pain
  • Heavy periods 
  • Spotting between periods 
  • Chronic fatigue
  • Pain during or after sex 
  • Pain when going to the toilet
  • Nausea 
  • Discomfort during ovulation 
  • Chronic constipation and diarrhoea 
  • Blood in urine or feces 
  • Fertility issues 
  • Depression and other mental health issues 

Many of these symptoms are also common in issues with digestion and the gut, which is why endo is often misdiagnosed as IBS. Whilst gut health and endometriosis are often connected, treatment for IBS will not cure the condition, so it’s essential that we are able to differentiate between the two. 

Is there a cure for Endometriosis? 

Sadly there is currently no known cure for endometriosis. Many women with the condition are put on birth control at an early age to either stop their periods completely or stop their cycle so that they only have a withdrawal bleed. In some cases, this can help with the pain in the short term, but in reality, it is only masking the problem. 

Surgery is another option for trying to treat endometriosis – although it is not always guaranteed to work and there is a chance the endometriosis will return. The most common surgery is a laparoscopy (key-hole surgery) which can be used to firstly confirm an endometriosis diagnosis and then remove impacted tissue. This can either be done by excision (cutting the endometrial tissues and scar tissue out) or ablation (destroying the cells using diathermy) or a combination of these two processes.  

Lifestyle changes can also be helpful in reducing the impact endometriosis has on the life of someone with the condition. A diet of anti-inflammatory foods and foods that support gut health can be really helpful as can improving sleep and getting regular exercise – as moving the body can help to reduce muscle tension which can add to the pain. 

The fact that endo has no cure is one of the hardest things to deal with for many people living with the condition and this can have a huge impact on their mental wellbeing, which is why it’s so important they are able to access the support they need to lead a happy and healthy life, even whilst battling the condition. 

Can endometriosis impact fertility? 

Many people with endometriosis go on to become parents, but approximately 30-50% of female infertility cases are associated with endo. It’s still not fully understood how endometriosis causes infertility – and it varies from person to person – but for many people it’s because the scar tissue has damaged their reproductive organs – such as the ovaries – or has blocked the fallopian tubes. 

For women with endo who are struggling to conceive, there are assisted fertility treatments that can help them – including IUI, IVF and ICSI. Ahead of any fertility treatment it’s advised that both partners do everything they can to protect and improve their egg and sperm quality. For women this might look like adapting their diet and lifestyle – and their doctor will be able to help them prepare for any treatment they may be having. For men this could involve getting your sperm tested proactively to ensure the quality is good and making lifestyle changes like quitting smoking, reducing alcohol intake and improving diet and sleep; these can help get their sperm count, sperm motility and sperm volume to an optimum level.

Supporting a partner with Endometriosis 

Whilst there may be no cure for endometriosis, there are plenty of things we can do to support our partner if they are facing the condition. 

  • Believe them when they say they are in pain – this might sound simple but so many people with endo feel dismissed by society (and sometimes even doctors!) when they try to describe the pain they are in
  • Offer to help them advocate for themselves – doctor’s appointments can be tough for people with endo, but offering to accompany them and help them track their symptoms ahead of a doctor’s visit can be a simple but powerful way to show them you have their back 
  • Support their healthy lifestyle choices – find low impact exercise classes you can do together and offer to cook healthy meals that can help with symptoms and your fertility if that’s a journey you’re on together
  • Offer at home pain relief – The pain of endo can be debilitating but if a bath, a hot water bottle or a massage can ease it slightly, offer it to them without them asking
  • Spread awareness and fight misinformation – we need to keep the conversation about endometriosis going way after Endometriosis Awareness Month is over. Use your voice and help bust myths around the condition 
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Wearing tight pants and underwear

Studies show that men who wear looser underwear have higher sperm concentration and total sperm count compared to men who wear tighter underwear. So, lose the tight clothes and wear something loose to give your testicles some air.

CONCLUSION: learn more about how heat can affect sperm quality here.


Besides higher mortality rate and various diseases, stress is associated with low sperm quality. Stress is known to be associated with lower testosterone levels and oxidative stress with both playing an essential role in producing and maintaining healthy sperm cells.

CONCLUSION: If you feel stressed, we recommend you get some help so you can have a balanced mental health. For a stress management guide, download the ExSeed app for free and start your personalized action plan today.

