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The Breakthrough Option for Treating Unexplained Infertility

Dr. Elizabeth Yuko is the Health Editor at SheKnows. She is a bioethicist and writer specializing in sexual and reproductive health and the intersection of bioethics and popular culture. She is an adjunct professor of ethics at Fordham ...

This test could change the game for people who don't know the cause of their infertility

For those experiencing infertility, it can be a long, expensive and sometimes difficult path to finding its cause. But for some, no matter how many tests they take, there is no specific diagnosis in sight, significantly decreasing their chances of pregnancy.

As it turns out, at least 25 percent of unexplained infertility is caused by endometriosis — and the figure could be as high as 40 percent. While endometriosis — which affects approximately 176 million people worldwide — is typically associated with a set of symptoms (namely, severe pain) it is also possible to have the conditions without the symptoms. That’s what a new test panel, ReceptivaDx, is designed to detect.

Unlike laparoscopy, the typical diagnostic technique for endometriosis, the new test can be done quickly and cost-effectively using an endometrial biopsy sample collected during a routine office visit.

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“As one of the early adopters of the ReceptivaDx test, our experience has exceeded my expectations,” said Dr. Aimee Eyvazzadeh, a reproductive endocrinologist based in the San Francisco Bay Area. “We can now identify and treat women with early endometriosis who might have gone undetected before. For our patients, this has led to improved success rates, reduced costs and the avoidance of multiple IVF cycles.”

There are a few ways of doing the test, which costs $790 with results available in three to five days. One is by doing a mock transfer, meaning that the patients take medications as if they’re going to do their embryo transfer. But rather than transferring an embryo, doctors take a sampling of the cells and study them to make sure there are ideal conditions for the embryo.

Another way of doing the test is during a window after ovulation where you can sample a patient’s uterine lining. Eyvazzadeh said that in order to do this, she talks to her patients ahead of time and plans in advance, as they shouldn’t have sex three to six days before or after the test.

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Because this is a type of biopsy, it has the potential to be painful. Eyvazzadeh “doesn’t believe in pain” and offers anyone who gets the test done a Valium and a Tylenol with codeine. She said that 90 percent of her patients opt for that combination, while 5 percent choose anesthesia and the remaining 5 percent don’t use anything for the pain.

The test tries to identify an inflammatory marker associated with endometriosis; if the patient has it, they are three times more likely to develop the condition. Although it’s possible to use it as a general test for endometriosis — regardless of whether the patient plans to try to get pregnant – for now, Eyvazzadeh primarily uses it with patients seeking fertility treatment.

Many patients with unexplained infertility don’t have the traditional symptoms of endometriosis, so they would have had no reason to think they had it. Though it doesn’t explain every case of infertility, the new test does help pinpoint the cause for some.

Eyvazzadeh first learned of the test from one of her patients who went through 18 unsuccessful embryo transfers before eventually taking the test, getting pregnant and giving birth.

“I can honestly say that this test has changed lives and helped women carrying pregnancies for themselves,” she said.

For Eyvazzadeh, it’s all about science. She said that she has had patients come to her saying, “Oh, my doctor doesn’t believe in this test. My doctor says I don’t have endometriosis.”

“But this isn’t something to believe in — it’s science,” she explained.

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Using the test results, Eyvazzadeh determines the best course of treatment for the patient, which may include Lupron Depot — a medication used for endometriosis — as well as suggesting diet and/or lifestyle changes.

“If you communicate to a patient that there are things we can do in 2017 [to help treat infertility], they’ll keep coming back,” she said. “Once you tell someone there’s nothing you can do, they don’t come back.”

When people go through the IVF process to create an embryo, they expect success, Eyvazzadeh said — and she’s going to do everything possible to achieve it. Even, for instance, if her pregnancy rate is 80 percent, she wants it to be 100 percent, and this test has the potential to close that gap.

Eyvazzadeh said that she offers it to every patient, referring to it as “the e-vite to your embryo party.”

“You’re spending all this money; you’ve worked so hard for this embryo. Spend the $700 for this test so you’re giving this embryo its very best chance,” she added.

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