Ep. 53: Is the Receptiva test best for Endometriosis diagnosis?, with Dr. Nicholas Kongoasa
Caitlin:
Welcome to the Woven Well Podcast. I'm your host, Caitlin Estes. I'm a certified fertility care practitioner with a master divinity degree. Each episode will cover a topic that helps educate and empower you and your fertility while honoring the deep connection your fertility has with your faith. Let's get started.
Welcome back to the Woven Well Podcast. Today is going to be a really great episode because we have Dr. Nicholas Kongoasa, also known as Dr. K, with us today, and I have really long respected Dr. K for his restorative health approach, both to endometriosis and reproductive health overall, and have even had the privilege of working with him as he gets health education out to teens across the country. So he serves as the reproductive surgeon at the Center for Restorative Reproductive Surgery, as well as the Chief Medical Officer for Reproductive Health Medicine and Gynecology out of Atlanta, Georgia. So Dr. K, thanks so much for being on the show today.
Dr. Kongoasa:
Oh, thank you, Caitlin, for having me. It's a great pleasure to be here.
Caitlin:
Well, we're certainly happy about it. I already mentioned that you work with both endometriosis and gynecology, but your approach to both may be a little different than the mainstream. So would you tell us just a little bit about why you refer to your work as a restorative approach to both?
Dr. Kongoasa:
Yeah, I think that the main thing is a lot of physicians, when we are dealing with women's health, the approach that is being done is not restorative. I think for example, in gynecology, if you speak to many, many gynecologists and they will agree at a point that most of gynecological issue like irregular bleeding, acne, no period, all that has to do with a dysfunction in a woman's ovulation, and that's why you have the symptoms. Now, here's where we kind of disagree. Where most GYN take the suppressive approach, kind of saying that, "Yeah, we know that there's an issue with ovulation, but rather than finding out what that is, we now have this pill, this injection, this implant, the IUD for example, that will suppress your ovulation." So it's like, "Yeah, we know that there's a problem with ovulation, but rather than finding out what is wrong with ovulation, let's just suppress it and give you this seemingly normal cycle, but it's not because of ovulation cycle."
Whereas what we say is that, "Well, you know what, yes, we agree that there's an issue with ovulation and that's why you are having this problem. Now rather than suppress it, we want to get down to the root cause and therefore by doing that, then we are able to correct the underlying issue, and then you will then have normal ovulation. And guess what? If you have normal ovulation, then your symptoms will disappear."
So this is where we say, "Okay, we want to restore normal ovulation. We do not want to suppress ovulation." Likewise with infertility, for example. Our approach as well is restorative, be it tubal factor, be it ovulation factor, PCOS, endometriosis, for example. We agree, "Yes, there's an issue there, but rather than suppress, or rather than bypass the abnormal function, we want to restore the normal function."
So the philosophy, I think, with a lot of REs, is that we don't really pay attention too much on what is wrong with you nowadays, because modern technology has allowed us to bypass whatever is abnormal and then produce a baby for you. So I think that is, for the general, I think that is what the IVF approach is. Whereas, in our case, then, no, no, no. We want to know why is it that the couple cannot conceive. We want to work hard, because we want to identify what is wrong. And we see infertility more as a symptom rather than a diagnosis. And I think that one thing that I find it unacceptable is that if you Google causes for infertility, Google will tell you, and this is agreed upon with the infertility REI specialist in general, that one third of infertility is unknown.
And then if you tell someone that, "Hey, you know what? One third of cough is unknown, but I can just give you this medication to stop you from coughing." I don't think anybody will accept that. When you go to see your doctor for coughing, you want to know why is it you're coughing, or you have a headache. You're not just going to be satisfied, "Here, for your headache, just take Tylenol forever." Right? No, no. You want to know why. I think a lot of our patients come to us with that question, "Why is it that me and my husband cannot get pregnant?" They want to know. Yes, they want to have a baby, but I think more so, I believe they want to know why. Because it's just instinct. You want to know what is wrong with you.
Caitlin:
Yeah. And that seeking to be healthy, overall, to have a healthy reproductive system, to have healthy functioning ovulation, that can only be good for women. Short term and long term. So you're investing in your own health when you really prioritize that restorative approach as well. And I think that that applies even to something like endometriosis. You were just talking about infertility, and so I know a lot of times that is one thing that is looked into to see, does a woman have endometriosis? And it could be for infertility, it could be for other reasons. And I know on this podcast we've talked about endometriosis several times, and our listeners know that the only way to diagnose endometriosis is through surgical confirmation.
