THIN UTERINE LINING

Endometrial lining is routinely measured using the vaginal ultrasound in IVF cycles and is expected to be of adequate thickness for embryo implantation. An endometrial thickness of 8 mm or greater is generally considered adequate thickness and less than 7 mm has been associated with lower pregnancy rates, with almost no pregnancies observed with a lining less than 5 mm.
 
Poor endometrial lining most commonly occurs in women with a history of unexplained recurrent IVF failures or early recurrent miscarriages and is usually attributable to the following factors:

• Endometritis: Chronic infection of the endometrial cells.
• Fibroids of the uterine wall (non-cancerous muscle tumors of the uterus).
• In-Utero exposure to the synthetic hormone called diethylstilbestrol (DES).
• Women using clomiphene citrate (Clomid, Serophene).
• Scar tissue of the endometrium (Intra-uterine adhesions or formerly known as Asherman’s syndrome).
• Distal tubal blockage (hydrosalpinx) and leakage of toxic fluid back into the uterus.

 
 
When thin endometrial lining is observed during an IVF cycle, additional estrogen in the form of vaginal suppositories may improve the overall endometrial thickness and outcome. Some investigators have used baby aspirin to improve the outcome, but results have been quite variable and most likely there is no benefit. Acupuncture and other relaxation techniques may be helpful in some cases, but large scale studies are needed to demonstrate a significant improvement with these treatment modalities. In some cases, the endometrial lining never reaches the acceptable thickness.
 
Sildenafil (Viagra) is a commonly used drug for erection problems in the male and has been shown to increase the penile blood flow. Investigators have used Viagra to increase the blood flow to the uterus with the hope of delivering more estrogen hormone to the uterine lining. Viagra vaginal suppositories can be used to achieve this goal in I