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One of the big things that can make failed implantation even harder to process is not knowing why it failed.
Dr. Bruce Lessey, the foremost expert on BCL6, is a Reproductive Endocrinologist, Infertility Specialist, and Professor at Wake Forest Baptist Health in North Carolina. He notes that the reasons for failed implantation during IVF can range from lifestyle (think smoking or obesity) to systemic (PCOS-related) to issues with the endometrium (or the uterine lining).
While many common reasons exist for failed IVF cycles, we wanted to dive deeper into the connection between endometriosis and failed implantation.
What is endometriosis?
Let’s start at the beginning: According to the Office on Women's Health, over 6.5 million women in the United States navigate endometriosis.
The CDC explains that endometriosis is when tissue similar to the endometrial lining grows outside of the uterus and can cause everything from extreme pain to infertility or, in some cases, failed implantation.
Dr. Lessey adds:
“Endometriosis is a common inflammatory condition that takes on average 7 to 11 years to get diagnosed. Due to the increasing reliance on IVF, it is likely that endometriosis is more common today than in years past in unexplained infertility patients. Since these are the women who often are recommended IVF, this diagnosis should always be considered when IVF fails despite genetically tested normal (euploid) embryos.”
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Endometriosis and failed implantation: What's the connection?
As Dr. Lessey notes, women who believe they have endometriosis often do not have a confirmed diagnosis until later in life, if at all. One of the primary reasons for this is the high percentage of women who have no overt symptoms (known as silent endometriosis) or are misdiagnosed with other conditions like IBS.
“Endometriosis is the one condition that is rarely screened for prior to IVF and is likely present in 60 to 70% of unexplained infertility cases, making it the prime suspect for unexplained implantation failure,” explains Dr. Lessey.
Given how inflammatory endometriosis can be, it (put in very simple terms) can lead to hormonal imbalances and an endometrial lining that isn’t supportive enough for implantation. While increasing research connects endometriosis and failed implantation, Dr. Lessey notes that it’s even more important to use research to inform your fertility journey and involve your care team in that process.
Questions to ask your fertility doctor if you think you have endometriosis
Going back to the notion that there are certain elements of your IVF journey that you can control, one of those is the conversations you have with your doctors. In other words, be proactive!
Dr. Lessey, who specializes in reproductive endocrinology and infertility, walks his patients through an enhanced screening when he suspects endometriosis may be at play.
He’ll ask questions like:
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Do you have a history of IBS?
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Do you spot before your menstrual period?
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Did you have very painful periods as a teenager?
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Have you ever had pain with intercourse?
The goal with these questions isn’t to definitively diagnose endometriosis based on these answers alone but to use them as a guide that can contextualize your reproductive health a bit better.
Dr. Lessey adds:
“Positive responses to these would prompt a heightened concern for the diagnosis. I use ultrasound to rule out endometriosis in the ovaries and in most women I recommend an endometrial biopsy to rule out endometriosis. If we do a biopsy, we usually send it to ReceptivaDx to check for BCL6 expression assocated with endometriosis and CD138 to identify endometritis, a bacterial infection.”
In some cases, Dr. Lessey has also found that laparoscopic surgery can help alleviate endometriosis symptoms and increase the likelihood of conception without the need for IVF.
“For detection of endometriosis and general inflammation of the uterine lining, one of the most studied biomarkers is called BCL6 (offered at ReceptivaDx), performed through an endometrial biopsy,” notes Dr. Lessey. “Laparoscopy is a surgical procedure that is the gold standard for diagnosis of endometriosis, but it is invasive and expensive. In our practice in North Carolina, the use of BCL6 to identify endometriosis including asymptomatic endometriosis followed by treatment has improved our success rates significantly. Studies show a five-fold increase in success from untreated BCL6 positive patients versus treated.”
The ins and outs of how endometriosis and failed implantation are connected are still being researched, but there are things you can do today to help you feel more empowered in your trying to conceive journey.
If you suspect you may have endometriosis or have experienced recurrent implantation failure, ask your doctor about the ReceptivaDx test. You never know; it could make all the difference!