Endometriosis can raise a lot of questions, especially when it comes to fertility. Recently, Carla Cressy of The Endometriosis Foundation sat down with Aria Fertility’s Ms Srividya Seshadri to discuss the link between endometriosis and fertility.

Carla: We’re sitting down with gynaecologist and fertility specialist, Ms Srividya Seshadri at Aria, where we’ll be talking openly and honestly about what endometriosis really means for reproductive health. We’ll cover everything from lifestyle and early testing to fertility preservation treatments and planning a pregnancy so that you can feel informed, supported and empowered to make decisions that are right for you at the right time. Before we talk about medical treatments or fertility preservation. I wanted to start with something a little more fundamental, like the everyday things that people can do to support their fertility.

How do nutrition, stress and sleep play a role in long -term fertility, especially for those with endometriosis?

Vidya: You’ve highlighted two very important factors that could affect fertility. Recently, there has been a focus on PFAS, or forever chemicals, and their potential effects on egg and even sperm quality.

I’m a big believer that nutrition should be in pristine health, at least before any fertility treatment is contemplated. This can range from diet, what triggers to avoid, or curbing excessive caffeine or alcohol intake

Vitamins are also important for fertility, especially folic acid. Folic acid is paramount for egg quality and early pregnancy development, especially the central nervous system development of the baby. Vitamin D also plays a powerful anti-inflammatory role, and we should really be taking it year-round.

One of our government’s guidelines is that all of us who live in the UK must take a daily dose of 10 micrograms of vitamin D. It’s not only helpful during the Winter, but it’s also very good for symptoms of endometriosis and improving egg quality.

However, anything taken in excess is also not great for egg quality. Vitamin E is thought to be good for the eyes and the skin. But it’s a fat-soluble vitamin and so is stored in our fat deposits for a considerable length of time.  Also, taking too much vitamin A in early pregnancy is not conducive to embryonic growth and could be quite toxic for early embryo development. So, I would say avoid vitamin A if you’re trying to conceive.

Sleep is also very important, and we often underestimate its effect on egg quality. There have been some observational studies in the US that looked at how sleep quality affects egg quality, and I’m a firm believer that we need everything in balance to achieve an optimum outcome.

Carla: What fertility tests are available for someone with endometriosis, even if they’re not trying to conceive yet?

Vidya: The fertility investigations would include a blood test that checks our Anti-Mullerian Hormone level. It’s a hormone secreted by small cells lining the follicle, or fluid bubble, that contains our eggs.

It gives us a rough indication of our egg reserve at a given point in time compared to that of a woman of our age. But it does not often predict your future fertility.

So, if you’re an individual wanting to exercise your reproductive choice or even have underlying endometriosis and considering fertility preservation, then doing that test may be valuable because then you can ascertain if you want to do an IVF cycle for egg freezing before embarking on endometriosis treatment.

The test is not dependent on your cycle, so it can be done at any point in your menstrual cycle. The second test is a transvaginal or internal scan.

For individuals with endometriosis, this scan will be very important because endometriosis often causes scarring due to inflammatory deposits or adhesions. A transvaginal scan will also ascertain the position of the ovaries and the number of follicles.

As I alluded to earlier, follicles are the bubbles that contain eggs, so they represent the number of eggs recruited from the federal egg bank reserve each month.

Those are the two tests I would initially offer. But doing tests just for the sake of checking things without wanting to do anything about them is not advisable. But I tell any patient, it is valuable to ensure that our diet, exercise, nutrition, and supplements are in order. Those are the parameters I would look for or try to optimise before we start thinking about reproduction.

Carla: When should someone with endometriosis consider having fertility preservation?

Vidya: If they have been diagnosed with stage 3 to stage 4 endometriosis, and they’ve done their AMH level, and it is borderline.

I feel strongly that the number doesn’t always matter because I have seen individuals with severe endometriosis with a very good AMH value, but I still would encourage them to consider egg or embryo freezing because of the nature of the condition.

The reason for that is that endometriosis is a very difficult condition to predict. Unfortunately, we cannot map out the reproductive cycle and tell an individual how many months they have before their AMH or egg reserve drops. And with endometriosis, that drop could be quite sudden, from a very good egg reserve to negligible.

So, a blood test should not explicitly dictate what an individual should do.

Carla: At what point should someone with endometriosis who is actively trying to get pregnant seek help?

