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Future of Fertility

An Expert Explains Endometriosis

There’s no such thing as “unexplained infertility.” More than 6 million women have fertility issues, and while there are various potential causes of infertility, a common one that is underdiagnosed in women is endometriosis. The disorder affects an estimated 2 to 10 percent of women ages 25 to 40 in the United States.


Aimee D. Eyvazzadeh MD, MPH

Fertility Expert, The Egg Whisperer Show

If you’re facing infertility, becoming aware of this potential explanation can help you advocate for yourself in your doctor’s office and get answers. People with endometriosis do have options.


What happens during endometriosis?

Endometriosis happens when the tissue that usually lines the uterus — called endometrial tissue — pops up elsewhere in the body. Similar to normal uterine tissue, endometrial tissue accumulates and, during menstruation, breaks down and bleeds. As a result, scar tissue forms in the pelvic region, such as in and around the ovaries and fallopian tubes. Extreme pain and infertility are two of numerous possible symptoms.

Sometimes infertility is the only symptom of endometriosis, which is one of the reasons the disorder may be so underdiagnosed. In fact, it takes an average of eight to 12 years for a person with endometriosis to get the right diagnosis.

How is endometriosis diagnosed?

To provide a definitive diagnosis for endometriosis, most doctors perform an invasive surgery called laparoscopy. Laparoscopy involves making an incision in the belly and inserting a thin, lighted bulb to analyze the endometrium, which is the lining of the womb or uterus. The procedure tends to be costly — by one estimate, upwards of $5,000 out of pocket — making this out of reach for some patients.

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Over the last 10 years, a wealth of published research suggests testing for a protein marker called BCL6, collected as a simple endometrial biopsy, is a less invasive alternative diagnostic approach. This marker is strongly associated with endometriosis, and in 2015, my practice was the first to offer this test to patients we suspected may have endometriosis as the cause of their fertility issues. Today, the majority of IVF centers in the United States are offering the test.

How are patients with a positive BCl6 result treated?

There are two options. The same surgical laparoscopy used to diagnose endometriosis will also remove endometrial scar tissue, providing a more receptive surface for an IVF transfer. The second, and less invasive, option is hormone suppression drugs that shrink abnormal uterine tissue, making the uterus more receptive and thereby increasing the likelihood of a successful IVF transfer and carrying a pregnancy to term.


What patients can do to educate themselves

If you’ve faced infertility and your doctor hasn’t mentioned endometriosis, start asking questions, and don’t hesitate to seek out a second professional opinion. No one knows your body better than yourself, and it’s your job to take care of it. Doing so will give you and your family the best shot at making your dreams a reality.

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