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Management of Thin EndometriumDr. R. Anandraj
http://cimarindia.orghttps://facebook.com/cimarfertilitycentre/https://twitter.com/ItCimarhttps://plus.google.com/+CIMARFERTILITYCENTREKochi/abouthttps://youtube.com/channel/UCsz24WtmG4jvg6jfPFpUzswhttps://linkedin.com/in/cimar-fertility-centre-033b69120https://vimeo.com/cimarfertilitycentre
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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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