Vidya: I believe that after three to six months of trying naturally, if there is no natural conception, they should seek medical investigations and further intervention.

Now, saying that, not all women with endometriosis have difficulty conceiving. There have been many anecdotal cases where women have had severe endometriosis and have fallen pregnant naturally and have had a wonderful pregnancy and child delivery.

So, I don’t think we need to sort of compartmentalise based on the severity of the diagnosis, but it would depend on the individual’s symptoms, what stage they are at in their life, and their individual circumstances before they make that decision.

Carla: How do you help patients to understand results without any unnecessary fear or anxiety?

Vidya: That is a very important question because, as a clinician, conveying a test result without causing undue anxiety for the patient is paramount. And often it’s difficult because what they take home from the discussion about the results may be completely different from what the clinician discussed with them.

I discuss their results with them, give them time to reflect on the discussion and, if they want, have a follow-up appointment so they can ask any questions that have been left unanswered or help with any ambiguity in their decision-making.

Carla: One of the most common and often kind of frightening beliefs around endometriosis is that it automatically means infertility. What is the real link between endometriosis and infertility?

Vidya: Very good question. The link between endometriosis and infertility is not clearly defined, but up to nearly 50 % of women with endometriosis have problems conceiving. It is a lot, but again, we must bear in mind the other side of the coin that the majority have no problem conceiving.

But endometriosis is an inflammatory condition; those deposits, as they travel through the tubes, can cause scarring and therefore tubal blockage, preventing the egg from fertilising the sperm. Or it could mean that these deposits sit in the ovaries and are akin to rust on metal.

And this inflammation of the ovaries can mean that egg numbers and egg quality can rapidly deteriorate.

Carla: And what do the actual statistics tell us versus the myths that we often hear?

Vidya: The myth we often hear is that if you’ve got endometriosis, you can’t conceive, and you’re doomed for infertility, or you can only conceive through IVF treatment, and the answer is no, because most women with endometriosis have no problem conceiving.

Another myth is that if you get pregnant, be it through natural conception or IVF, your endometriosis will improve. That is a myth that’s been busted. Some women can have a smooth pregnancy, but quite often symptoms will return shortly after birth; for others, their pain just exacerbates during pregnancy.

What I don’t want is for everyone to panic about being diagnosed with endometriosis, because number one, we have so much more information compared to 25 years ago.

For more advice on how we treat patients with endometriosis, please arrange an initial consultation with one of our fertility experts.

Yesterday, Aria’s Srividya Seshadri and Zoe Webb attended a panel held at the Houses of Parliament in aid of Endometriosis Awareness & Action Day. Hosted by Carla Cressy of The Endometriosis Foundation, the inspiring event was dedicated to crushing the taboo surrounding endometriosis.

Dr Seshadri spoke on the panel about the link between endometriosis and fertility and what we can do to help patients:

“It was an honour to join the panel of experts to discuss this often distressing disease. I believe in the four Es of endometriosis. First, it’s essential to educate everyone about this condition. We should also encourage individuals to discuss its impact on them. Then empower them to make informed decisions about their reproductive choices. Lastly, help them evolve into an endometriosis warrior!”

Aria’s theatre manager, Zoe, herself suffers from endometriosis and was honoured to attend both on a professional and personal level. “It was incredibly inspiring to hear such courageous and vulnerable stories as well as listen to the top experts in the field of endometriosis and fertility, which included Aria’s Dr Seshadri. We have a long way to go in the fight for better endometriosis care, but today reminded me exactly why we keep going.”

For more advice on your reproductive choices if suffering from endometriosis, get in touch to arrange a consultation with one of our fertility experts.

There has been an explosion in the consumption of ultra-processed food or UPFs in recent years and it’s estimated that over 50% of the food bought in the UK now consists of UPF. Compare this with 14.2% and 13.4% for our French and Italian neighbours respectively.

In a large-scale review involving almost 10 million people around the world, UPF has been linked to 32 harmful effects to our health, including high risk of heart disease, cancer, type 2 diabetes and early mortality. While this particular review did not examine the impact of high consumption of ultra-processed foods on fertility, there is an increasing body of research into this field.

What are ultra-processed foods?

“Our consumption is so high because so much of our diet come under the banner of being a processed food in the first place,” explains dietitian Alex Ballard. “Often, we think that this just means crisps, sweets or ready meals and, while it is true that many ultra-processed foods are high in unhealthy fats, sugar, and salt, not all are ‘unhealthy’.

