Optimizing implantation. Why does a thin endometrium (uterine lining) result in lower implantation?

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For successful implantation to occur an embryo needs a “receptive” uterine lining.  In a previous blogs, Katie Koss and Janet Chiarmonte have discussed the various pathologies that can prevent implantation and the three common techniques used to evaluate the uterine cavity.  In this blog, the importance of measuring endometrial (lining of the uterine cavity) thickness during cycle monitoring will be discussed.

The endometrium responds to estrogen by growth in its glands and the surrounding tissue (stroma).  This is reflected on ultrasound by an increase in thickness and formation of a triple-line endometrial pattern.   When ovulation occurs, or when progesterone is started, a “secretory” change occurs in the endometrium, which then becomes receptive for implantation.

What is “normal” endometrial thickness?

There is no definite cut-off level below which implantation will not occur.  The consensus seems to be >7 mm in cross-section, with a triple-line endometrial pattern.  An endometrial thickness <6 mm is associated with a lower rate of full-term pregnancy.  Other publications suggest that thickness >9 mm is important.

Slide1What are the causes of a “thin” endometrium?

  • Scar tissue inside the uterine cavity (intrauterine adhesions or Asherman’s syndrome) may result in a thin lining.
  • Other causes include medications such as clomiphene citrate, which can cause depletion of endometrial estrogen receptors.
  • Prolonged use of birth control pills will also result in a thin uterine lining.
  • In a large number of patients, there is no apparent cause for a thin endometrial lining.

Why does a thin endometrium result in lower implantation?

Several theories have been proposed to answer this very important question

  • Estrogen receptor abnormalities.  For the uterine lining to grow, estrogen has to bind with estrogen receptors.  If these receptors are abnormal, the lining will not grow
  • Oxygen tension theory.

Slide2In a recent publication (Fertil Steril 2011;96:519-521), Dr. Robert Casper from the University of Toronto, Canada offers an interesting mechanism by which a thin lining results in lower implantation. The uterine lining has two layers, a “functional” layer which gets shed with menstruation and a “basal” layer which persists.  The functional layer of the endometrium has plenty of small blood vessels (capillaries), in contrast to the larger spiral arteries in the basal layer.  With ovulation, there is constriction of the spiral arteries with reduced blood flow to the functional layer.  This results in reduced oxygen tension, which is good for embryo implantation.  In the endometrium, when the thickness measured by ultrasound is <7 mm, it is the functional layer that is thin or absent, and the implanting embryo would be much closer to the spiral arteries and the higher vascularity and oxygen concentrations of the basal endometrium. The high oxygen concentrations near the basal layer could be detrimental compared with the usual low oxygen tension of the surface endometrium.  Interesting!

In my next blog, we will discuss the various treatments that have been tried to correct a thin endometrial lining.










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101 Responses to Optimizing implantation. Why does a thin endometrium (uterine lining) result in lower implantation?

  1. Commenter says:

    I have been diagnosed with a thin endometrium lining. I had 2 miscarriages and 1 was an ectopic pregnancy. I have a 7 years old daughter and never had problems with my 1st pregnancy. What new treatment options do you have?

    • You need to be investigated for the thin lining. You should have a hysterosonogram or hysterosalpingogram to rule out scar tissue in the uterus. Please consult with a Board Certified Reproductive Endocrinologist to get more specific advise.
      Sincerely
      Dr V Karande

  2. Anonymous says:

    Jst got diagnosied with a thickend endometrium(19.1),free fluid in pod n my right ovary I enlargend..I am congused can u help me know what exactly I would b suffering from and how to get myself health again please

    • You may have just ovulated. We often see a cyst on the ovary (it is the corpus luteum — what’s left behind in the ovary after the egg is released) and free fluid behind the uterus (cul de sac).

      Another possibility is you may have an endometrial polyp. For that diagnosis to be confirmed, you need a hysterosonogram, hysterosalpingogram or a hysteroscopy.

      Please reconsult with your physician to get a more specific answer.
      Sincerely
      Dr V Karande

  3. Commenter says:

    My endometrium lining is sitting at around 4.5 on day 16. I am on 10mg Progynova and 2x 100mcg Estraderm Transdermal Patches every 3 days.
    Apparently I am not responding to the medication and that is why the endometrium isnt thickening up.

    I have a 10 year old daughter with no complications. We had a very successful round with IVF getting 5 frozen embryos but cannot do anything with them as my lining will not thicken up.
    Do you have any suggestions?

    • Please get specific advise from your physician.
      At InVia, we would add Estrace (estradiol) 2 mg vaginally twice daily for a week and reassess. The estrogen gets absorbed through the vaginal walls and directly reaches the uterine lining.

