Dr. Bruce Lessey is passionate about his work in reproductive medicine and helping families achieve their dreams of conception and childbirth. If you have a question for Dr. Lessey, please use the form at the bottom of this page for submissions. Dr. Lessey will attempt to respond to as many patient questions as possible, but we cannot guarantee a response or that your question will be published on our site.

Healthcare providers are also encouraged to reach out to Dr. Lessey with questions or requests concerning the ReceptivaDxTM assay and how it may be beneficial to your practice.

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Carol A.  -  West Palm Beach, FL

Dear Dr. Lessey,
My doctor thinks I have “unexplained infertility”. How will the ReceptivaDxTM test help “explain” my infertility?

Hi Carol. Thanks for the question. In light of recent advances, we don’t think that “unexplained infertility” really exists. Increasingly, this diagnosis simply reflects an incomplete examination of all the potential causes of infertility. Unfortunately, one of the most common causes is endometriosis, and it is increasingly not being diagnosed, simply because laparoscopies are not being done as frequently as in years past.

The ReceptivaDxTM test is a diagnostic test for the presence of endometriosis. BCL6 and the Beta 3 integrin can be used to detect inflammation in and around the uterus. In our published and ongoing studies, over 80% of women with unexplained infertility have evidence that they have endometriosis based on this test.

While that number seems high, the test detects even subtle forms of the disease and is being used in a population of women who commonly have this disease. In women with endometriosis and infertility, there doesn’t seem to be a lower limit on what stage of endometriosis can impair fertility.

Since the diagnosis of endometriosis is delayed almost 11 years in the US, having this new test available will hopefully change that way couples approach the infertility workup. Now it will be possible to establish whether endometriosis may be present early in the diagnostic workup.
Shauna F.  -  Olympia, WA

Dear Dr. Lessey,
I am very frustrated. My husband and I have now failed two IVF cycles. Our doctor says we have grade “A” embryos and we still have a few more frozen eggs left. Will the ReceptivaDxTM test be able to provide more information on why we haven’t had any success? I’m hesitant to attempt another cycle without more information on what might be going on.

Shauna, thanks for writing in. This question comes up a lot, since IVF success in the US remains below 50% in most centers. The ReceptivaDxTM test has been shown to predict a low IVF success rate, while women without the biomarkers used in this test do very well. We have many examples including a testimonial from a woman named Beth M. who failed IVF and frozen embryo transfers over 5 times. Once she was tested, her endometriosis was diagnosed and treated and her very next transfer resulted in a twin pregnancy; the boys are now 3 years old.

The effect of endometriosis on IVF outcome is dramatically underestimated; the percent of women listed on the SART database suggests only 3% of IVF patients have endometriosis (www.sart.org). This is lower than the general population. In fact, it is estimated that 40 to 50% of women going to IVF probably have endometriosis.

The ReceptivaDxTM test can help you find out if you are in this group or not. If you have no obvious reasons for your infertility or have failed IVF for unknown reasons, then you probably do have this disease. Treatment options include surgical and medical treatments; both work well and should be considered before your next transfer.
Peggy D.  -  Naperville, IL

Dear Dr. Lessey,
I have had unexplained infertility for over 14 months now. When I asked my doctor about endometriosis and the ReceptivaDxTM test, he said the test was only for women with symptoms of endometriosis. Is that true? I don’t have any of the classic pain symptoms of endometriosis but other support sites on the web say that endometriosis can be mild and still affect infertility?

Hi Peggy, thanks for the great question. One of the reasons endometriosis is likely proving to be much more common than doctors suspected is because there was not accurate test for it. Now that we have such a test, we, and others, are finding that one of the major “symptoms” of endometriosis is unexplained infertility. Many women don’t have the typical painful periods that generalists consider the hallmark of this disease.

Subtle signs of endometriosis also include spotting before your period, bowel disturbance (IBS) that is cycle-dependent, bladder symptoms (IC) especially if they get worse with your menses, and just unexplained infertility. Published reports suggest that 80+% women with UI have endometriosis, many without characteristic symptoms.
Caitlyn D.  -  Westerville, OH

Dear Dr. Lessey,
I have a question about endometrial biopsies. When researching on the web about endometrial biopsies and general risks, I read that a biopsy can make a woman more fertile. Is that true or is this just another piece of misinformation on the web?

Caitlyn, the Internet is full of misinformation, but this statement appears to be true! The endometrium (the lining of the womb) is remarkable for many reasons, but one phenomenon that has been well documented is that a biopsy (endometrial scratching) appears to make the woman more fertile in the month of biopsy and for several months afterward. No one has defined why this is, but it may have to do with a shift in the immune cells associated with healing.

We’ve documented 50 women who conceived in the month of biopsy, and we continue to see women conceive after the biopsy while waiting to have a laparoscopy for suspected endometriosis. It is one of the hidden benefits of doing the ReceptivaDxTM test, and why many IVF clinics do a biopsy the month before IVF or frozen embryo transfer (FET).
Anna P.  -  San Diego, CA

Dear Dr. Lessey,
I just had the ReceptivaDxTM test done and will be seeing my doctor again in two weeks to discuss next steps. She said my ReceptivaDxTM report came back stating I was “out of phase”. She was quick in her explanation and maybe I didn’t hear everything correctly, but can you tell me what that means and if it’s something they can correct?

Anna, thanks for the question and the chance to respond. If you had the ReceptivaDxTM test, you received much more information than just endometrial histology. One of the attributes of this test is to examine endometrial “dating” in the context of other biological markers. In your pathology report, your physician will have received not only the “dating” report of being “out of phase”, but also an HSCORE for the beta 3 integrin and an HSCORE for BCL6. In out of phase samples like yours, the beta 3 integrin is always negative. No big deal. The real question is whether BCL6 was HIGH or LOW. If BCL6 was high (> 2.0), you may have endometriosis. If it is low, you likely will just need extra luteal phase support, like progesterone or hCG shots. You should talk to your physician about those treatment options. By the way, “Out of Phase” endometrium is fairly common but should be treated if that is the only finding. If BCL6 is positive, endometriosis can cause “progesterone resistance” and this may be why the endometrium is lagging behind histologically.
Charla B.  -  Atlanta, GA

Dear Dr. Lessey
I had previously failed IVF and taken a similar test called “Etegrity”. The test indicated that I probably had endometriosis and I conceived on my next cycle. I am now trying to get pregnant again, but have failed both a fresh and frozen IVF cycle. Can endometriosis come back and how does the ReceptivaDxTM test compare to the one I used before.

Dear Charla, thanks for your question. The ReceptivaDxTM test includes the Beta 3 integrin, which is the same as the Etegrity test used. We are using the same laboratory and pathologist but have now added a sensitive test for endometriosis. Many women who test negative for Etegrity, still test positive in the ReceptivaDxTM test, simply because it picks up a larger population of women with implantation failure.

If you test positive for ReceptivaDxTM, your may want to talk to your doctor about surgical or medical suppression for the endometriosis, since it commonly returns and causes infertility in women who once had this diagnosis.
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The ReceptivaDxTM Test was developed by CiceroDx in conjunction with Pathology Consultants, Inc. of Greenville, SC. Pathology Consultants, Inc. is a laboratory certified under the Clinical Laboratory Improvement Amendments (CLIA). As with other laboratory-developed tests, this testing service has not been cleared or approved by the US FDA or any other federal regulatory agencies. Data have not been submitted to or evaluated by Federal regulatory agencies and the test is not for sale as an In Vitro Diagnostic (IVD) in the US or the EU.
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