“So, things like fortified breakfast cereal, such as Weetabix or Shredded Wheat, wholegrain bread, low fat yogurts, hummus can be classified as processed foods yet still be part of a healthy diet.”

Indeed, there is no single, universally agreed definition for ultra-processed foods. The term itself originates from the NOVA classification system, which was created by scientists at the University of São Paulo in Brazil.

NOVA divides foods into four main categories according to how much industrial processing they undergo.

• Unprocessed or minimally processed foods: These are natural foods like fruit, vegetables, milk, fish, pulses, eggs, nuts, and seeds that have had minimal or no alteration and no added ingredients.
• Processed culinary ingredients: These include substances used in cooking rather than eaten alone, such as oil, sugar, and salt.
• Processed foods: Made by blending ingredients from the first two groups, these are foods that could feasibly be prepared at home and examples include jams, pickles, canned fruits or vegetables, cheeses, and freshly baked breads.
• Ultra-processed foods: These contain multiple industrial ingredients and additives rarely used domestically. They often feature preservatives, emulsifiers, sweeteners, and artificial colours or flavours, to give them a long shelf life.

What impact does ultra-processed food have on fertility?

Emerging evidence indicates that consuming large amounts of ultra-processed foods may adversely affect fertility in both women and men although the lack of a universal definition of what a UPF is contributes to the confusion of what we should and shouldn’t be eating.

“Although we have studies that show high consumption of these foods can produce poorer health outcomes and affect things like fertility, one research study will be testing certain foods, and another research study will test completely different foods.

“When it comes to fertility, researchers have examined the impact on both men and women, and several mechanisms are believed to play a role.”

Increased inflammation and oxidative stress

Ultra-processed foods are typically high in sugars, unhealthy fats, and artificial ingredients, all of which can trigger inflammation and oxidative damage in the body. Such effects may interfere with reproductive function by disturbing hormone regulation. In men, oxidative stress can attack sperm membranes and fragment DNA, which is linked to lower sperm motility and higher miscarriage risk.

Hormonal disturbances

Diets rich in highly processed products can disrupt hormone balance by impacting the endocrine system. For instance, spikes in insulin levels from processed sugars may impair reproductive hormones, potentially disrupting ovulation in women and reducing sperm production in men.

Depriving the body of essential nutrients

These foods often provide minimal vitamins, minerals, and antioxidants. The resulting nutrient deficiencies can affect fertility by lowering the quality of eggs and sperm.

Weight gain and metabolic problem

Frequent consumption of ultra-processed items is linked to obesity and other metabolic issues. Conditions like obesity and metabolic dysfunction are known contributors to infertility, such as polycystic ovary syndrome (PCOS) in women or diminished sperm quality in men.

In a 2025 study, healthy young men were placed on two tightly controlled diets, one high in UPFs and one composed of unprocessed foods, while ensuring that calorie intake was the same. It found that men gained fat mass on the UPF diet despite eating the same calories. As LDL cholesterol levels rose, there was a notable decrease in follicle‑stimulating hormone (FSH), a key driver of sperm production.

A fertility dietitian’s advice on UPFs

An NHS dietitian for ten years, Alex’s keen interest in female health and understanding of how diet can improve conditions such as PCOS and endometriosis led her to specialise in fertility nutrition.

“I believe we should approach UPFs in a nuanced way rather than demonising everything that falls under the banner of being processed. We should always ask ourselves, does this seem healthy? Is it nutrient dense? Does it have lots of vitamins and minerals? Is it high in fibre?

“If you’re answering yes, then then they’re going to be good things to include. Even the foods that do not have a lot of nutritional value can still have a place. Typicallly, they taste good and absolutely we can have food just for enjoyment’s sake. However, if we are having them in large quantities on a regular basis over a long period of time, then they are likely to have a detrimental impact on our health.

“I think it’s also important to highlight that sometimes we hear the word additives, and we think that’s a negative, whereas it can mean nutrient fortification, including added calcium vitamin D, or iodine, and that’s a positive. Or it could be quite a natural ingredient that is making the food safer to consume, increasing the shelf life, or making it more affordable so it’s accessible for more people.”