      Hope this helps.
      Sincerely
      Dr V Karande

  4. Commenter says:

    I have had two miscarriages in 2012, and have not been able to get pregnant in over a year. I have a thin uterine lining measuring at 4mm before ovulation, and 5mm right before my period. I have a high progesterone level (18) and didn’t respond to progesterone supplement. Can you recommend what other medications can thicken my lining? Also, would you recommend a HSG or hysteroscopy for me?

    • I am sorry about your miscarriages. Have you had a work up for the miscarriages? Some of the tests that may be useful are chromosomes (you + husband), immune labs (to rule out antiphospholipid antibody syndrome), cavity check (hysterosonogram, hysterosalpingogram or hysteroscopy) and hormones (FSH, LH, E2, TSH, fasting prolactin).
      A thin lining can be secondary to adhesions in the uterine cavity (which can occur after a D&C). Please have a cavity check (see above) to rule out adhesions.
      Please consult with a fertility specialist for more specific advice. We would welcome you as a patient at InVia.
      Sincerely
      Dr V Karande

  5. Commenter says:

    I was a gestational carrier in 2009 and had a great lining (10-12mm). After the baby was born I got on birth control. I am currently working on another surrogacy. We were cycling in July and August but my lining would not exceed 5.5mm. We decided to discontinue birth control to give my body a chance to regulate on it’s own before we proceed with our next FET.

    After stopping birth control I had 2 short anovulatory cycles. I am now on my 3rd cycle and I finally ovulated. Is this a sign that my lining may be cooperating again? Or should we wait a few more months?

    • To be able to answer this question, I need to understand why your lining was thin. Birth control pills usually do not affect lining thickness once the patient has stopped taking them. Have you had a cavity check to rule out intrauterine adhesions?
      I see no point in waiting a few more months.
      Perhaps your physician may want to do a “mock cycle” where you take the medications as if you were doing a real cycle and an endometrial biopsy is done 7 and 12 days after starting progesterone to see if the lining is “in phase”.
      Sincerely
      Dr V Karande

  6. Clomid? says:

    How long after stopping clomid does it take the endometrium to recover? Does Femara affect it at all?

  7. Lo says:

    How long does it normally take the endometrium to thicken after stopping birth control? My ultra sound showed my endometrium at 0.563 cm being on the pill for 7 years and im 37.

    • Hi Lo
      I am presuming you were taking regular (daily dose) birth control pills and not some of the long acting medications.
      The lining should “thicken” in the very first cycle after stopping the pills.
      The hormones in birth control pills are short acting (which is why you have to take them daily). When you stop the pill and get a menses, the lining that is affected by the birth control pills is shed.
      The “new” lining is bereft of any influence from the birth control pills and should “thicken” normally.
      Are your periods regular when you are off the pill? Your lining of 5.63 mm is normal for the early follicular phase of the cycle (days 3 – 10). As you approach ovulation, the lining will often get thicker and develop a tri-laminar (three-layer) pattern.
      I plan to write a blog about this in the near future.
      Hope this helps.
      Sincerely
      Dr V Karande

  8. Lo says:

    How long does it take the endometrium to thicken to normal mm after stopping birth control pills? mines is 5.6mm after being on birth control for 7 years.

  9. Clomid 50 mg says:

    Can clomid 50mg cause thinning of the endometrial lining I on my 2 nd cycle of clomid and my period is unusually light bleeding I have right fallopian blocked tube and been trying to conceive for 2.5 years im 35 yrs old but doctor would not do laparoscopy and wants me to take clomid 50mg for 6 months- scared about side effects though my progesterone level went up to 51 from8.5 on my 21 day cycle .. Suffering from severe menstrual cramps an getting worst as I get older.. Please help..

    • Yes, clomiphene citrate is an anti-estrogen and can cause thinning of the endometrial lining.
      Please discuss tubal catheterization as an option with your doctor.
      Clomiphene citrate along with timed intra-uterine inseminations has a higher pregnancy rate than with intercourse alone. Most of the pregnancies are in the first 3 – 4 cycles after which other options need to be discussed.
      Your menstrual cramps could be secondary to endometriosis. This by itself could be an indication for laparoscopy in your case.
      If your physician is not giving you satisfactory answers, please get a second opinion.
      We would welcome you as a patient at InVia.
      Sincerely
      Dr V Karande

  10. Commenter says:

    I had a D&C Suction 3 weeks ago. I am emotionally ready to start trying to conceive again, but I’m scared that my uterine lining is not thick enough to sustain a pregnancy. Is this an issue or should my uterine lining thickin back up in 3 weeks?

