Management of Thin EndometriumDr. R. Anandraj

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Contents

Importance

What?

Why?

Strategies?

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Importance

EM maturation is crucial↑ trends of e SET and vitrification; optimization of endometrium is paramount.

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Assessment of endometrium

Endometrial parametersThickness, Pattern, Volume, Sub endometrial doppler

Thickness >7 & <14 → favourable pregnancy outcome

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0.6 - 0.8% in ivf cycles despite no demonstrable causesMight result in failure of implantation

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Cancel cycle

G-CSFWatchful expectancy

Estradiol

If EM thin in OI?

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If thin in IVF?

? Pregnancy not achievable? Cycle cancellation? Freezing? Refrain from further ivf treatment

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Why thin?

Compromised response of deep basal layer

FibroidsAdenomyosisUt Surgeries

EndometritisPost surgicalAshermanTB

ClomipheneDevelopmental DES

Permanent damage

Resistance to E2 ↓ Blood flow ↑ Testosterone

Older >40Poor responder ↑ LH PCOS

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HormonesE2HCG priming+E2 Luteal GnRHa

VasodilatorsAspirinSildenafilL-Arginine

Vitamin E ± Pentoxyphylline SteroidsG-CSF

Hysteroscopy ± scratchingHeparin

Immunomodulators

Intralipid/IVIG

Autologous PRP

Management Options

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EM gas irrigationNMES

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Low dose Aspirin – Conflicting evidence

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Sildenafil

Start of cycle/Post OPU? Till?25mg QID vaginally/50mg orally

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Vitamin E ± Pentoxyphylline

G-CSF

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Conclusion

Thin unresponsive EM is an enigma!Various treatments tried empiricallyStudies have to be interpreted with

cautionE2, Aspirin, EM scratch….

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