ReceptivaDx™ test results explained – the expert perspective on your BCL6 levels

If you’ve been ‘diagnosed’ with unexplained infertility – an outcome that should always be thought of as a question mark, rather than a full stop on your fertility journey – you might already know about ReceptivaDx™, and their groundbreaking BCL6 test.

But what can the test actually tell us? How should we read and interpret the results, and what kind of treatment and next steps in IVF should we expect?

We’ve seen a fair few of these questions about understanding the Receptiva test results  floating around online. So, for the expert perspective straight from the source, we caught up with the ReceptivaDx™ team.

Here’s the Q&A.

1. First off, what is BCL6? 

The primary component in the ReceptivaDx™ test profile is BCL6 – a protein biomarker associated with inflammation. 

BCL6 is dramatically over-expressed in women with endometriosis, the most likely inflammatory condition causing unexplained infertility, recurrent miscarriage, and implantation issues. 

Progesterone is required for a normal pregnancy, so a protein that interferes with progesterone action would explain much about the problems encountered in women with endometriosis.

ReceptivaDx™ is the first test to detect uterine lining inflammation most commonly associated with endometriosis – silent, or otherwise. It can also predict your chances for a successful IVF transfer and successful pregnancy.

2. What does it mean to test positive for high levels of BCL6? Is there a BCL6 positive endometriosis link?

Testing positive for high levels of BCL6 with the ReceptivaDx™ test is highly suggestive of inflammation, most commonly associated with endometriosis. 

In fact, studies have shown a high association between a positive BCL6 result and confirmed endometriosis by surgical laparoscopy – the gold standard for a diagnosis.

Additionally, women with high levels of BCL6 are 5 times less likely to succeed in IVF than women testing negative. We know this because the BCL6 marker has been studied for over a decade, with numerous studies showing the failure rate of women testing positive and not getting treated.

3. Receptiva test results explained – what is the range for a ‘positive’ result? 

Anything above 1.4 is considered a positive result with the Receptiva test. 

ReceptivaDx™ uses a technique called immunohistochemistry where a piece of tissue taken from the endometrium is placed on a slide and stained with the BCL6 marker. 

Pathologists then evaluate the staining intensity to come up with a value, called an H-score. This number will range from 1 to 4. The cut-off value, meaning the value separating a positive from a negative, is 1.4. 

This value was determined during a validation process involving hundreds of confirmed positive endometriosis patients and hundreds of control patients.

4. Can our BCL6 levels tell us which stage of endometriosis we’ve got?

If you are found to have endometriosis, you’ll then be “staged” from 1, meaning earlier stage endometriosis is present, to 4, which means endometriosis is present in its most severe form. 

This can be confusing if you’re BCL6 tested because ReceptivaDx™ also uses a pathology H-score range of 1 to 4, as we’ve explained above.

However, there is no relationship between H-score and endometriosis stage. 

Doctors will only be able to stage your endometriosis under laparoscopy, where the disease can be physically observed throughout your pelvic area.

5. What does it mean to get a ‘negative’ result? 

Anything under 1.4 is considered negative. And getting a negative result is just as important as a positive result in helping you determine next steps. 

If negative, the results suggest that inflammation is not your issue, and statistically, it puts you into the same category of success as a first-time IVF patient – meaning you’ll have around 60% probability of a positive outcome on the next transfer attempt. This can feel really reassuring as you move forward.

6. How accurate are the ReceptivaDx™ test results? 

We often use the word “accurate’ to define how good a test is. But if we’re going to get technical about it, better terms would be sensitivity and specificity. 

Sensitivity and specificity are measures of how well BCL6 can classify a person as having endometriosis or not. A highly sensitive test means that there are few false negative results, and thus fewer cases of endometriosis are missed. A highly specific test means that there are few false positive results. 

The ReceptivaDx™ test has a sensitivity of 93% and a specificity of 96%. This has been confirmed independently by OBGYN surgeons who performed laparoscopies on patients referred to them with positive BCL6. 

7. What are the next steps, after a ‘positive’ result?

If positive, you and your doctor will discuss several next steps, and the published data currently defines two primary options. 

1. The first is surgical laparoscopy. However, because many patients show little to no symptoms of endometriosis, they don’t want to go through this invasive and expensive procedure.
2. The most common treatment is 60 days of Lupron Depot™, or Zoladex™ in Europe. This treatment suppresses the inflammation caused by endometriosis long enough for the embryo to attach and lead to a live birth.

Recently, studies have shown the effectiveness of other drugs in management of endometriosis, including Letrazole and Orlissa® (Elagolix).

8. Should we ask to repeat the ReceptivaDx™ test after treatment, to compare results? 

Once you’ve been tested and treated, if positive, the advice is to proceed with the normal IVF transfer protocol, without being retested. 

In addition, if your transfer fails, it is not recommended to re-biopsy and test either. 

According to Dr. Bruce Lessey, one of the pioneers of BCL6 testing with 30 years of clinical experience, the likelihood of learning anything new with another test is limited.

However, depending on the patient’s history, he often recommends another 30 days of treatment.

Looking to rule out endometriosis from your unexplained infertility? The ReceptivaDx™ approach for 2024 is simple – learn, empower and advocate. 

Connect with them to schedule a free 20-minute consultation, and book your test. As a TRB reader, you can get $75 off your test with code TRB23 on your request form.