September 19

5 Holistic Ways To Improve Fertility With Endometriosis


Endometriosis is an incredibly common disease among women. It can cause severe period and pelvic pain, infertility and a host of other symptoms.  About 10-15% of the general female population has endometriosis. However, incidence of endometriosis can be as high as 50% among women with infertility. So it’s no wonder women want answers on how they can improve fertility with endometriosis! 

At the Natural Procreative Technology clinic in Omaha, a center that sees a large volume of infertility patients, they have found that about 70% of their women patients have endometriosis. 

There are a number of ways endometriosis can negatively impact fertility, and all of these have to do with the inflammation caused by this disease. But thankfully, there are many holistic approaches to addressing this inflammation and improving fertility with endometriosis. Read on to learn how!

What Is Endometriosis?

Before discussing how to improve fertility with endometriosis, it is helpful to take a closer look at the nature of this disease. Endometriosis is a disease that causes  endometrial tissue to implant outside of the uterine cavity. 

The ovaries, anterior/posterior cul-de-sac, broad ligaments and uterosacral ligaments, uterus, fallopian tubes, and sigmoid colon are the most common locations of these endometrial lesions. 

Because endometriosis is an estrogen-dependent condition, these endometrial implants grow and shrink with the rise and fall of estrogen throughout a woman’s monthly cycle. 

It’s most important to note, when considering how to improve fertility with endometriosis, that  endometriosis is also a chronic, pro-inflammatory disease. It is this inflammation that can contribute to infertility in a number of ways. 

Symptoms Of Endometriosis

As a pro-inflammatory disease, it is not surprising that a common symptom of endometriosis is pain. This could be painful periods, painful sex, or pelvic pain in general. 

However, this inflammation can also be silent and produce no symptoms.  About 20-25% of affected women do not have obvious symptoms, with infertility being the disease’s only manifestation.

How To Diagnose Endometriosis

Laparoscopic surgery is the gold standard for diagnosis. Biopsy of implants showing endometrial tissue confirms the diagnosis. Interestingly, surgical findings do not necessarily correlate with symptom severity.

It’s not uncommon for women to experience extensive delays in receiving a diagnosis of endometriosis, even with severe symptoms. This is due in part to a lack of non-invasive methods to detect and confirm endometriosis. Laparoscopic surgery remains the primary way to identify, diagnose, and treat endometriosis with certainty.

5 Ways Endometriosis Can Negatively Impact Fertility

To improve fertility with endometriosis, we need to understand how endometriosis affects fertility first. As previously mentioned, the culprit is inflammation. Below are 5 ways endometriosis, by way of inflammation, can negatively impact fertility: 

1. Adhesions

Due to local inflammation, women with endometriosis tend to develop adhesions, which are bands of fibrous scar tissue. These endometrial adhesions can attach to pelvic organs causing distortion of pelvic structures. Distorted anatomy can...

  • Impair release and pick up of the egg cell
  • Decrease motility of the fallopian tube in transporting the egg and sperm
  • Cause disordered contraction of the uterus, interfering with embryo implantation

2. Poor egg quality

It’s important for women hoping to conceive to have an understanding of egg quality when working to improve fertility with endometriosis.

Egg quality refers to the egg's ability to result in a live birth, and this is related to mitochondria function. Interestingly, research shows that egg cells retrieved from women with endometriosis are more likely to have lower mitochondrial content. There are also IVF studies showing women with minimal or mild endometriosis have decreased fertilization rates. 

3. Impaired ovulation

The process of ovulation is impaired in women with endometriosis, according to this study.

And, as noted above, adhesions can impair release of egg cells from the ovary. 

4. Impaired sperm quality / function

Because endometrial implants develop where they do not belong, various white blood cells such as leukocytes and macrophages, which are part of our immune system, gather in and near these implants.

You can also find these immune cells in the fluid of the abdominal and pelvic cavity, also known as the peritoneal fluid. This inflammatory peritoneal fluid can damage sperm, negatively affecting sperm quality and function. 

5. Toxic effects on embryo 

That same inflammatory peritoneal fluid mentioned above is also toxic to the embryo, at the very beginning of life. Inflammation contributes to free radicals that can negatively impact embryo survival.  

NSAIDS: The Conventional Approach To Inflammation

Additionally, most women are advised to take non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen, Motrin, naproxen, etc. However, chronic use of NSAIDs can inhibit ovulation and lower progesterone levels, although these effects are noted to be reversible. That said,  NSAIDs are not good options when trying to improve fertility with endometriosis.

5 Ways To Decrease Inflammation And Improve Fertility With Endometriosis

Despite the many ways endometriosis can negatively impact fertility, there are ways to improve your fertility even with endometriosis!

1. Nattokinase & Serropeptase for reducing adhesions

Fibrin, which is created by our body to form clots and scabs, is an important ingredient for adhesion formation. 

Enzymes known to break down fibrin include nattokinase and serropeptase (also known as serratiopeptidase or or serrapeptidase). Nattokinase is isolated from natto, a traditional Japanese fermented soy product. Natto is best known for its benefits in treating heart disease. Serrapeptase is made by a bacteria in the digestive system of silkworms, and has been shown to help reduce inflammation and pain. 

