When “Unexplained” Isn’t the End of the Story
Patricia Cullen, founder of, explores how endometriosis may lie behind many cases of “unexplained infertility” and explains why specialist ultrasound can help women find answers and clarity.
Unexplained infertility may not be unexplained after all.
For many women, the words “unexplained infertility” arrive after months or even years of tests, appointments and quiet worry. Everything appears normal, yet pregnancy does not happen. For some, this label becomes a frustrating full stop. But for a significant number of women, unexplained infertility is not the end of the story. It is the beginning of one that has not yet been fully explored.
Endometriosis is one of the most common conditions linked to fertility difficulties, yet it remains underdiagnosed. It is estimated to affect around one in ten women, and many will live with it for years without realising. Some experience clear symptoms, while others have very few or none at all. This is why so many women only discover it during fertility investigations.
Endometriosis occurs when tissue similar to the lining of the womb grows outside the uterus. These areas can cause inflammation, scarring, and changes in how pelvic organs move and function. In some cases, this can affect fertility, even when menstrual cycles appear regular and hormone tests look normal.
Many women who later discover they have endometriosis describe symptoms that were easy to dismiss at the time. Bloating that seemed digestive in nature. Bowel changes that came and went. A heavy or uncomfortable feeling low in the pelvis. Discomfort during or after sex. A pulling sensation when emptying the bladder. Lower back pain that never fully settled. Fatigue that felt out of proportion to daily life.
These symptoms are often brushed aside or attributed to stress, irritable bowel syndrome, or simply getting older. For some women, pain is not a major feature at all. This is known as silent endometriosis, where the condition causes little day-to-day discomfort but may still affect fertility or pelvic organs.
This is why awareness is so important. Many women seeking fertility support want to understand whether their symptoms could be connected to endometriosis, or whether something has been missed along the way. Others are simply looking for reassurance that everything has been properly assessed.
Ultrasound plays an important role in this process when it is carried out with a specific focus on endometriosis. While it cannot identify every case, a detailed ultrasound can detect ovarian endometriomas, assess how pelvic organs move, and identify features that suggest deeper disease. It can also highlight areas that may require further investigation or specialist input.
What many people do not realise is that not all pelvic ultrasounds are the same. A routine scan is designed to look at basic anatomy. An endometriosis-focused assessment involves a more detailed evaluation of specific areas within the pelvis and how structures interact with one another. This type of scan requires additional training and experience, as the signs can be subtle and easily overlooked.
For women in their late thirties and forties, this can be particularly relevant. Many are balancing fertility decisions, changing hormone patterns, and long-standing symptoms that have never fully made sense. Others may have been told for years that everything looks normal, yet still feel that something is not quite right.
Ultrasound does not replace surgery when surgery is necessary, but it can provide valuable information that supports clinical decision-making. It can help guide referrals, assist with planning, and in some cases provide reassurance when findings are normal. Having a clearer picture can reduce uncertainty and help women feel more informed about their next steps.
Endometriosis does not always present in obvious ways. Sometimes it is loud and painful. Sometimes it is quiet and hidden behind symptoms that seem unrelated. And sometimes it is only becomes visible when fertility is affected.
Understanding this condition, and knowing that symptoms do not have to fit a textbook description, is an important step in helping women feel heard. If something does not feel right, or if fertility challenges remain unexplained, it is reasonable to ask whether endometriosis has been fully considered.
Being informed allows women to ask better questions, seek appropriate assessment, and feel more confident in their care. And in many cases, that clarity alone can be an important step forward.
At Ovascan, we offer endometriosis-specific ultrasound assessments. To find out more, contact info@ovascan.ie or visit www.ovascan.ie.
3 Leopardstown Gardens | Off Brewery Rd, Stillorgan, Dublin, A94 W8C3
www.ovascan.ie | Tel: 083 3366747
