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Endometriosis can feel like a medical mystery — and that’s especially true when it comes to fertility. Some people with endo get pregnant easily. Others struggle for years. Some have Stage I disease and face multiple failed IVF cycles. Others have Stage IV and conceive naturally. The frustrating part? There isn’t always a clear explanation.
If you’ve been trying to conceive without success, have had IVF that didn’t work, or experienced multiple miscarriages, endometriosis could be a factor — even if you’ve never had a diagnosis. And if you do have endo, what matters isn’t necessarily how “bad” it looks on paper. It’s how much inflammation is happening inside your body — and whether that’s affecting your ability to carry a pregnancy.
Adhesions are one piece of the puzzle, but they’re not the whole story. So let’s break it down: what are adhesions, how do they relate to fertility, and why is inflammation the real culprit we need to pay attention to?
What are endometriosis adhesions?
Adhesions are bands of scar tissue that form when endometriosis lesions heal. Instead of healthy, flexible tissue, you get sticky, fibrous connections that can bind organs together — like the ovaries sticking to the pelvic wall, or the uterus attaching to the bowel.
These adhesions can be incredibly painful, especially during ovulation, menstruation, or sex. They can also interfere with fertility by physically blocking the fallopian tubes or distorting the anatomy needed for ovulation and fertilization to happen naturally.
But here’s the thing: not everyone with endo has adhesions, and not all adhesions cause infertility. In fact, some people with extensive adhesions still conceive. And others, with little to no visible disease, don’t.
So while adhesions may explain infertility in some cases, they’re not the full picture.
Why inflammation — not stage — is what really matters
One of the biggest misconceptions about endometriosis is that the stage of the disease determines how likely someone is to get pregnant. That’s not true. You can have Stage I endo and struggle for years, or have Stage IV and never have a problem conceiving.
What does matter? Inflammation — especially the kind that affects the endometrial lining (the place where an embryo needs to implant and grow).
Even if your tubes are open and your ovaries look fine, ongoing inflammation inside the uterus can create a hostile environment for implantation. It’s like trying to plant a seed in soil that hasn’t been watered in weeks. It might look okay from the outside, but nothing’s taking root.
This inflammation can increase the risk of implantation failure, recurrent miscarriage, and unexplained IVF failure — even if everything else seems normal on paper.
How ReceptivaDx can help
This is where the ReceptivaDx test comes in. It looks for a specific marker called BCL6, a protein that’s associated with chronic inflammation in the endometrium, often caused by silent endometriosis. A positive BCL6 result means there may be endo-related inflammation affecting the uterine lining — even if you’ve never had pain or been diagnosed with endo before.
It’s a simple, minimally invasive test, performed by an OB/GYN or fertility specialist during an endometrial biopsy. And while it’s not a definitive diagnosis of endo, it can be a powerful clue — especially for people who are experiencing:
- Unexplained infertility
- Multiple failed IVF transfers
- Recurrent pregnancy loss
- Normal imaging with no clear answers
If the test is positive, it gives doctors the information they need to take next steps — whether that’s surgery, suppression therapy, or a more tailored fertility protocol.
Why some people with endo get pregnant and others don’t
This is the question so many patients — and doctors — want an answer to. And the truth is, we still don’t fully know.
Endo affects people in incredibly individual ways. It can alter the immune system, hormone levels, uterine function, and pelvic anatomy. It can exist quietly, or it can rage loudly. And not all of it is visible on imaging or during surgery.
What we do know is that:
- You can have endo without pain
- You can have endo with normal hormone levels
- You can have endo and regular cycles
- You can have endo and never know it — until you can’t get pregnant
That’s why testing for inflammatory markers like BCL6 with ReceptivaDx can be so helpful. It shifts the focus from what doctors can see to what the body is actually doing — and how it’s responding to the idea of pregnancy.
When to consider testing
If you're in the thick of trying to conceive and it’s not happening, especially if you’ve had more questions than answers, it’s okay to ask about endo. Even if no one’s brought it up before. Even if your ultrasounds are normal. Even if you’ve never had “bad periods.”
You might want to talk to your doctor about the ReceptivaDx test if you’ve experienced:
- More than 6–12 months of trying to conceive without success
- Two or more failed IVF transfers
- Miscarriages with no clear cause
- A known history of endometriosis or symptoms that could point to it
The bottom line
Endometriosis is more than just painful periods. It’s a whole-body inflammatory disease that can affect fertility in subtle, invisible ways. Adhesions might be part of the picture, especially if they’re physically blocking or distorting reproductive organs. But the bigger story is inflammation — and how it impacts the endometrial environment where a pregnancy begins.
If you’ve been struggling to get pregnant, and nothing else explains why, silent endo could be the missing link. And thanks to diagnostic tools like ReceptivaDx, we’re getting better at uncovering it — and giving people the answers and care they deserve.
Because you shouldn’t have to wait years for someone to take your experience seriously. And you shouldn’t have to go through IVF cycle after cycle without knowing what’s really going on.
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.