Hi friends,
This week, we've been thinking about the word unexplained.
It's one of the most common labels a fertility workup hands back, and one of the most misunderstood. In a meaningful share of cases, what may look unexplained is really a diagnosis that hasn't been made yet, often after years of dismissed symptoms, normalized pain, or a standard workup that wasn't built to catch it.
So this week we're digging into the conditions hiding in plain sight of a standard fertility evaluation: endometriosis, adenomyosis, a version of PMOS that's been mislabeled, and an earlier form of premature ovarian insufficiency. We're doing it now because, for the first time in over a decade, the major US and European guidelines are actually moving, and the math of how long patients have been waiting for them is staggering.
We hope you find this week’s focus helpful, and empowering.
Let’s dive in.
In this Issue We'll Cover...
Endometriosis and the 10-Year Wait
In February 2026, the American College of Obstetricians and Gynecologists did something it rarely does. It issued a brand-new clinical practice guideline whose opening pages essentially acknowledge that the field has been failing patients for a decade. The exact text: "Diagnostic delay is a significant issue, with people waiting between four and 11 years on average from the onset of symptoms to receipt of diagnosis." That's an ACOG sentence, not an advocacy one.
This week's longform maps why the diagnostic wait got so long for the four conditions hiding in most standard fertility workups (endometriosis, adenomyosis, mislabeled PMOS, and earlier-form POI), what the newest guidelines from ACOG, ESHRE, and NICE actually changed, and where the still-on-the-books 2012 ASRM opinion is leaving American patients in a gap their European counterparts have already left behind.
Different Takes on the Diagnostic Gap
The diagnostic wait for endometriosis, adenomyosis, and the conditions hiding behind "unexplained infertility" isn't just an emotional cost, it's a clinical one. It shapes fertility outcomes, the treatments that get offered, and the workups that get ordered. The conversation about that wait, and what should change about it, has been moving faster in 2026 than at any point in the last decade. Here are five pieces that help map where the field is now, and where it's headed:
Systematic Review Puts Real Numbers on the Endometriosis Wait A 2025 BJOG systematic review pooling studies from 2018 through 2023 finds median diagnostic delays of five to twelve years, the most current authoritative answer to "how long does it really take." Open access. READ ARTICLE HERE
Bindi Irwin and the Story That Brought Researchers Along NPR's 2023 piece on the Irwin family disclosure is one of the rare celebrity-health stories that bothered to interview scientists, including MIT bioengineer Linda Griffith, whose lab is reshaping how endometriosis is studied. READ ARTICLE HERE
Lena Dunham's Hysterectomy Essay, Still the Bar Eight Years Later The 2018 Vogue essay on nine surgeries and a hysterectomy at 31 remains the high-water mark of first-person writing on what a decade of medical dismissal does to a body. READ ARTICLE HERE
Padma Lakshmi on Why Silence Is a Structural Problem The Endometriosis Foundation of America co-founder's NBC News op-ed lays out why she turned a 23-year personal wait into a policy and education project, structural advocacy, not just disclosure. READ ARTICLE HERE
Inside How Specialists Actually Think About Adenomyosis BackTable OBGYN's clinician-to-clinician podcast on adenomyosis is unusually accessible for non-doctors, and revealing about how a workup actually changes when a specialist is on the case. READ ARTICLE HERE
When You Suspect Something’s Being Missed
Seven questions for the moments when your gut is telling you the test result isn't the whole story.
A practical companion to this week's longform article. We pulled together seven of the questions readers have asked us most often about pushing back at a fertility workup, with sourced answers covering everything from when to ask for an MRI to whether your old PMOS diagnosis still applies under the 2023 criteria.
If you enjoyed this issue of Path to Parenthood, be sure to share with anyone you know who is currently on a TTC journey ❤
