Could Your Unexplained Infertility Be Endometriosis?

Unexplained infertility. Just reading those words can feel like a punch to the gut. After months (or years) of trying to conceive, or experiencing heartbreaking miscarriages, hearing “we don’t know why” can feel devastating. For many people, unexplained infertility becomes the frustrating diagnosis given when everything else looks “normal” on paper. But what if it’s not unexplained at all? What if there’s a silent culprit hiding beneath the surface?

Unexplained infertility and endometriosis

Endometriosis is a condition where tissue similar, but not identical, to the lining of the uterus grows outside of it. While painful periods, heavy bleeding, fatigue, or discomfort during sex are often associated with the condition, it can sometimes fly under the radar.

On average, it takes 7 to 10 years to receive an endo diagnosis. During that time, some women face challenges conceiving or carrying a pregnancy without knowing the reason. For others, there may be no clear symptoms at all — what experts call silent endometriosis.

What is silent endometriosis?

Silent endometriosis refers to endometriosis without the “classic” red-flag symptoms. Instead, its signs often show up only in fertility struggles: trouble conceiving despite regular cycles, recurrent pregnancy loss, or difficulty sustaining early pregnancies.

Because it affects the uterine lining, silent endometriosis can make it harder for an embryo to implant and thrive. It can also impact the ovaries, egg quality, and overall reproductive health.

As Kristin Diversi, endometriosis patient and infertility warrior, puts it: “Sadly, no one told me endometriosis was the likely cause of my infertility. But, knowing what I do now, I wonder if they should have suspected it had something to do with it.”

Silent endometriosis symptoms

So how can you suspect something you can’t feel? While silent endometriosis doesn’t always come with pain, there are still subtle clues, including:

• Recurrent pregnancy loss or difficulty conceiving despite “normal” test results

• Ovarian cysts (endometriomas): blood-filled cysts that can reduce egg quality and ovarian reserve

• Hormonal imbalances: abnormal levels of estrogen or progesterone, both critical for conception and sustaining pregnancy

• Links to other conditions: autoimmune diseases like lupus, thyroid disorders, rheumatoid arthritis, and fibromyalgia are all more common in women with endometriosis

Without physical symptoms, silent endometriosis is often overlooked, leaving many individuals and couples with the label of “unexplained infertility.”

Silent endometriosis and miscarriage

Commonly, silent endometriosis reveals itself only after repeated struggles to conceive or carry a pregnancy. Research shows that inflammation caused by endometriosis can reduce implantation success and increase miscarriage risk. This is why unexplained infertility and recurrent pregnancy loss are often misdiagnoses hiding the real issue.

“There’s no doubt that the impact of grieving recurrent implantation failure or multiple pregnancy losses takes a tremendous physical and emotional toll. But know that if you’re dealing with an exceptionally long and difficult fertility journey, there is hope," says Diversi.

Silent endometriosis and egg quality

Endometriosis can reach beyond the uterus, too. When it develops in the ovaries, it can form cysts called endometriomas. These cysts can damage healthy ovarian tissue and negatively affect egg quality, making it harder to conceive naturally and more difficult to produce viable embryos during fertility treatments.

This is why some women with silent endometriosis struggle not only with implantation but also with producing high-quality eggs in the first place.

Silent endometriosis and IVF

For those who pursue IVF, silent endometriosis can play a hidden (and frustrating) role. Even when embryos appear genetically normal and transfer procedures go smoothly, inflammation from endometriosis can interfere with implantation. This may look like repeated “failed cycles” with no clear explanation.

Silent endometriosis can also affect ovarian response to stimulation, lowering the number of eggs retrieved or leading to poorer-quality embryos. Together, these factors make IVF less effective unless the underlying inflammation is addressed.

The hopeful news? Research shows that identifying and treating silent endometriosis before an IVF or embryo transfer cycle can dramatically improve outcomes. 

How to test for silent endometriosis

You don’t have to wait for symptoms to appear — there are tests that can spot silent endometriosis without surgery. OB/GYNs and fertility specialists can use MyReceptiva, a minimally-invasive test that looks for a protein marker called BCL6. Elevated levels of BCL6 are strongly associated with endometriosis and uterine inflammation, even when symptoms are absent.

• A negative result offers reassurance that endometriosis is unlikely the cause.

• A positive result suggests endometriosis or another uterine inflammatory condition may be at play.

For many patients, this test provides the missing puzzle piece after years of unexplained infertility or recurrent pregnancy loss.

Silent endometriosis treatment

If MyReceptiva testing suggests silent endometriosis, treatment can signficantly improve fertility outcomes. Options include:

• Hormone suppression therapy – often 60 days of treatment to reduce inflammation before trying to conceive again (naturally or with support).

• Surgical laparoscopy – removing endometriosis lesions to restore a healthier uterine environment.

Without treatment, pregnancy success rates for women with silent endometriosis are significantly lower. With treatment, those rates can increase substantially — a (quite literally) life-changing difference.

Unexplained infertility isn’t always “unexplained"

For many people, silent endometriosis is the hidden factor behind years of TTC struggles, repeated miscarriages, or failed fertility treatments.

The bright side is there are tests and treatments that can help. By asking your doctor about MyReceptiva and testing for BCL6 (and CD138, which checks for endometritis), you can move one step closer to a diagnosis and the possibility of healing.

Because the truth is: unexplained infertility doesn’t have to be the end of your story.

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Kristyn Hodgdon is a passionate women's health advocate and the Co-Founder and Chief Creative Officer of Rescripted, where she helps break down complicated medical info into content that's easy to understand — and actually helpful. As an IVF mom who’s experienced pregnancy loss and lives with PCOS, Kristyn blends her professional know-how with real-life experience to support others navigating similar journeys. Her work has been featured on Good Morning America, ScaryMommy, and more, and she’s the host of the podcast From First Period To Last Period. A Fordham University grad, Kristyn also volunteers with the Fly Again Foundation, which supports breast cancer patients. You can find her on Instagram or connect with her on Linkedin.