But there's been this continued buzz about the Receptiva test that says that it can demonstrate the presence of endometriosis from just a uterine biopsy instead of an exploratory surgery. So I'd love to hear a little bit about that. How does this test even work?
Dr. Kongoasa:
So the Receptiva test requires an endometrial sampling. So you need to go to your doctor's office, they will need to do endometrial biopsy, post the biopsy canula through the cervix, and then extract the endometrium, and then they will then send it to the lab, or to Receptiva lab for them to see if there's an expression of BCL6. And that's what they are looking for. And if you meet a certain threshold that you are positive and then you have positive, then there is an association with inflammation. And then therefore because you have inflammation, it may mean that you have endometriosis. It's more a marker of inflammation rather than a marker for endometriosis, in my opinion.
And when we are looking at inflammation, endometriosis is one cause of many causes of inflammation. And also, I think that Receptiva tests have its own role. I don't necessarily do it, or that's not my preference. I think it's also because I do believe that when we are finding the root cause of someone with infertility, broadly speaking, there is a medical cost and there is a surgical cost. This is my opinion, to put things very simply. And in some sense, medicine is not going to correct something that is surgical, surgery is not going to correct something that's medical. You're not doing surgery to correct a thyroid unless you need thyroid surgery, but you know what I mean.
Likewise, medicine doesn't necessarily treat the issue and you can give suppression before your cycle, for example, before your egg retrieval cycle or your embryo transfer because we suspect you have endometriosis. But I think it's one of those things that, "Well, that sounds okay, but then you kind of need to stimulate me at some point anyway, because I need to have a lining for my baby to implant."
So you can kind of down regulate and suppress the endometriosis, but at some point you need to be stimulated. And the other thing also, is that because in my mind, you have these two broad categories for infertility, therefore the same way you have a medical workup to look as to what is the cause of the infertility symptoms, you can also do the same thing for surgery, as well. So surgically evaluate a woman's reproductive function.
And I think that I'm surprised, in a sense, that people are now not doing more and more surgery. Surgery is now a lot more safe than say compared to 20 years ago. You have very good optics, 4K cameras in the laparoscopic surgery that you are able to see at very high resolution. When I'm doing cystoscopy I'm able to see the red blood cells. That is how good the magnification and the resolution.
But yet, for infertility workup, as a specialty, we are moving away from surgical workup. I think it's not good for the patient because if you have things like endometriosis for example, and you ignore that and then this patient go through egg retrieval cycle, then if you believe endometriosis can be suppressed, you have to believe the endometriosis can be stimulated. And if endometriosis a cause of the patient fertility issues, then you also have to acknowledge that at the end of that egg retrieval cycle, that patient with endometriosis is going to be less fertile than when she first started. Because surgery is very safe, you have very good resolution. Why are we not doing more surgery to diagnose someone with surgical causes of infertility?
Caitlin:
And I think for a lot of women, surgery feels like this big commitment, this big step. But it sounds like what you're saying is "Yes, it is a surgery, but compared to where we've come from, this is the absolute best time in history to be having surgeries and it's worth it because there's so much beneficial information that you can gain from it." Even if you were to go in and not find endometriosis, it could still be a beneficial surgery for other reasons as well.
I would imagine the same thing if you have the Receptiva test and it comes back positive, like you mentioned earlier, you know that you do have inflammation. So those results are accurate that there is this specific marker, but whether or not that specifically indicates endometriosis is maybe questionable.
Dr. Kongoasa:
Yeah, I would think so. Yeah, because I think that I believe is in 1.5% patients with positive BCL6, they don't have endometriosis. I don't like to generalize thing because we have positive BCL6, and therefore you have endometriosis, and therefore you don't look at other things. Hormonal, immunological, anatomical, infection that could be causing your lining to be inflamed. And what it tell you, okay, so there is an association with endometriosis, but it doesn't mean that endometriosis is the only cause of a woman's infertility if they have BCL6 positive. So I think that's the other thing as well, to think about because with fertility, trying to find the root cause, we want to make sure all the systems are checked out and all the systems are working.
Caitlin:
That is very well said. That is such a good point. And so for your patients, if you had someone coming to you, maybe on either side, maybe from the gynecology side, or the they suspect endometriosis side, the surgical side, what would you recommend as their general approach as they get started?