  11. Commenter says:

    Please advise recently got ultrasound scan report which shows Uterine linning of 2mm on day 11 of the menstrual cycle. I also completed clomid

    • I do not have enough information to give you specific advice.
      A 2 mm lining is something that needs further investigation.
      This is so especially if it is a persistent finding.
      Clomid does cause the endometrial thinning, but the effect is transient.
      You need to have a hysterosonogram, hysterosalpingogram or a hysteroscopy.
      Intrauterine adhesions need to be ruled out.
      Sincerely
      Dr V Karande

      • Commenter says:

        Hi, I am currently on my 4th round of Clomid. I just had my day 14 scan and my lining was only 4.5mm. I had a HCG shot the same day and they gave my Evorel patches to use, my question is- is it possible for the lining to thicken enough before implantaion in this short time between ovulation and implantation? I had a triple layer for the first time also. Thanks

        • Your lining was this at 4.5 mm.
          It could be due to the “antiestrogenic” effect of Clomid.
          It is reasonable to try giving you Evorel patches, but I doubt if they will make a difference.
          If this cycle is unsuccessful, you should discuss other options with your physician.
          These include the use of Letrazole, use of Tamoxifen or gonadotropin (FSH) injections or moving on to IVF.
          Sincerely
          Dr V Karande

          • Commenter says:

            Thank you for your reply :-) in your opinion will the triple layer make it possible even if it is this thin on day 14?

          • It is always possible.
            You currently should be waiting for your pregnancy test result.
            I do hope you beat the odds.
            Good luck!
            Sincerely
            Dr V Karande

  12. Commenter says:

    i had embryo transfer 7days ago on 17/05 on progynova endometrium was 14mm and am still on progynova 2mg twice daily is that safe.
    Concern.

    • We do not use estradiol valerate at InVia. We prefer to use Estrace (17 beta estradiol).
      Estradiol valerate has been used by other IVF centers and its use is believed to be safe.
      Sincerely
      Dr V Karande

  13. Bianca says:

    I have not had a period for 15 weeks and have experinced major pregnancy symptoms such a nausea, fatigue, headaches, dizziness, mood swings, weight loss from the nausea now weight gain and extreme bloating, gerd, sweating, sensitivity to smells, higher temp, breast discharge. In April I went to the ER for pelvic pain on the left side but they found a small cyst on my right ovary and a lining of 2mm. I have taken many pregnancy tests (blood,hpt) all negative. I went on provera 10mg for 5 days and never got a period. Symptoms are still there. Could a 2mm lining cause me to not have my period and feel sick like this?

    • Your thin lining may be due to low estrogen levels.
      That could also be the reason why you did not withdraw with Provera.
      I do not know your age, but it is possible you may be menopausal.
      You need to see an Ob/Gyn physician for further evaluation.
      In terms of hormones; getting a FSH/LH/estradiol level along with AMH, TSH and fasting prolactin may help with diagnosis in your case.
      Sincerely
      Dr V Karande

  14. Commenter says:

    I was in the process to be a gs and my linning got up to a 7 and then they increased the dose of estrogen. I would go back in a week later and my linning would drop to 5.77 as well as my blood levels dropping, do you know why my body isn’t absorbing the medicine and decreasing? I was oral, vaginal, and patches

    • I am presuming by “gs” you mean “gestational surrogate”.
      You need a hysterosonogram, hysterosalpingogram or a hysteroscopy to further evaluate your cavity.
      There are several protocols that are used to get the uterine lining ready.
      Perhaps trying again with a different set of medications will be the way to go.
      Another option would be to do a “natural cycle” frozen embryo transfer.
      Hope this helps.
      Sincerely
      Dr V Karande

  15. Anonymous says:

    I have PCOS. On Follistim 75. Today is day 7 of shots. I went in on Thursday for US. Had 7 follicles. Biggest was 9.0. So I go back to RE tmw morning. Should I be starting my ganerlix tonight? Paperwork said after 7 days of shots. But it’s to prevent O. I might not even have a follicle big enough. I’ll ask Dr tmw but that isn’t helping me today.

    • We usually start Ganirelix when the lead follicles are 12 – 13 mm or the E2 level is > 250 – 300 pg/mL.
      You seem to be doing alright and not quite ready for the Ganirelix.
      Hope this helps
      Sincerely
      Dr V Karande

  16. Commenter says:

    Hi
    I have a thin lining, fertility clinic tried Viagra pesseries ,double estrogen patches plus Gonal F injections for first 15/16 days then trigger. I ended up overstimulated with 11 large folicles and a lining of just 7.5mm on my own without medication I reach about 4-5mm approx 3-4 days before ovulation.
    Apart from natural methods not sure what else to try. I ovulate on my own this month I have one large folkie on each ovary largest 20mm, post ovulation progesterone is always good. I’ve also just stated metformin as the suspect I has pcos due to previous history of cysts. Thanks

