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“Unexplained infertility” can feel like a dead end, especially after you’ve done everything you were told to do and the embryo transfers still don’t stick. We sit down with Dr. Sadikah Behbehani, a double board certified fertility doctor and minimally invasive gynecologic surgeon, to talk through a reality many patients never hear clearly: endometriosis is frequently the hidden cause behind infertility, recurrent implantation failure, miscarriages, and years of confusion, even when pain is mild and imaging looks normal.

We get practical about the decision points patients face every day. How do you screen for endometriosis when fertility workups focus on sperm, tubes, ovulation, and “normal” ultrasounds? Why is laparoscopy with expert excision still the only definitive diagnosis, and why does surgeon skill change what gets found, treated, and prevented from recurring? Dr. Behbehani explains how inflammation and scarring can interfere with fertilization and implantation, how endometriomas can affect ovarian response, and why age and timing often matter more than any single lab result, including AMH.

We also tackle the hardest planning questions: whether to do IVF before surgery or after surgery, why IVF medications can flare endometriosis pain without clear evidence of worsening disease stage, and when GnRH agonists like Lupron make sense for embryo transfer versus egg retrieval. We discuss symptom management when surgery has to wait, plus nuanced medication decisions including cannabis use, SSRIs, and newer weight loss drugs, with an emphasis on individualized care rather than rigid rules.

If you’re trying to protect your fertility while living with endometriosis or adenomyosis, share this with someone who needs clearer options, then subscribe and leave a review so more patients can find it. What decision are you facing right now: surgery first, IVF first, or egg freezing as a backup?

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