By Dr. Beth Taylor
Special to the Post

One in six Canadian women trying to conceive struggle with infertility issues and 15%-20% of women undergoing an infertility evaluation are diagnosed with unexplained infertility, where no cause can be identified. One of the biggest challenges for the doctor and patient is a diagnosis of unexplained infertility. Unexplained does not mean there is no underlying cause, it just means that we don’t know what it is.

Approximately 50% of women with unexplained infertility have undiagnosed endometriosis. These women are less likely to have a successful IVF outcome.

However, a simple test called Receptiva, which measures the level of the protein BCL6 in the lining of the uterus, is becoming an important tool in identifying patients with mild to moderate endometriosis who might have gone undetected before.

What is Endometriosis?

Endometriosis occurs when tissue – like the lining of the uterus – grows on other parts of the body like the ovaries, bladder, bowels, and pelvic wall. Because endometriosis is so misunderstood, diagnosis can be delayed from 7 to 11 years. For women trying to get pregnant, the delayed diagnosis can cost thousands of dollars in failed IVF cycles.

What are the Symptoms?

About 40% of women with endometriosis report no symptoms at all until they experience infertility. Women who do have symptoms can have painful periods, abnormal menstrual bleeding, painful intercourse, or bladder and bowel symptoms.

How is Endometriosis Diagnosed?

Until recently the most definitive way to diagnose endometriosis is with a laparoscopy, a minor surgery during which a woman is put to sleep (in the hospital) and a camera is inserted through her belly button to look inside at the uterus, tubes, ovaries, bowel, and bladder. Scar tissue, unusual anatomy, and endometriosis can be diagnosed, and potentially treated, by this procedure (in British Columbia a laparoscopy procedure is MSP funded with a typical wait time of 4-8 months).

In contrast to a laparoscopy, the Receptiva test is non-invasive, and endometriosis can be identified quickly and cost-effectively by taking an endometrial biopsy of the uterine lining in the doctor’s office.

The lining of the uterus or endometrium in women with endometriosis is different from those who don’t have endometriosis. One main difference is in levels of BCL6. Women with endometriosis have abnormally high levels of BCL6 in their endometrium.

Women who do IVF with endometriosis benefit from having the endometriosis suppressed before an embryo transfer. If a woman with unexplained infertility has the Receptiva test and it shows high BCL6, she could have her hormones suppressed with medication for 2 months prior to having a frozen embryo transfer.

This new test allows doctors to provide appropriate treatment that can improve IVF success rates, reduce costs, and the avoid multiple IVF cycles. A study Published: 04 January 2019  showed an increased live birth rate of 44.2% for women who received treatment compared to no treatment.

Elizabeth Taylor MD FRCSC is co-founder and co-director of Olive Fertility Centre and Clinical Associate Professor at UBC. Her interests include IVF, egg freezing and third-party reproduction (e.g., surrogacy, egg donation, sperm donation). Olive Fertility Centre is one Canada’s leading fertility centres with clinics in Vancouver, Surrey, Victoria, and Kelowna.