Finding Hidden Answers: How BCL-6 and CD138 Testing Can Support Your Fertility Journey

At our clinic, we understand how frustrating and painful it can be to go through repeated miscarriages, failed IVF cycles, or months of trying without clear answers. That’s why we are introducing BCL-6 and CD138 testing as part of our fertility investigations. These new tools can sometimes uncover hidden issues in the womb that routine tests may miss, giving us more clarity and helping us plan the right treatment for each patient.

We spoke with Dr. Bhushan Mokoonlall, consultant gynaecologist, about what these tests mean for women and couples facing fertility challenges.

Q: What is BCL-6 testing, and why is it important?

Dr. Mokoonlall: BCL-6 is a marker linked to progesterone resistance and endometrial inflammation. Several studies have shown that women with high BCL-6 expression may have a lower chance of implantation and reduced IVF success rates. Research also suggests that BCL-6 positivity may indicate hidden endometriosis, with high sensitivity in some studies.

This test gives us additional information that routine scans or hormone tests may miss, especially in women with unexplained infertility, endometriosis, adenomyosis, or repeated miscarriages.

Q: And what about CD138 — how does that fit in?

Dr. Mokoonlall: CD138 is another important marker we test for. It helps us detect chronic endometritis, which is a low-grade, often silent infection of the womb lining. This condition can cause inflammation, reduce implantation rates, and contribute to miscarriages — yet it is frequently overlooked.

By combining BCL-6 and CD138 testing, we can assess both progesterone resistance and infection-related inflammation. This dual approach provides a clearer picture of the womb environment, enabling us to target treatment more precisely.

Q: How do you use these tests in practice?

Dr. Mokoonlall: We don’t look at these tests in isolation. We usually combine them with:

• Hysteroscopy, where we look directly inside the womb cavity and, if needed, treat small issues such as polyps or adhesions on the spot.
• 3D ultrasound scans, which provide a detailed view of the uterus.
• Comprehensive blood work to check full hormone profile, clotting, thyroid, and immune markers.

Together, these investigations provide a comprehensive assessment of the uterine cavity and overall fertility health.

Q: Are there any limitations patients should know about?

Dr. Mokoonlall: Yes, it’s important to be transparent. Currently, large randomised trials are still lacking, and international guidelines (such as ESHRE) have not yet incorporated BCL-6 testing into routine fertility investigations. These tests should be viewed as complementary tools that can enhance imaging, laparoscopy, or other diagnostic investigations.

That said, for selected patients — particularly those with recurrent pregnancy loss, failed IVF cycles, or unexplained infertility — BCL-6 and CD138 can provide valuable insights that help us plan more personalised treatment.

Q: What does this mean for patients in real terms?

Dr. Mokoonlall: It means fewer unanswered questions. If BCL-6 or CD138 are positive, we can address inflammation, infection, or progesterone resistance before moving to the next stage of treatment. For some women, this may prevent unnecessary repeated IVF cycles; for others, it may increase the chances of IVF success.

Not every patient needs IVF, and not every patient will need these tests — but our philosophy is that every patient deserves an individualised approach.

That’s why we invest in advanced tools like BCL-6 and CD138, while also offering hysteroscopy, ultrasound, and blood tests.

Q: What is your overall goal with introducing these tests?

Dr. Mokoonlall: The goal is clarity and personalisation. Many patients come to us saying, “All my tests were normal, but I still can’t get pregnant.” By introducing BCL-6 and CD138, we can identify hidden issues such as inflammation, endometriosis, or chronic endometritis that might otherwise go undetected.

Ultimately, we want to optimise the womb environment, reduce the risk of miscarriage, and give patients the best possible chance of a healthy pregnancy.

If you’ve experienced recurrent miscarriage, failed IVF cycles, or unexplained difficulties conceiving, contact us to learn whether BCL-6 and CD138 testing — alongside our full fertility evaluation — may be right for you.