    • We generally consider a lining > 6 mm to be acceptable.
      You seem to have a lining that has reached 7.5 mm and I am not sure why you did not get pregnant.
      I do not have all your details and am not able to give specific advice as part of a blog.
      There is no harm in your getting a formal second opinion.
      We would welcome you as a patient at InVia.
      Sincerely
      Dr V Karande

  17. Anonymous says:

    I am 31 and got pregnant on my first ivf cycle but sadly miscarried at 5 weeks. My lining was 6.5 at transfer. Is my thin lining likely to be the cause of my miscarriage? We had a very good quality embryo put back. I don’t understand how the embryo would implant in the first place if the lining was the problem

    • I am sorry you have miscarried.
      The commonest reason for miscarriage is that the embryo was chromosomal abnormal.
      As far as endometrial thickness is concerned, we use a cut off of 6 mm at InVia.
      I therefore think your lining was probably okay.
      Please request a cavity check — hysterosonogram or HSG.
      Please try again and I do hope you have a positive outcome.
      Here is a link on why IVF fails
      http://www.inviafertility.com/infertility/draniruddhamalpani/why-did-my-ivf-cycle-fail/
      Sincerely
      Dr V Karande

      • Commenter says:

        Good day. I am on CD 18 today. I took synthetic progesterone for 14 days, had my menses, took Clomid 50mg CD3-7 and went for follicular tracking on CD13 and CD16. On CD16 two follicles of about 1cm each showed on the ultrasound, but the dr said they were about half the size they should be for ovulation to take place. My endo lining was 0.27cm. I am now using estrogen cream to thicken the lining. My question: Is there still hope to become pregnant this cycle? And if not, will all these induce a natural period or is it more likely that I will have to take synthetic progesterone again? (Note: I have a history of endometriosis and have PCOS. I have been off birth control since January this year and have not had a natural period since. I also have a hormonal imbalance. I am taking Glucophage for that. I am slim and fit.)

        • I generally avoid giving specific advice as part of a blog post.
          You have PCOS and are on metformin.
          Your follicles need to show interval growth.
          If there is no increase in size over the next few days, you amy have to consider other options.
          I am delighted you are “slim and fit”.
          Here is a link you may find to be useful
          http://www.inviafertility.com/infertility/drvkarande/when-clomiphene-citrate-fails-what-next/
          Sincerely
          Dr V Karande

          • Commenter says:

            Thank you. I will have a look at the link.
            (I merely mentioned I’m slim and fit to convey that that is not where the problem lies. My problems are not due to my weight/lifestyle.) I’m scheduled for a second round of Clomid if this cycle failed. Hopefully I do not have to resort to more severe interventions.
            Kind regards.

  18. Commenter says:

    Good day. I am on CD 18 today. I took synthetic progesterone for 14 days, had my menses, took Clomid 50mg CD3-7 and went for follicular tracking on CD13 and CD16. On CD16 two follicles of about 1cm each showed on the ultrasound, but the dr said they were about half the size they should be for ovulation to take place. My endo lining was 0.27cm. I am now using estrogen cream to thicken the lining. My question: Is there still hope to become pregnant this cycle? And if not, will all these induce a natural period or is it more likely that I will have to take synthetic progesterone again? (Note: I have a history of endometriosis and have PCOS. I have been off birth control since January this year and have not had a natural period since. I also have a hormonal imbalance. I am taking Glucophage for that. I am slim and fit.)

  19. Commenter says:

    Hi

    I am 35 and have a 2 year old son. We fell pregnant with him on our first attempt at conceiving. We fell pregnant again on our first attempt at conceiving our second child, however this pregnancy was diagnosed with Trisomy 18 and we made the painful decision to terminate the pregnancy at 14 weeks via D&C in January this year.

    We have been trying to conceive again immediately since, however have been unsuccessful which surprised us as we fell pregnant so quickly with our first two pregnancies. I have had some initial tests completed to see if there are any factors prohibiting conception again as I am worried the D&C has damaged my reproductive system. I had a vaginal ultrasound scan performed on day 10 of my cycle and the technician commented that my lining was quite thin for day 10 and the largest egg follicle was only 11mm and therefore she expected that I would ovulate a little later this month than day 14. However, I’ve been conducting the at home ovulation tests daily and got a positive on day 14 anyway. Could I not be falling pregnant due to my lining not being thin enough to support implantation? Would my lining grow sufficiently by the time implantation is due? She didn’t see any issues from the scan otherwise and said everything looked normal. Could a vaginal ultrasound determine if there are and adhesions in my uterus following a D&C?

    Your advise greatly appreciated.