Alex’s tips on navigating UPFs:

• Try to be organised with food planning and prep so you don’t reach for convenience foods which are likely to be ultra processed.
• Take a packed lunch into work or take snacks out with you when you’re on the go.
• Try to cook meals from scratch if you can as you’re likely to use ingredients in their naturally occurring form.
• You don’t have to abstain completely but look at your consumption and try to reduce it down and switch over to natural foods as much as possible.
• Look at the ingredients list on foods you’re considering consuming. As a very general rule, if there is only a small handful of ingredients, most of which you recognise or have a place in the domestic kitchen, then the food is likely to have gone through a minimal amount of processing. Whereas a long list of ingredients that you don’t recognise is a red flag.

For more advice on fertility nutrition, please visit our support hub or arrange a consultation with Alex Ballard.

This month, we’re speaking to fertility dietitian Alex Ballard (@alextalksdiet), who specialises in preconception nutrition and offers support to Aria Fertility patients.

What are your qualifications and experience as a dietitian?

I qualified as a dietitian in 2015 following a four-year degree involving various clinical placements. These included specialties such as paediatrics, intensive care, oncology and surgery.

Since then, I have worked in the NHS for ten years, seeing patients from all walks of life needing nutritional support. A lot of my current NHS work focuses on diabetes, cardiovascular disease, menopause and elderly care within GP surgeries.

Five years ago, I started my private practice as a specialist fertility dietitian following extensive research and additional training. I have advised hundreds of clients on diet and fertility, fertility treatment and foetal development.

I am a member of the British Dietetic Association and am HCPC registered.

What is the most rewarding part of your role as a fertility dietitian?

That is easy!

Firstly, clients’ feedback that they felt listened to, not judged, and were motivated to make changes following our session.

Secondly, getting updates from past clients to say they are pregnant. I love hearing back from clients to know how their journey is going.

What do you consider to be a healthy diet?

The reason it is so valuable to see a dietitian is that a ‘healthy diet’ can look incredibly different from person to person.

It is fantastic that diet is such a powerful tool for helping with fertility and managing health conditions (such as PCOS, diabetes, coeliac disease and endometriosis), but it’s essential that advice is personalised to an individual.

In general, balance is key! All foods can be part of a healthy, balanced diet. However, focusing on adding a variety of different colours and maximising naturally occurring foods is a helpful foundation for most people.

What inspired you to get into fertility nutrition?

I have always had a keen interest in female health and understanding how diet can improve symptoms for conditions such as PCOS, hypothalamic amenorrhea and endometriosis. This likely started following some of my own hormonal issues.

I started reading the research available on how diet can impact fertility and was astonished that nutrition wasn’t being talked about more in this space. I really wanted to use my knowledge to help individuals on their fertility journey and give them back some control.

What can clients expect when they work with you?

A friendly face and a non-judgemental conversation. My private consultations are relaxed and involve working together to formulate realistic nutritional goals.

My consultations are online, and an initial appointment ranges from 60 to 75 minutes. I can see individuals or couples.

We will start by getting to know each other and you explaining your goals. Then we will gather information about your current dietary intake and lifestyle. Following this, we will discuss relevant information about how nutrition can help you and together agree on what you want to work on first.

Review appointments are also available so that we can chat about how things have gone, discuss any challenges and add in some more changes when the time is right.

What are the most common challenges that your fertility clients face?

Often, my fertility clients may have multiple nutritional needs alongside trying to conceive and, for example, have a health condition that is impacted by diet (such as PCOS, high blood pressure, IBS), an allergy or intolerance to particular foods or food preferences (such as following a vegan diet).

Typically, in these cases, there can be so much information – often conflicting – that they are left confused and unsure of what to do.

A dietitian can help unpick this and make sure the agreed goals are appropriate for all of your needs.

Do you have one piece of advice for couples or individuals trying to conceive?

There can be too much of a good thing. Always have a sensible hat on when you hear advice about food.

It is fantastic that particular nutrients can be so helpful for fertility. However, it is always good to have a wide variety of ingredients instead of overloading on the same specific foods.

Yes, red/pink fruits and vegetables are helpful for lycopene. No, you do not have to drink glasses of beetroot juice each day.

Yes, a preconception supplement can be helpful for some people. No, you do not need to take three different ones or spend a fortune.

Yes, eating more nuts and seeds can be fantastic for fertility. No, restricting yourself to just seed cycling is not necessary.

Contact fertility dietitian Alex Ballard for more advice. We work closely with a wide range of practitioners to provide support throughout your fertility journey – click here to visit our Support Hub.