One way to describe the trait of Bina is receptivity- receiving information, processing it and absorbing it using discernment and gaining understanding before taking outward action.
After being on this journey for some time, I was offered to take the Receptiva dx test. It is known to test for “silent endometriosis”. It actually measures BCL6, a marker associated with inflammatory signaling and progesterone resistance, most commonly correlated with endometriosis but also seen in other inflammatory uterine conditions. We decided to do it, thinking it was pretty unlikely since it’s brought up as an afterthought. About a week later the results came in and I was positive for a marker that indicates inflammation in the endometrium. The doctor recommended months of hormonal suppression of estrogen and mentioned that surgery is the gold standard for actually diagnosing endometriosis and removing it.
I was kind of shocked. I had been coming in all the time for testing and ultrasounds, and I was told everything looked fine. And I didn’t have the classic symptoms of endometriosis. But inflammation, I was familiar with. Digestive inflammation, chronic fatigue and some other symptoms that now I was starting to put together.
I looked up statistics. Apparently, endometriosis (known or “silent”) is one of the most common underlying factors in women who go in for fertility treatments. Especially, in “unexplained” cases (>50%!). I asked the doctor why this test is offered as an option after much time and expensive interventions if the results are considered highly clinically significant and actionable. There wasn’t really an answer. I also wondered why doctors often treat estrogen as a non-issue until a woman is tested and then recommend suppression. I wondered if they would adjust medications or the recommendation of rounds of clomid if they know there is an elevated inflammatory marker. Endometriosis is fed by estrogen. Elevated bcl6 is often associated with excess estrogen and progesterone resistance, the hormone necessary for pregnancy.
Oh.
Until then, I was encouraged (but confused) by the constant testing indicating that everything appeared normal. I was encouraged to take estrogenic drugs like clomid and to do interventions that were quite expensive and draining. I felt like it was all without basic context.
I learned that there are other tests that indicate uterine inflammation from chronic infections in the uterine lining or endometritis, which is also very common. According to the NIH, when the inflammation in the uterine lining is addressed, pregnancy rates significantly increase.
Shira* went to a fertility specialist and did some preliminary testing in which it was found that she had a uterine polyp. She was advised to have it removed, as the doctor explained that it could be an obstruction. About a year later, she went to another doctor. At that point Shira* and her husband went through months and months of interventions which included many blood tests and ultrasounds, iuis, egg retreival. At that point, she was offered the Receptiva dx test and found that her uterine lining was inflamed- she had elevated bcl6 marker. She was advised to take lupron or do excision surgery before transfer.
Shira remembered the polyp. It had been a while, but she realized after looking some things up, that uterine polyps are associated with excess estrogen and inflammation. So, years ago and since then, she was not advised to look into that given that,
- She was struggling with fertility
- She had a sign of excess estrogen and inflammation in her uterus
She and her husband were pointed elsewhere until they came back around after a process of many interventions, to what would seem obvious unless you are not really looking for context.
According to the National Institute of Health, among women with endometrial polyps, 51.35% have chronic endometritis- that means they have chronic infection and inflammation affecting the uterine lining. The prevalence of CD-138 positivity among those women was 70.73%. CD-138 is a marker for chronic endometritis.
Vatomer Devorah 
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