    Regards

    Janine

    • Hi Janine
      I am so sorry to hear about your having to terminate the abnormal pregnancy.
      It can be an emotionally challenging situation.
      My suggestion to you is to see a Board Certified REI.
      You need a hysterosonogram or hysterosalpingogram to evaluate the uterine cavity.
      You should also get your baseline hormones checked and your husband a semen analysis.
      Ovulation induction with timed intrauterine insemination would be a reasonable first step if the tests are all normal.
      Please avoid getting medical info from ultrasound technicians. They are NOT qualified to give medical advice.
      We would welcome you as a patient at InVia.
      Sincerely
      Dr V Karande

      • Commenter says:

        hi docter.
        i am 23 yrs old married. female.i have had irregular periods from past few years.. in 2013 i didnt got my periods whole year. and now finally i decided to go to the obgyn she tested my blood levels. FSH,LS,ESTRADOL and also thyroid hormones. all came out to be normal. she induced my periods with yasmin tablets. and on the 3rd day of bleeding she did the tests. all blood levels were normal. and even she did blood tests without periods even then all hormones were normal.. my ultrasound report is a bit abnormal. may be
        anteverted uterus measures 5.5×2.9×3.8 cm homogenous echotexture.
        endotorium thickness 4.8 mm
        rt ovary measures 1.4×0.7×1.3 cm (volume o.8ml)
        lt ovary measures 1.2×1.ox1.3 cm (vloume 0.9ml)
        both ovaries with tiny follicle.
        there is no obvious adnexal mass noted.
        there is no fluid in POD seen.

        when she did my ultrasound she was soo worried and told me that you ovaries are not working.. but she waiting for my periods which were induced mu yasmin tablets then she waited blood tests and everything turned out normal …
        even she told me that ovulation has occured in this period. by looking at the estrogen levels..
        my questions here is i soo want to get pregnant this ultrasound of pelvic was done at the 4 or 5th day of period is the utrine lining according to that ok ??? 4.8mm?
        my doc now gave me progyluton to regulate my periods and also she prescribed clomid 100 mg for 5 days only when from the sec day of period… all i want to know is it safe ?? if lining is already thin will clomid not make the situation more worse?i dont know the normal size of my lining means when not menstruating… can i get pregnant and end up with misscarriage ?? i have to take progyluton for 21 days today was my day 1 what else can i take to thicken the uterine lining for successful pregnancy ???your concern will be highly appreciated .
        thanks

        • Commenter says:

          and yes to give more info i have always beeen on junkfoood … never ate healthy foood from yrs now … just from this june when i really got worries about my health i said no to junk and started taking vitamins and herbs. which for now i will stop taking them becoz they have interaction with clomid. can my lifestyle be the reason behind misssing periods??? if i again i got my periods with progyluton will my uterine lining be thick ?? doc plz tell me possible ways to thicken the uterine lining… i live in UAE and i am traveling to my country ,,,,, i asked my doc to treat the uterine lining but she said that you wont be here and i cannot prescribbe you anything .. like this.. so she only gave me progyluton and clomid 100 mg … also i want to know that clomid can effect utrine lining if taken more than 3,4 months orr even if taken for 5 days ?? plz reply me sir i am really worried plz go through my previous post and let me know what could be the possible condtion.

        • Your ovaries are small. At your age we like the ovarian volume to be more than 3 – 5 cc.
          If your hormone levels are all normal, you do not have premature ovarian failure.
          Ovulation induction with clomiphene citrate is a reasonable first step.
          With rising estrogen levels, your uterine lining should get thicker.
          I agree with your doctors recommendation.
          Sincerely
          Dr V Karande

      • Commenter says:

        Thank you for your speedy reply. You are very kind to provide guidance online.
        Best Regards
        Janine

    • I am presuming you do not have an uterus and wish to have a “transplant”.
      Currently we do not know how to transplant an uterus.
      Hopefully, the technology will be developed in the next few years.
      Sincerely
      Dr V Karande

  20. Commenter says:

    in the vaginal ultrasound, the doctor says the uterus view is not proper(not like three layered normal view)…. she has suggested progynove 2mg for this problem…. i’m still not getting what is the problem exactly… plz tell me will i get concieved and my husband sperm count is 70 millions/ml but motility is only 36%…. plz tell me that who is having exactly problem… plz i am waiting for my first pregnancy……

  21. Miracle says:

    Sir I’m 381/2yrs old I had miscarriage in 2012 then later discovered l had Asherman syndrome, had an operation in Dec. 2012, got pregnant immediately in Jan. 2013 lost the pregnancy again due to thin endometrium.(4.5mm), had another operation in Dec. 2013, because the scar was severe, since then I’ve been trying to get pregnant but no luck, I also find out one of my tube is blocked so. I’ve been on chlomifen and progynova mite with IUI since about 3 months now but still no pregnancy, this month my Dr put me on Gonal F 300IE, i had one dominant follicle at 18mm, endometrium at 6.5mm on day 12, then on day 13 had pregnyl 5000 shot for to trigger the ovulation on day 14 had IUI then I was asked to use Utrogestan suppositories (200mg 3x daily) and aspirin (1 daily ) till 17 days after the insermination. Please Dr what is my chance of becoming pregnant this month,and also can the Asherman syndrome still have effect on my endometrium even after the operation? Pls your pls your quick reply will be appreciated. Thanks.