In my wholistic fertility clinic near San Jose, California, I have patients who reported using this specific nattokinase and serropeptase helped reduced their external surgical scars. These capsules are best taken on an empty stomach in order for them to exert the strongest anti-inflammatory effect. 

There is not yet research on these enzymes on endometriosis adhesions directly, likely because there is not much money to be made on these natural treatments. 

Note that you should NOT take these enzymes if you  are already on anti-clotting medications like Coumadin or aspirin. People with ulcers or those who have had recent surgery should avoid these enzymes, too.

2. Improve egg quality

As mentioned earlier, egg quality is a reflection on mitochondrial health and quantity. And women with endometriosis are known to have poorer egg quality.

There are many things that can negatively impact egg quality, including stress, free radicals, and environmental toxins. So to improve egg quality, it is important to work on stress management, take antioxidants to neutralize the free radicals, and avoid environmental toxins. It is also essential to work on removing toxins stored inside our body.

Poor egg quality can also contribute to recurrent miscarriage, unexplained infertility, and difficulty getting pregnant at older age.

3. Low Dose Naltrexone (LDN)

Naltrexone is a prescription medication that is typically used to treat opioid addiction, at doses of 50mg or higher. 

However, in recent years, research has shown that low dose naltrexone (LDN), at doses of 3-4mg, can reduce symptom severity in chronically painful conditions such as fibromyalgia and complex regional pain syndrome. Studies also show that LDN has an anti-inflammatory effect by suppressing TNFα and other inflammatory markers produced by the white blood cells.

Given that endometriosis implants generate these very same inflammatory markers, it is therefore likely that LDN can reduce inflammation and pain associated with endometriosis.  However, no studies to date have examined this directly.

In my wholistic fertility clinic, many of my patients have noticed improvement in painful periods when taking LDN. 

I consider LDN to be a holistic approach because it addresses one of the root causes of endometriosis, inflammation. 

LDN is well tolerated, non-invasive, and relatively affordable (about $40 for one month supply). However, it should never be taken with narcotics, as it is an anti-opioid. Keep in mind that obtaining LDN requires a prescription from a doctor, and it needs to be specially compounded for the lower dose.     

4. Anti-inflammatory Diet

When it comes to diet considerations and improving fertility with endometriosis,  it is best to eat foods rich in anti-inflammatory omega-3 fats. Examples include avocados, olive oil, flax seeds, and wild Alaskan fish. Also, eat lots of green vegetables (broccoli, kale). Foods to avoid include carbohydrates that break down easily into sugar (bread, pasta, rice) since sugar promotes inflammation.

5. Surgery

It may be shocking to hear that surgery is considered a holistic approach. But when I talk about holistic, I often mean the "functional medicine" approach. And functional medicine is all about finding and addressing the root causes of health problems.

Since endometrial implants are the source of inflammation in endometriosis, it makes sense that removing those endometrial implants surgically would reduce inflammation and improve fertility. 

And indeed, studies show that surgical treatments can improve fertility with endometriosis, for both severe and minimal-moderate disease. 

In severe endometriosis, surgery can restore pelvic anatomy by taking down adhesions. And even with minimal to moderate disease, the excision of endometrial implants can reduce inflammation, and improve egg quality and embryo survival. 

However, it is important to work with a surgeon who specializes in endometriosis surgery. I strongly recommend surgeons who had Natural Procreative Technology (NaPro) training.

This is because NaPro surgeons take the time to meticulously look for, then excise (laser), all the endometrial implants. The result is a lower recurrence rate of endometriosis.

Many surgeons may simply cauterize (burn) the endometrial implants, which is much less time-consuming to perform, but significantly less effective. Recurrence of endometriosis is higher with this approach.

Individualized Investigations Of Root Issues To Improve Fertility With Endometriosis

Every woman is different, and how her endometriosis presents can also be different. This is why in my clinic I always conduct a very thorough history and order comprehensive lab work to assess for degree of inflammation, among other factors. And based on the results, I then come up with a tailored treatment plan. 

In conclusion, the good news is that with the holistic approach, it is possible to decrease menstrual pain, improve quality of life, and significantly improve fertility with endometriosis. 

Are you trying to improve fertility with endometriosis? Then check out my FREE Top 7 Tips for Getting Pregnant Naturally

As always, this content is meant to be education, not medical prescription. Talk to your own doctor before starting any supplements.


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  6. Stilley JA et al. Cellular and molecular basis for endometriosis-associated infertility. Cell Tissue Res. 2012. 
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  8. Tomioka RB et al. Non-steroidal Anti-inflammatory drugs induces luteinized unruptured follicle syndrome in young female juvenile idiopathic arthritis patients. Clinical Rheumatology. 2018.
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  10. Ethiraj S et al. Production, purification, characterization, immobilization, and application of Serrapeptase: a review. Frontiers in Biology. 2017.
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  1. Hi, do you recommend infertility patients trying to get pregnant go on a Gluten Free diet to improve egg and sperm quality?

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