Physical activity

Scientific studies show that men who are physically active have better semen parameters than men who are inactive. Fertility specialists also state that regular physical activity has beneficial impact on sperm fertility parameters and such a lifestyle can enhance the fertility status of men.

Prioritizing exercise can help improve your overall health and result in healthy, fast swimming sperm cells that have good chances of fertilizing an egg.

CONCLUSION: Try incorporating exercise in your weekly schedule to you ensure exercising at least twice weekly. We recommend a combination of cardio training and strength exercise. Read more about exercise and male fertility on our blog.


Fast Food
Processed foods damage the health of sperm-producing cells and cause oxidative stress, which lead to poorer sperm quality. Heavy consumption of junk food (every week) can increase the likelihood of infertility since men who consume vast amounts of unhealthy food are at risk of having poor sperm quality. Besides harming your fertility, junk food enlarges your waistline, harms your cardiovascular system, kidneys, and more.

Eating more fruit and vegetables can increase your sperm concentration and motility. It’s important that you consume a healthy diet filled with antioxidants and that you eat vegetables every day. Foods such as apricots and red bell peppers are high in vitamin A, which improves male fertility by nurturing healthier sperm. Men who are deficient in this vitamin tend to have slow and sluggish sperm.

Sugary snacks/beverages: several times a week Excessive consumption of high sugar items can lead to oxidative stress, which negatively impacts testosterone levels and sperm motility. Sugary snacks and beverages are also highly associated with obesity and low fertility.
CONCLUSION: To boost sperm quality, stay away from fast food, processed food, and sugary snacks or beverages. You need to implement a healthy prudent diet filled with necessary superfoods needed for good sperm production. Check out our guide to Male Fertility Superfoods. For personalized guidance and support on how you can start improving your sperm health, check out the Bootcamp.


Direct heat can inhibit optimal sperm production and cause Sperm DNA damage. Sperm cells like environments that are a couple of degrees lower than body temperature. Avoid overheating from warm blankets, seat warmers, heat from your laptop, hot showers, and saunas.

Cigarette smoking

The exposure to tobacco smoke has significant negative effects on semen quality. The damage of cigarettes and nicotine of course depends on how many cigarettes you smoke per day and for how long, but even low usage (up to 10 cigarettes / day) can inhibit healthy sperm production.  

CONCLUSION: Stay as far away from cigarette smoking as possible if you care about your general health and your fertility. Read more here.

Cell phone

When you have your cell phone in your front pocket, your testicles are exposed to electromagnetic radiation, which studies have shown to damage the sperm cells. Put your phone in the back pocket of your pants or in your jacket pocket.


There is a clear association between obesity and reduced sperm quality. At least part of the reason for this is that obese men may have abnormal reproductive hormonal profiles, which can impair sperm production and lead to infertility. 

A BMI higher than 30 can lead to several processes in the body (overheating, increase in oxidative stress in the testes, sperm DNA damage, erectile dysfunction) that can have a negative impact on male fertility. This can result in problems when trying to conceive.  

CONCLUSION: BMI is one of the risk factors that influence semen quality and, for example, sperm motility.  


A beer or glass of wine now and then do not really harm sperm quality. But excess alcohol drinking (more than 20 units per week) can reduce the production of normally formed sperm needed for a successful pregnancy.

CONCLUSION: If you want to stay safe, stay under 14 units of alcohol per week. For more information on how alcohol can affect male fertility, take a look at our blog: “Alcohol and Sperm Quality”.


Studies show that women younger than 35 and men younger than 40 have a better chance of getting pregnant. Men can produce sperm cells almost through their entire life, but the sperm cell DNA is more fragile and prone to damage after the age of 40.

As men age, their testes tend to get smaller and softer resulting in a decline in sperm quality and production. These changes are partly because of an age-related decrease in testosterone level, which plays a very important role in sperm

production. Higher male age (>40 years) is not only associated with a decline in sperm production but also with increased sperm DNA fragmentation and worsened morphology (shape) and motility (movement). These negative effects make the sperm cells less qualified for egg fertilization.

CONCLUSION: with an age under 40, you shouldn’t have to worry much about age as a factor in itself. However, studies have shown a slow decline after the age of 30-35 years

and if you are above 40 years of age, your sperm quality can be affected due to increased sperm DNA damage resulting in a decrease of sperm motility and concentration. Remember that you cannot evaluate the quality of a sperm sample by just looking at it – this requires a sperm analysis.