    • The pregnancy rate with FSH/IUI is about 15% per cycle.
      If the scar tissue has been removed, you should do well.
      Good luck!
      Sincerely
      Dr V Karande

      • Commenter says:

        Hello Dr. Karande, I need your advice.
        I have had regular period but no success with pregnancy. My doctor put me on Clomiphene (Siphene 100) for this cycle. On day 10, the endometrium thickness is 3 mm, based on which my doctor has suggested me to go for IUI and take the injection (Recagon) for five days.
        You blogs are quite informative and I need you confirmation on following queries: Is it usually recommended to go for IUI on first trial with clomiphene with endometrial thickness of 3mm as the only indication? Should I be going through 2-3 more cycle of clomiphene as suggested in one of your blogs?
        I am 30 years old.

        • Commenter says:

          I have Turners syndrome and have an extremely frustrating problem with my endometrium lining. I have had 2 cycles of IVF and both times my endometrium achieved a thickness of around 7mm but lots of fluid built up. The first time my doctor built me up for 3 months with elleste duet 2mg then a gradual buildup to 6mg on cycle month. Quite a bit of fluid built up but mostly gone by transfer day. It was an unsuccessful cycle but we mostly put this down to the fact that our donor didn’t respond very well to the stimulation and only 2 very poor qual day 3 embryos were transferred

          After this we have started another cycle with another clinic. Much beter embryo results with 2 blastocysts transferred and 6 excellent blasts in the freezer. However, no luck with the first fresh cycle despite 2 perfect embryos transferred. This clinic treated me very aggressively with 8mg a day progynova orally and 8mg vaginally. By egg collection day lots of fluid which they aspirated but it returned after a couple of days. They treated me with A growth stimulating factor and then rescanned on transfer day. There was still a small amount of fluid but it was decided to transfer anyway.

          I am desperate to make this work and feel so frustrated that I have so many perfect embryos but can’t make them a good enough home. Nobody seems to be able to give me a straight answer about how to handle my endometrium situation. Is there anything that can be done? What is the ideal treatment regime I should be aiming for? Or is it just beyond hope? If I am chasing an unreachable dream I would rather know

          Any of your input would be greatly appreciated, many thanks

          • With your diagnosis of Turner syndrome, I do hope you have seen a cardiologist and your aorta has been checked for abnormality. There is a small chance of serious complications (including death) if there are structural problems with the aorta in patients with Turner’s syndrome. There are publications suggesting patients with Turner’s syndrome NOT get pregnant because of this risk.
            My suggestion is you have a HSG to rule out hydrosalpinx. If your tubes are dilated, they need to be removed prior to your next attempt.
            Otherwise, please try again and hope for the best.
            Sincerely
            Dr V Karande

  22. Commenter says:

    I have Turners syndrome and have an extremely frustrating problem with my endometrium lining. I have had 2 cycles of IVF and both times my endometrium achieved a thickness of around 7mm but lots of fluid built up. The first time my doctor built me up for 3 months with elleste duet 2mg then a gradual buildup to 6mg on cycle month. Quite a bit of fluid built up but mostly gone by transfer day. It was an unsuccessful cycle but we mostly put this down to the fact that our donor didn’t respond very well to the stimulation and only 2 very poor qual day 3 embryos were transferred

    After this we have started another cycle with another clinic. Much beter embryo results with 2 blastocysts transferred and 6 excellent blasts in the freezer. However, no luck with the first fresh cycle despite 2 perfect embryos transferred. This clinic treated me very aggressively with 8mg a day progynova orally and 8mg vaginally. By egg collection day lots of fluid which they aspirated but it returned after a couple of days. They treated me with A growth stimulating factor and then rescanned on transfer day. There was still a small amount of fluid but it was decided to transfer anyway.

