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Lotus Endometriosis Institute is a program under Steven Vasilev MD PC, which operates out-of-network with all insurance providers. Our patient advocacy finance team will contact your insurer on your behalf and can often help arrange coverage.
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Santa Monica, CA
2121 Santa Monica Blvd, Santa Monica, CA 90404
Arroyo Grande, CA
154 Traffic Way, Arroyo Grande, CA 93420
Common Questions
Is it normal to feel like you’re making up endometriosis symptoms?
Yes—this is incredibly common, and it usually happens because you’ve been living in a system where pelvic pain is often normalized, minimized, or explained away. When tests come back “normal,” or you’re told it’s stress/IBS/UTIs without a cohesive plan, it can start to feel like the problem must be you. Endometriosis symptoms can be wide-ranging and sometimes seem unrelated, which makes self-doubt even easier to fall into—especially if you’ve had years of mixed messages.
In our practice, one of the first goals is validation through clarity: we take your full story seriously, look for symptom patterns and flare timing, and evaluate for endometriosis along with common look-alike or coexisting conditions that can amplify pain (like pelvic floor dysfunction, central sensitization, GI imbalance, or vascular causes). Endometriosis can cause many symptoms, but it doesn’t explain everything—so we’re careful and specific about what fits, what doesn’t, and what to investigate next. If you’re stuck in the “maybe it’s nothing” loop, reach out to schedule a consultation so we can help make your symptoms clinically legible and build a real path forward.
Can you have endometriosis without pelvic pain?
Yes—endometriosis can be present even if you don’t have classic pelvic pain. Symptom severity doesn’t reliably match the amount, location, or “stage” of disease, and some people have minimal or no pain despite significant findings.
When pelvic pain isn’t the main feature, endometriosis may show up in other ways, such as infertility, heavy or abnormal bleeding patterns, pain with sex, bowel or bladder symptoms (especially if they fluctuate with your cycle), or persistent bloating and GI disruption that gets mislabeled as “just IBS.” Because endometriosis can involve different organs and can coexist with look-alike conditions, our evaluation focuses on your full symptom pattern, exam findings, and high-quality imaging when appropriate.
If you suspect endometriosis despite little or no pelvic pain, we can help you sort out whether endometriosis is likely, what else could be contributing, and whether a surgical diagnosis and strategic excision makes sense for your goals (pain relief, fertility, or both). You can explore our approach and reach out to schedule a consultation with our team when you’re ready.
When does fertility return after childbirth with endometriosis?
Fertility can return surprisingly soon after birth—even if you have endometriosis—because ovulation often happens before your first postpartum period. The biggest drivers of when you become fertile again are breastfeeding patterns, how quickly your cycles restart, and whether you’re using hormonal suppression postpartum (which can also be used to help keep endometriosis symptoms quieter).
With exclusive, frequent breastfeeding, many people have a longer stretch without ovulation, but this isn’t reliable contraception and fertility can still return earlier than expected. If your periods come back, that’s a strong sign your ovaries are active again—though you can ovulate before the first bleed. If you’re trying to conceive again or, just as importantly, trying to avoid an unplanned pregnancy while managing endometriosis symptoms, our team can help you map a postpartum plan that fits your goals and minimizes flares.
Should I be tested for endometritis after IVF failures?
Yes—endometritis (often chronic, low-grade inflammation of the uterine lining) can be worth evaluating after repeated IVF failures, especially when embryos appear good-quality, transfers are well-timed, and implantation or early pregnancy loss keeps happening. It’s not the only possible explanation, but it’s one of the “missed” contributors that can coexist with endometriosis, adenomyosis, fibroids, polyps, or immune/hormonal factors that affect the uterine environment.
The key is choosing a workup that’s targeted to your exact pattern—failed implantation vs recurrent miscarriage vs poor embryo development—because the testing pathway can differ. In our evaluation process, we zoom out and look for coexisting drivers that can be treated or optimized before you commit to another cycle, using a careful history, imaging interpreted with endometriosis/uterine expertise, and selective testing when the story fits.
If IVF hasn’t worked despite multiple attempts, reach out to our team so we can review your full fertility timeline and symptoms and decide whether endometritis testing makes sense as part of a broader, actionable plan.
Can endometriosis cause recurrent implantation failure in IVF?
Yes—endometriosis can be one contributing factor in recurrent implantation failure (RIF) for some IVF patients. Beyond pelvic anatomy, endometriosis can create an inflammatory environment and may alter how the uterine lining functions, including changes in endometrial receptivity signals that support embryo attachment and early development.
At the same time, RIF is rarely explained by a single diagnosis, and many people with endometriosis still have successful IVF outcomes—especially when endometriosis is the only identified fertility factor. If you’re experiencing repeated failed transfers, the key is a careful, coordinated evaluation of endometriosis biology and severity alongside other common drivers of RIF, so we’re not missing treatable contributors.
Our team can help you look at the whole picture—symptoms, imaging, prior IVF response, history of endometriomas or pelvic adhesions, and any signs of adenomyosis or uterine factors—then discuss whether excision surgery, timing, or other strategy adjustments may improve the chances of implantation in future cycles. If you’d like, reach out to schedule a consultation so we can map a plan tailored to your fertility goals and your timeline.
What tests are done after two miscarriages with endometriosis?
After two miscarriages, our goal is to look beyond a single “endo explanation” and map out all the factors that can affect implantation and early placental development. We start by reviewing your full history in detail (loss timing, symptoms, prior imaging, surgeries, cycle patterns, and any fertility treatments), because the pattern of your losses often guides what to test first. We typically include expertly interpreted pelvic imaging—often ultrasound and, when helpful, MRI—to look for endometriosis features (like endometriomas), adenomyosis, uterine shape issues, and other pelvic conditions that can coexist with endo.
Because endometriosis can overlap with immune, inflammatory, and hormonal drivers, we may also evaluate thyroid function and other endocrine factors, and consider autoimmune overlap when symptoms or history point that way. If your symptom picture suggests contributors outside the uterus and ovaries, we may broaden the workup to related conditions that can worsen inflammation or pelvic dysfunction, rather than stopping at a standard checklist. If you’d like, you can reach out to schedule a consultation so our team can tailor a miscarriage evaluation plan to your history and goals—and help you understand which findings are most actionable for your next steps.