Dr. Kongoasa:
So it's a workup. So we need to really thoughtfully think the patient's symptoms to kind of identify what other symptoms the patient have. Yes, we have infertility as a symptom, but what else? We look at the chart, that's something that's very important in our practice as well. What is the cycle pattern? What is the bleeding pattern? What is the mucus pattern? And so far.
Caitlin:
And that's excellent. We talk all the time about how our charting is like gold to the right medical professional. So I love to hear you talk about all the things that you look at. That's great.
Dr. Kongoasa:
Yeah, because we do a lot of telemedicine that how can you examine the patient with telemedicine? We always kind of go back, well, actually we look at a chart and we examine them for the entire month.
Caitlin:
That's right.
Dr. Kongoasa:
Because we take a look at their cycle. So from there we are able to kind of see, okay, no diminished mucus. You have other symptoms that is pointing to an insulin resistance. So we look for that. If you have mucus all the time and you have other symptoms that point towards androgen and that's why we have mucus all the time. So the chart is something that is very important in our practice.
Say for example, because this patient have thyroid symptoms, we will order a thyroid function test because we recognize that that could affect infertility. Now we take the same approach as well with regards to the surgery. I think it is when a patient come to us for a restorative reproductive surgery, we are not just going in and remove the endo and come out. We are not just going in to remove the fibroid, and done, the cyst and done.
We do a workup from the vagina all the way up. We check the cervix, we check the mucus crypts to see if there's any scar tissue. We check to look at the lining to see if there's any micro polyps or strawberry linings that is suspicious for inflammation. We sample the lining, we send it to microbiology to see if there is any bug that has grown, or we send it to pathology for them to look at microscopic signs of endometritis, not endometriosis, so there's inflammation of the lining.
We check the tubes. We can do selective [inaudible] tubation where we check the tube in the visually, usually the right side first and then the left side. And then we can push on the guide wire if we feel there's resistance. And after that, then we go in laparoscopically, we look at the adhesions, we take the adhesions down, we look at endometriosis, we remove the endometriosis. So it's a very systematic approach. We are not just going in looking for endo, "Oh, no endo," and then done. No, it's the same approach. You do a medical hormonal panel to work someone up medically. In a sense, we do a surgical panel to evaluate where is the breakdown?
Caitlin:
What an incredible amount of information to gain from that surgery. And you can't get any of that from a uterine biopsy. I mean, maybe, if you got a biopsy at the specific point where there was something, you could get one of those results, but everything else you'd miss out on. So that is extremely helpful in understanding both the approach and why the surgery may be beneficial to different women. So, of course, there are women out there researching things like endometriosis, and also restorative approach to reproductive health, and they have a lot of questions, they have concerns. Understandably. So, if they'd like to learn more about your approach and your specific recommendations, what would you recommend as the best ways for them to get involved and learn more?
Dr. Kongoasa:
So you can visit our website. There's some information on our website about our approach, about our philosophy. Every two weeks we have a lunch and learn, that's usually on Monday, 1:30 to 2:30 eastern, that anybody anywhere in the world can join in, that you just need to go to the website and sign up, and you can post your questions and I will answer them, basically.
And then we also have free records review. So for anybody who want me to take a look at their records more into details and give a more personalized answer and recommendations, I do invite you to do that, to take advantage of that.
Caitlin:
That's an incredible option. To be able to have you look at all of their records and give that individualized recommendation before they get started is phenomenal. So if anyone's out there listening and interested in that, I will make sure to have links to both of those things in the show notes so that you can have easy access to that. Well, Dr. K, I know you're very busy between your two practices and a busy family, so I appreciate you taking the time to be on and share with our listeners today.
Dr. Kongoasa:
My pleasure, Caitlin, thank you so much for having me.
Caitlin:
So if you'd like to schedule a consultation or appointment with Dr. K or his staff, you can find links in the show notes as I mentioned, to both of his practices, and for the gynecological practice, he is seeing patients in Georgia, Alabama, Florida, Virginia, and California, as of this recording date. It could expand. And if you're listening and wondering how you can learn more about a restorative approach to women's health overall, I encourage you to listen to some of our earlier episodes on NaPro technology and how the Creighton method can help you understand and advocate for your health as you get to that root cause of health issues that Dr. K was talking about. So you can be sure to find those episodes also in our show notes. We're so glad you chose to listen to us today and we hope you'll share this episode with others who you think may find it helpful. As always, thanks for listening as we continue to explore together what it means to be woven well.