    I am desperate to make this work and feel so frustrated that I have so many perfect embryos but can’t make them a good enough home. Nobody seems to be able to give me a straight answer about how to handle my endometrium situation. Is there anything that can be done? What is the ideal treatment regime I should be aiming for? Or is it just beyond hope? If I am chasing an unreachable dream I would rather know

    Any of your input would be greatly appreciated, many thanks

    • Commenter says:

      Thanks very much for your reply. Thanks for your concern and (unlike some doctors) having the good sense to discuss the cardiac issues. I have indeed had scans and have a normal tricuspid valve and no other abnormalities. I am aware that there is still a small risk involved with pregnancy

      Can I just make one small further enquiry. I had an oophrectomy as a teenager as my particular turners karyotype carries a risk of ovarian malignancy. Does this rule out the hydrosalpnyx or could they have left my uterine tubes in place?
      Thanks

      • They usually do not remove the tubes when they remove the ovaries.
        You may want to check the operation note from your surgery to confirm this.
        Sincerely
        Dr V Karande

        • Anonymous says:

          Sir , i am done taking progyluton for 21 days now. I want to know that after how manydays periods must come …??? Today is 3rd day after stopping tab but no periods … Approx how many days it could take periods to come . Thanks

        • Anonymous says:

          Sir , i want to know that after how many days i must get my periods after stopping progyluton?? Today is my 3rd day after stopping progyluton but no periods … How many days i must wait ? For periods to come ?

        • Commenter says:

          sir, i want to know that after taking progyluton how many days should i get my periodss??????? i have been taking progyluton for 21 days today is my 3rd day after stopping it but no periods :( how many days it could normally take to get periods?? after progyluton .. somewhere i read 3 to 7 days … kindly let me know …. i wrote you before also.. i have no peremature ovarian failure , no pcos, all hormones are normal … but have irregular periods… doc told me to take progluton and then when periods come i have to take clomid…. i am worried that its the 3rd day and no periods :( ….. your reply is awaited … thank you so much for your concern .. GOD bless !!

  23. Commenter says:

    My husband and I have been trying to conceive for ~2 years. Found out that both tubes were blocked. Had a dual fallopian tube recanalization. Both tubes were open. Tried 3 rounds of Clomid, but no pregnancy and it thinned my lining ~4 MM. Had another HSG done and the left tube is still open. Currently on my first round of Letrozole. My vaginal ultrasound, showed I ovulated on my own on my left side (open tube) and didn’t need the trigger shot. It also showed that I had a thin lining (reason I got off clomid). Currently, taking 2 MG of estradiol 2x/day, just started yesterday. What’s the chance of implantation, what should I do in addition to estradiol to make sure it’s thick enough for implantation? Baby asprin?

  24. Eager to learn says:

    Dear Sir,

    My husband and I are eager to conceive. I had amenorrhea for 5 years with Mirena IUD and was on OC for 7 years prior. My mother struggled with secondary amenorrhea as well. My IUD was removed in March and I had 5 days immediately after of bleeding and then a month later one day of bleeding in April. Since then I have had nothing.

    I am a competitive runner, but body fat of 24% and BMI of 22 and stable. I have drastically cut back on running from 60 miles to 30 miles a week this month.

    I saw a fertility specialist and had multiple hormone levels drawn. My FSH and estrogen ( E2) were low (Estrogen undetectable). I failed a progesterone challenge, so repeat labs were done and my E2 was 9. US showed endometrial lining of 4.3 mm (2.5 weeks after completing progesterone). The NP had me start Femara anyway.

    My question is, should I be on estrogen supplementation (oral or vaginal)? Is my endometrial lining compatible with menses at the end of this cycle? Is estrogen supplementation compatible with fertility?

    The NP dismissed my concerns about low estrogen saying I just needed to keep repeating Femara cycles and get more frequent US and blood tests. How can Femara work with estrogen so low?
    Thanks.

    • Good question.
      Based on your history and low gonadotropin + estradiol levels you probably have hypothalamic amenorrhea.
      In this situation, oral drugs like clomiphene citrate, letrozole or tamoxifen usually are not effective.
      A better option with be ovulation induction with hMG (Menopur). Your lining should respond as the estradiol levels rise with the ovarian stimulation.
      The pregnancy rates are excellent especially if one starts with a low dose and gradually increase the dose to get a mono-follicular response.
      I am presuming your tubes are open, your other hormones (TSH, prolactin) are normal and your husband has a normal semen analysis.
      Please consult with a Board Certified REI for a second opinion.
      We would welcome you as a patient at InVia.
      Sincerely
      Dr V Karande

      • Commenter says:

        I have been trying to conceive for 8 years my doc says a have a thin uterus lining so he gave the medicine that makes my BP to go high I need your help.
        REGINAH FRO BOTSWANA

