“Thin” endometrium

“Thin” endometrium is a relatively common condition in which insufficient thickness of the uterine lining interferes with embryo implantation and, consequently, reduces the success rates of IVF programs.

The endometrium, or the inner layer lining the uterine cavity, plays an important role in a woman’s reproductive function. The endometrium consists of two layers: the lower basal layer and the upper functional layer. While the basal layer does not change in response to hormonal fluctuations, the functional layer is directly dependent on hormonal status and is responsible for embryo implantation and subsequent development.

When the endometrial thickness is less than 7 mm at the time of embryo transfer, the effectiveness of the entire IVF program is significantly reduced.

Causes of Reduced Endometrial Thickness

Inflammatory processes: acute and chronic endometritis (chlamydial infection, gonorrhea, tuberculosis, viral infection of the endometrium);

Hormonal and endocrine disorders (deficiency of female sex hormones);

Endometriosis;

Traumatic intrauterine procedures (abortions, dilation and curettage of the uterine cavity);

Congenital causes — defects in endometrial hormone receptors.

Symptoms

Scanty, spotting menstrual bleeding;

Short menstrual periods;

Irregular menstruation;

Infertility.

Diagnosis

This condition is diagnosed using ultrasound monitoring on days 3, 7, 10, 12, and 14 of the menstrual cycle. Diagnostic hysteroscopy with endometrial biopsy is also recommended for all patients before and after treatment.

Treatment

Correction of a “thin” endometrium is a complex and lengthy process. Various treatment regimens involving medications that affect the endometrium may be used over several months:

Cyclic hormone therapy;

Prolonged estradiol therapy administered continuously for 14 to 82 days;

Use of granulocyte colony-stimulating factor (G-CSF);

Use of metabolic and vasoactive agents as adjunctive therapy to improve endometrial blood supply, including sildenafil, low-dose aspirin, and long-term dipyridamole therapy;

Endometrial “scratching” during a Pipelle biopsy or hysteroscopy.