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Difficulties conceiving naturally can often stem from poor egg or sperm quality or underlying health concerns like endometriosis. Endometriosis is a condition where the endometrial tissue grows in other organs like ovaries, affecting egg growth and oocyte transfer to the uterus. While endometriosis occurs with symptoms in many women, some experience asymptomatic or silent endometriosis.

Symptoms of Endometriosis

Common symptoms of endometriosis include:

  • Pain during intercourse
  • Heavy menstrual cycles
  • Painful bowel movement and urination, especially during your menstrual cycle
  • Abdominal and lower back pain
  • Severe cramps
  • Migraines
  • Nausea
  • Constipation and diarrhea
  • Bloating
  • Vaginal bleeding between your periods
  • Infertility or challenges getting pregnant

These symptoms indicate potential endometriosis but can occur for other reasons. If you suspect you may have endometriosis, you should get a professional diagnosis by your OBG/YN.

Fertility specialists use various methods to diagnose endometriosis before treatment, including:

BCL6 Testing

Many women with unexplained infertility have endometriosis but do not show any symptoms. Silent endometriosis is easily diagnosed using a BCL6 test for customized treatment options.

BCL6 (B-cell lymphoma-6) is a gene that encodes a tissue-building protein and is an accurate marker for inflammation. Inflammation in and around your uterine lining can impede embryo implantation and development. This can cause a release of inflammatory cytokines that rise with the level of BCL6 cells.

BCL6 tests evaluate the levels of the B-cell lymphoma-6 gene in the body. High BCL6 levels indicate potential endometriosis cells, which your fertility expert can use to determine the proper treatment.

Pelvic Exam

Doctors might also manually examine the pelvic region when diagnosing endometriosis. During your pelvic exam, the clinician will palpate areas around your pelvis for abnormalities. Common abnormalities they check for include:

  • Cysts on reproductive organs
  • Scars within your uterine lining
  • Excessive tenderness or hyperalgesia
  • Thickened ligaments
  • Nodules
  • Displaced cervix due to excessive scarring
  • Fixed or frozen uterus (It does not move around freely due to scar tissue buildup)

A pelvic exam is helpful in the initial stages of diagnosis, but your specialist may refer to other methods for a clearer image of the endometrial development.

Medical Imaging

Endometriosis tests can sometimes offer ambiguous results; fertility specialists resort to medical imaging to confirm the presence of a mass in the reproductive system. Medical imaging techniques provide a visual map of your insides, helping highlight endometriosis. Some medical imaging methods doctors use include the following.

Transvaginal Ultrasound

This medical imaging technique helps create an image of the inner part of your body using high-frequency sound waves. Doctors can press the transducer against your abdomen or insert it inside your vagina. The device will capture images of inner tissues and reproductive organs for easy diagnosis.

When assessing the parts, your doctor will look for cyst-like masses within your ovaries called endometriomas. They will also check for nodules and deep lesions, which indicate the presence of endometriosis.

MRI Scan

Fertility doctors also use magnetic resonance imaging (MRI) to diagnose endometriosis. The MRI scans provide a clear image of the reproductive system, indicating potential areas with endometrial tissue.

MRI technology uses radio and magnetic waves to generate detailed images of soft tissues. Such details offer surgeons adequate information about endometriomas’ location and size for surgical planning.

While MRI scans are highly accurate, they can be expensive; doctors order them if they suspect endometriosis but no other evaluations can support the diagnosis.


Laparoscopy involves a surgical procedure where surgeons use viewing instruments to examine the inside of your abdomen. This method is highly accurate since it allows direct visualization of tissue overgrowth.

Surgeons perform laparoscopy under general anesthesia in a hospital setting. They make a small incision near the navel and inject carbon dioxide (CO2) to inflate the abdomen. Your surgeon will insert a slender viewing instrument (laparoscope) to view reproductive organs on a monitor.

Surgeons can confirm the presence of endometrial tissue and endometriomas by visualization. Laparoscopy surgeons can sometimes snip off some tissue during the procedure for biopsy to verify its existence.

Proper Diagnosis Helps Treat Silent Endometriosis

Endometriosis often manifests through multiple symptoms, but it can sometimes be asymptomatic. Silent endometriosis causes unexplained infertility and lowers the success chances of IVF. You can use techniques like BCL6 testing and medical imaging to confirm and diagnose endometriosis.

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