How to improve endometrial thickness before IVF

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In this article, we speak with Dr. Elena Santiago, a specialist in fertility at Vida Fertility in Madrid, about how to improve a thin endometrium before an embryo transfer.

As we will see below, if the endometrium is less than 6mm thick, achieving pregnancy will be a difficult task, and homeopathy will not be suitable for increasing its thickness. In these circumstances, at Vida Fertility, we recommend starting a hormonal treatment that includes estrogen and progesterone to stimulate endometrial growth.

What is the Endometrium?

The endometrium is the inner lining of the uterus (uterine cavity). This lining undergoes changes in appearance and thickness throughout the menstrual cycle, being very thin at the beginning of the cycle and thicker just before menstruation.

In fact, menstruation is the shedding of this lining to make way for a new endometrium and, therefore, a new cycle.

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Why is the endometrium so important in Assisted Reproduction?

When preparing a patient for embryo transfer, two aspects are crucial for the success of the treatment: the quality of the embryo and the endometrium. Without a suitable and receptive endometrium, achieving pregnancy can be more challenging.

The medical team must assess the endometrium’s ability to allow implantation and adjust endometrial preparation protocols according to each patient’s needs.

If the endometrium does not respond adequately to preparation, the transfer may be canceled.

What makes an ideal endometrium?

An ideal endometrium for embryo transfer has a “trilaminar” appearance and a thickness greater than 7mm.

In addition to these observable aspects in ultrasound, there are comprehensive studies of the endometrium that assess its receptivity, the presence of anatomical abnormalities, infections, and its immune response.

The ideal endometrium should also not present obstacles to implantation, such as diffuse adenomyosis, fibroids, adhesions, cysts, etc.

All these aspects of the endometrium should be investigated in cases of repeated implantation failures.

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Thin or Atrophic Endometrium: What to do if my endometrium doesn’t thicken?

Thin or atrophic endometria are endometria that do not reach the necessary thickness for embryonic implantation. In these cases, it is necessary to investigate the cause to improve these patients’ chances of pregnancy.

Causes of a Thin Endometrium:

Some possible causes include:

  • The presence of an infection in the endometrium. Endometrial infections are often painless and asymptomatic. Detection of an infection is done through endometrial biopsy, and antibiotic treatment can eliminate it.
  • Insufficient blood flow to the endometrium. An endometrium that does not receive enough blood flow may have difficulty thickening. In these cases, a protocol that improves blood circulation and increases vascularization can enhance the endometrial response.
  • Poor absorption of estrogen treatment. Endometrial preparation is based on estrogen administration. There are various formats for estrogen administration: oral, subcutaneous, or intradermal (patches). Therefore, it is necessary to find the right protocol and dosage for each patient, as each woman may respond differently.
  • Woman’s anatomy. In some women with smaller uteri, the endometrium may never reach the desired 7mm, and 6mm may be sufficient. Like with any organ in a woman’s body, everyone has a different size, and the endometrium can simply be smaller in certain cases. In these cases, if the endometrium has a trilaminar appearance and a thickness between 6 and 7mm, the transfer can proceed.

How to improve Thin Endometrial thickness: Endometrial Regeneration Solution.

The endometrial regeneration technique is relatively recent but has already shown very good results in endometria that are resistant to preparation or embryonic implantation.

This technique is based on blood plasma (obtained through the patient’s blood extraction), which is prepared to concentrate growth factors (PRGF). When applied to the endometrial wall, these growth factors help activate it and prepare it for implantation.

This blood plasma will be injected into the uterus three times (on separate days) during preparation and up to the embryo transfer.

At Vida Fertility, a fertility clinic in Spain, the endometrial regeneration technique with PRGF has helped many patients achieve pregnancy.

Need help improving the thickness of your thin endometrium? Contact our team of assisted reproduction specialists. We are here for you.

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