Endometriosis risk

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You have an increased risk of endometriosis. Here is what you need to know.

Endometriosis is a chronic, systemic, autoimmune disease. Your immune system is deregulated and confused. This causes abnormal secretion of inflammatory cytokines in the peritoneal cavity (abdominal cavity) which in turn initiate the transformation of the peritoneal cells to endometrial cells. The excessive inflammatory environment has the following effects on reproduction: (1) development of scar tissue which causes obstruction of the Fallopian tubes, (2) excessive inflammation of the ovaries causes oxidative stress and reduction of the ovarian reserve leading to infertility, (3) development of endometrial tissues in various organs including urinary bladder, intestine, ureters, and even the abdominal diaphragm, (4) inflammation of the endometrial cavity which causes recurrent implantation failure and recurrent miscarriages.

Most patients with endometriosis do not have any symptoms except for infertility. This is the main reason why endometriosis is missed so frequently. One in every three women who seek infertility treatments suffers from undiagnosed endometriosis. Every woman who fails IVF with a high-quality embryo has a 50% risk to suffer from undiagnosed endometriosis, and every woman who has failed two or more IVF procedures with high-quality embryos has an 80% risk to suffer from undiagnosed endometriosis.

Receptiva, a test requiring an endometrial biopsy, measures the endometrial levels of BCL-6, a protein highly connected to endometriosis in the abdomen. An abnormally high BCL-6 result is associated with a 94% risk of endometriosis. Therefore, patients with infertility should have an endometrial biopsy for BCL-6 to rule out endometriosis before they waste their embryos. Further, endometriosis causes low quality and low numbers of eggs, and all patients with low ovarian reserve should be examined for endometriosis. The best way to diagnose and at the same time treat endometriosis is by means of laparoscopy, an outpatient procedure.

A major problem I have noticed with most fertility experts is combining an endometrial biopsy for ERA with a biopsy for Receptiva. This makes sense to save money and pain for the patient, but ERA is usually done on a medicated cycle to examine endometrial receptivity. This is a problem for BCL-6 because the hormones used for the medical cycle cause a high rate of false negative BCL-6 tests. This is one of the reasons why so many patients with endometriosis are not diagnosed. Endometrial biopsy for Receptiva and BCL-6 testing should only be done on a natural menstrual cycle, even if this forces the doctor to do two biopsies.

Patients with suspected or confirmed diagnoses should be started on specialty supplements and medications to rejuvenate the ovaries and improve the number and quality of their eggs before they attempt another egg retrieval. This is essential but most fertility experts would rather proceed with one or more retrievals than do the correct thing. Banking of embryos in patients with endometriosis that was not treated properly will only create defective and poor-quality embryos that will fail to implant or end up in miscarriage.

What should you do:

Talk to your obstetrician/gynecologist or infertility specialist to make sure to rule out endometriosis the right way and not cut corners or dismiss the effects of endometriosis. Many fertility doctors use Lupron, and they believe this will suppress any endometriosis. This is not only a fallacy but also bad medicine to use such a strong medication without a diagnosis. Lupron can cause osteoporosis and should not be used lightly, in addition to the fact if there is undiagnosed endometriosis, Lupron does not help. I have seen this failure in hundreds of my patients coming to me because of “unexplained” infertility. If your doctor does not understand this, please, call my office for a consultation, virtual or physical. If you wish, we can order our recommended customized supplement protocols customized to your fertility needs and help you improve your egg number and quality.