Clinically, EMs_A patients exhibited elevated CA125 levels, increased uterosacral ligament tenderness, and reduced Day-3 high-quality embryo rates, which were consistent with the observed cellular phenotypes.<h4>Conclusion</h4>These findings suggest that exosomal LINC02701 may contribute to granulosa cell dysfunction through modulation of the GRP75-P53 axis and may be associated with impaired early embryo quality in active endometriosis, highlighting its potential as a candidate biomarker for EMs-associated infertility. Here, HSPA9 is linked to Infertility.