An infertility diagnosis is devastating, it just wasn’t part of the life plan. Some couples may have experienced health problems earlier on in life and know that they are going to need help conceiving through assisted reproduction. But for other couples, learning they can’t conceive naturally comes as a complete shock.
Frustratingly, there is also a diagnosis of unexplained infertility. So, after rounds of tests on both male and female partners, there is still no clear reason why they can’t conceive. This is frustrating for the patient but also frustrating for the fertility specialist. With a diagnosis, there is a treatment plan, but without a reason then healthcare providers try all options to help the patient.
Endometriosis Awareness
As March marks Endometriosis Awareness Month, I want to explore how endometriosis can be the unseen and unknown factor for unexplained infertility. Endometriosis is an inflammatory disease of the tissue that lines the uterus. Patients who suffer with this condition experience endometrium tissue growing outside of the uterus. During the menstrual cycle, this lining thickens in anticipation of an embryo to implant. If no embryo implants this tissue sheds and comes away during the monthly period.
Patients with Endometriosis may experience excessively painful menstrual cramps, abnormal or heavy bleeding and pain during intercourse. With severe endometriosis, your healthcare provider may be able to diagnose the condition via an ultrasound scan. But if the endometriosis can’t be seen via ultrasound, then traditionally they would have to perform a laparoscopy.
Asymptomatic patients
A laparoscopy is performed by making a small incision in the abdomen, then a thin tube with a video camera is inserted. This gives your surgeon a clear view of the organs in the abdomen. If Endometriosis is present, then your surgeon would be able to see this as the endometrium lining can attach to your organs. The problem here that some patients don’t have any symptoms and therefore Endometriosis isn’t suspected.
The real head scratching starts when despite your healthcare providers best efforts, still no pregnancy is occurring. When the patient has undergone IVF on a few occasions then the problem could be implantation failure.
BCL6 over expression
Enter Professor Bruce Lessey PhD, Reproductive Endocrinologist from North Carolina. He has spent his career researching the endometrium with a special interest in unexplained infertility and pregnancy loss. He identified the over expression of the BCL6 protein as an indication of endometriosis.
He developed a diagnostic test that can be routinely carried out during a visit to your Drs office. This test can also identify other conditions that may affect implantation. This test called ReceptivaDX has high sensitivity and specificity of 96% in detecting endometriosis. It can be useful when couples experience IVF failure.
BCL6 is over-expressed in endometriosis patients, which makes it a likely candidate for the cause of progesterone resistance that contributes to implantation problems. Progesterone is required for normal pregnancy and studies have shown that women with elevated BCL6 results are 5 times less likely to succeed in IVF.
How diagnosis helps
For your healthcare provider a negative BCL6 result provides reassurance that endometriosis is not the problem. But if the test is positive for higher markers, then it is likely that endometriosis is the problem.
The good news is once endometriosis is confirmed, then the treatment plan would be to suppress the endometriosis with medication prior to embryo transfer. This usually takes about 2 months and then you can proceed with the frozen embryo transfer.
For more information ask your healthcare provider about ReceptivaDX or visit their site for more information.
Veronica Montgomery
Publisher
The Fertility Hub
