A 2026 review explored why endometriosis surgery doesn’t always lead to pregnancy, highlighting factors like recurrence, undetected lesions, and underlying biological processes that aren’t addressed by surgery.
Unexplained infertility
A 2026 study showed that women with unexplained infertility who didn’t get pregnant after IVF had a more diverse endometrial microbiome with fewer Lactobacillus bacteria, and metabolites produced by other bacteria may influence how the uterine lining functions during implantation.
A 2025 study introduces the term “oocyte and early embryo competence defects” to describe younger IVF patients who repeatedly have no transferable embryos due to low quality eggs, finding that about 13–23% had genetic changes.
A 2025 study of women with repeated IVF failure and unexplained infertility found that about 13% had mutations affecting egg or embryo development, mostly in the TUBB8 and PATL2 genes, suggesting that many “unexplained” cases may have underlying genetic causes.
Even when embryos are euploid and pass PGT-A, miscarriage can still happen. A new 2025 study suggests that genetic mutations too small to be seen by standard PGT-A may explain some of these losses.
A 2024 study combined studies involving unexplained infertility patients and endometriosis, finding that nearly half of them have the condition.
Laparoscopy is the gold standard for diagnosing endometriosis, but other non-surgical tests are showing potential. Here we’ll take a brief look at ReciptivaDx based on the BCL6 protein, the Endotest and DotEndo test based on a miRNA signature, the EMScore which is based on a gene expression signature, and imaging tests like ultrasound and MRI.
Researchers in 2023 provide evidence-based guidelines for managing patients with unexplained infertility, as prepared by ESHRE.
Researchers in a 2023 study combined the results of 74 studies to investigate what factors contribute to euploid live birth and miscarriage rates, identifying embryo quality, maternal age, specific diagnoses, repeat freeze/thaw, and other factors.
Researchers in a 2021 review examined how sperm and eggs can sometimes be genetically incompatible, based on a group of proteins called human leukocyte antigens (HLA), which may lead to implantation failure or embryo arrest when they’re mismatched.