Is It Unexplained Infertility or Endometriosis?
Disclosure: This article is sponsored by ReceptivaDX
Is It Unexplained Infertility or Endometriosis?
I'll never forget the first time the relentless pain gripped me, a sensation that would later be diagnosed as endometriosis. At the tender age of fifteen, a stabbing pain in the lower left side of my abdomen brought me to my pediatrician, a familiar face who had been my doctor since birth.
"It's just cramps," he dismissed. "The only other thing I can think of is if her appendix were on the wrong side, but we would have known that by now."
Endometriosis wasn't even mentioned. Over the years, I endured agonizingly heavy periods, seeking solace in hot baths and swallowing NSAIDs like candy (not the wisest choice, but ignorance prevailed). Occasionally, I'd double over in sudden agony, as if I'd been shot in the lower abdomen.
The revelation of my endometriosis came much later, around my eighth or ninth ovarian cyst. I found myself in the hospital on a Friday afternoon, writhing in pain with cysts on both ovaries. The technician nonchalantly advised, "If you're still in pain on Monday, schedule an appointment with your gynecologist."
By Saturday night, the pain had escalated to the point where I couldn't stand straight. Sweating profusely, I abandoned my waitressing job and sought a different emergency room.
Pelvic exams and ultrasounds unveiled a burst cyst and another one that had rapidly grown within 24 hours. The medical team was uncertain whether it was twisting my ovary, cutting off the blood supply.
"We need to do surgery immediately," the on-call surgeon declared. Terrified at 24, I faced the real possibility of losing an ovary. Little did I know that another danger lurked beneath the surface.
Waking from surgery, I groggily asked my doctor, "Did you take my ovary?" Thankfully, he hadn't. As I emerged from the anesthesia haze, he shared the revelation.
"We found endometriosis," he disclosed. "It's scattered like buckshot over your ovaries and fallopian tubes." The pictures from my surgery revealed black spots, akin to hidden black mold beneath my skin.
That doctor became my gynecologist for years until I moved away. Despite several more ovarian cysts, none necessitated surgical removal. I embarked on hormonal birth control to "quiet the endometriosis," but my menstrual cycle vanished for four years.
When I decided to start a family, conception proved elusive. Despite numerous exams, timed cycles with medication, failed IUIs, a canceled IVF attempt, and another IVF cycle yielding no viable embryos, the diagnosis remained elusive. After years of uncertainty, a doctor finally uttered the words: Unexplained Infertility.
Regrettably, no one had hinted that endometriosis might be the likely culprit behind my struggles to conceive. Armed with this knowledge now, I can't help but wonder if it should have been considered sooner.
Endometriosis and Failed Implantation or Recurrent Miscarriage
Dr. Bruce Lessey of Wake Forest University and Dr. Steve L Young of Duke University – IVF doctors with extensive experience and research on the causes of recurrent pregnancy loss (RPL) and IVF failure or recurrent implantation failure (RIF), share with us that the most common reason given to almost two-thirds of patients for infertility, recurrent implantation failure, recurrent pregnancy loss, and pregnancy loss, is “unexplained.” However, in many cases, there is data to suggest that it may actually be due to inflammation of the uterine wall lining commonly associated with endometriosis, or “silent endometriosis.”
What is Silent Endometriosis?
Silent endometriosis refers to the development of endometrial tissue outside the uterus without usual symptoms. Unlike typical endometriosis, which may manifest as pelvic pain, heavy, painful periods, fatigue, or pain during intercourse, silent endometriosis conceals its presence, making it challenging to diagnose. This condition can affect fertility by influencing the uterine wall environment and contributing to recurrent pregnancy loss or implantation failure. The subtle nature of silent endometriosis underscores the importance of heightened awareness and thorough diagnostic evaluation, particularly for individuals facing unexplained infertility or reproductive challenges.
Even in the absence of common endometriosis symptoms, your OB/GYN or Reproductive Endocrinologist can proactively assess for signs of endometriosis before starting fertility treatments using a diagnostic tool called ReceptivaDx. This test specifically targets elevated levels of BCL-6, a protein marker strongly associated with uterine inflammation, often indicative of endometriosis. Without resorting to surgery or BCL-6 testing, a patient might remain unaware of potential endometriosis. Even when outward symptoms suggest endometriosis, Doctors Lessey and Young advocate for utilizing BCL-6 to confirm the diagnosis. Additionally, another marker, CD138, can be examined from the same sample to either rule out or identify endometritis.
Testing for BCL-6
The reassuring aspect is that in the event of a positive result for BCL-6 or CD138 in the ReceptivaDx test, there are available treatment options. A positive CD138 marker, indicating clusters of plasma cells, points towards chronic endometritis—a bacterial infection treatable with a course of antibiotics. Conversely, a positive BCL-6 result opens avenues for treatment: either 60 days of hormone suppression before initiating an IVF cycle or opting for surgical laparoscopy.
Navigating the emotional toll of recurrent implantation failure or multiple pregnancy losses can be daunting, but amidst the challenges, there is hope. While unexplained infertility may seem frustrating, ReceptivaDx can serve as a valuable tool to determine, or at least eliminate, potential causes. To determine whether silent endometriosis may be a contributing factor, consult your doctor about ReceptivaDx and inquire about testing for BCL-6 and CD138. Taking these steps brings you closer to identifying a suitable treatment strategy that could pave the way for a successful journey to bringing home a baby.
Medical Disclaimer:
The information provided in this blog is intended for general informational purposes only and should not be considered as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your healthcare provider or qualified medical professional with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this blog.