She walks into my clinic with hope and hurt in equal measure. “I had perfect embryos,” she says, almost in disbelief. “Good eggs, good sperm, the transfer went well. But it still didn’t work.”

And I ask gently, “Did anyone check your endometrial lining?”

A pause. A blank look. A slow shake of the head.

This is the story of thin endometrium — one of the most underdiagnosed, often ignored reasons for failed IVF cycles, even when everything else seems right.

Let’s talk about it in the way it matters. Not as a medical term, but as something that can quietly decide the outcome of your entire fertility journey.

The endometrium is the soft inner lining of your uterus — the place where the embryo attaches and begins its journey as a baby. Think of it as the bed where a seed must rest before it can grow. Now imagine trying to plant something in soil that’s too dry or too thin. It just won’t take root.

That’s what happens when your endometrial lining is too thin. Even the best embryo will have a hard time attaching, and the result is often heartbreak — a negative pregnancy test or an early miscarriage.

In most fertility cycles, we expect the lining to grow to at least 7 to 8 mm before transfer. But in some women, despite all the medications, it just refuses to grow. And when that happens, the answer isn’t more hormones. The answer is understanding why.

Sometimes it’s due to previous infections, like tuberculosis. Sometimes it’s the after-effect of surgical clean-ups (D&C). Sometimes, it's just poor blood flow or hormonal resistance. Whatever the reason, thin endometrium needs special care.

And yes — there are treatments. At our center, we use a combination of techniques based on what the body needs. For some, estrogen support is enough. Others benefit from PRP (Platelet Rich Plasma) — where growth factors from your own blood are used to stimulate the lining. In very tough cases, we even explore adjuvants or endometrial scratch methods. It may sound like science fiction. But it’s all real — and it’s giving real women real results.

And more than anything else, we give women time. Sometimes the body just needs a few cycles to respond. We don’t rush. We don’t pressure. We prepare. Because your womb deserves to be ready — not just open. If you’ve had failed IVF cycles and no one has explained the role of your uterine lining, ask. It might be the missing link. The one quiet factor that no one looked at — and the one gentle fix that changes everything.

Because in fertility, it’s not just about creating the best embryo. It’s about creating the best home for it too.