  25. Anonymous says:

    Hi dr
    I am 28 years old and have been married for 5 years and trying to conceive for 4 years when my husband was diagnosed for non-obsrtuctive azoospermia. We had 2 failed ivf with beautiful blastocysts. Then i had several tests that showed high thrombotic risk ( mthfr-and homozygous for c- ?). I had a celioscopy and hysteroscopy 2 months before the next cycle which was In june 2013 at a different fertility center. My husband was on gonal f 150×2 a week and diclair 5000×3 a week for several months before that cycle. I had 14 eggs but i had transferred 4 embryos graded (A and A-) 2 dpo and my endometrium was 10mm. I was on cyclogest 400×2 – cycloproginova (only white ones)x2- deacapeptyl each second day- and lovenox 0.4 .I fell pregnant but it was an ectopic pregnancy had a rupture and lost my left tube. I had an ultrasound to confirm it and my endometrium was only 6.5 mm!!!! The dr did a laparoscopy to remove the tube without curtage.
    Again i had a cycle around Christmas with same protocole, but i was negative.
    On march i had my 5th cycle but this time at another center and the dr said that no need for my husband to take any medication. On the day of retrieval i had 14 eggs but tesa showed no sperm

  26. Dawn says:

    Hello, I got pregnant with my son at 42 after only two mos of trying. We have now started trying again the past 5 mos and I am 44. I was on the mini pill for about a year due to breastfeeding. I’ve noticed my periods are much lighter than before. Is there anything I can do naturally to help? Am I likely producing less estrogen?

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  28. Commenter says:

    HI Sir, Recently I went to doctor she did ultra sound scanning the endometrium thickness measures 9.2mm on 2nd day of my periods, this is the constant thickness since 3 months, doctor wants to prescribe clomid in order to conceive, but she says 9.2mm is too thick to conceive, and she did endometrial biopsy which came normal, now she is suggesting to go for D&C, is 9.2mm abnormal? is it too thick to conceive how much normal thickness measures? can i conceive with uterine lining 9.2mm thickness?

  29. Commenter says:

    sir
    Iam 24 year old I got marriage. it is for 18 monthe I tried to get prignant but I couldnt. when I Was at 10th follicular stage after finished regular menstrual cycle I visit my Doctor, I did ultrasound the endometrium thickness is 3.5 mm , each ovary volume (22-23)each side contain multiple smoll size follicules (6-7) sign of PCOS .she wrote QuNatal(11 vitamin&12mineral) and allylstirenol treatment.
    what is your suggestion for me? am I have PCOS? What is your treatment for me?>
    best regard

  30. Commenter says:

    Ever since the return of my cycle after having my son and breastfeeding for 1 year, my cycle has been significantly different than before conceiving (longer cycles ~30 days, heavier bleeding with lots of red blood and hardly no tissue, and ovulating very late in cycle ~day 20 resulting in short luteal phase). I had all my hormones tested and my estrodial came back as low 7.5 on day 2 (progesterone was normal .2 on day 2, and 11.4 on day 23). We have been trying to conceive since my cycle returned 7 cycles with no luck. I am wondering what I should be doing to increase my estrogen and if there is a connection between low estrodial and a thin uterus? Is this just a result of breastfeeding for 1 year and will everything most likely bounce back after a while or is it a good idea to see a reproductive specialist? I am 28.5 yo with 1 successful pregnancy.

    • I do not know how long it has been since you stopped breast feeding.
      Have you stopped completely?
      Is your prolactin level normal?
      What about TSH, FSH, LH , E2 and AMH?
      It may indeed be a good idea for you to see reproductive specialist.
      We would welcome you as a patient at InVia.
      Sincerely
      Dr V Karande

      • Commenter says:

        I stopped breastfeeding completely 6 months ago. Prolactin level was 2.8 on day 2.
        TSH- 1.620
        FSH (day 2)- 6.8

        I have never had LH, E2, or AMH tested through a lab. LH surges every month are detected through OPKs.

        I am wondering what I should be doing to increase my estrogen/prolactin and if there is a connection between low estrodial and a thin uterus? Is this just a result of breastfeeding for 1 year and will everything most likely bounce back after a while or is it a good idea to see a reproductive specialist?

        • Most pediatricians will agree that breast feeding is usually a great idea.
          Things will most likely bounce back to normal.
          Please make sure you have stopped breast feeding COMPLETELY!
          I have no idea why you are checking only your E2 and lining. It would be useful to get a complete evaluation of your hormonal status.
          A thin lining can be due to scar tissue in the uterus. Please have the cavity evaluated with a hysterosalpingogram or hysterosonogram.
          If you are getting regular periods, your E2 level IS rising.
          If you are NOT getting periods, please consult with a Board Certified RE.
          We would welcome you as a patient at InVia.
          Sincerely
          Dr V Karande

  31. Commenter says:

    Hello I am a gestational carrier that carried twins from a semi natural cycle in 2011 and we are doing a semi natural cycle again. I was on birth control for almost 6 weeks, took my last pill October 2, started period on the 3rd, and had my baseline appointment on the 6th. At that appointment I had a thick lining of 10.74 with fluid and a clot. My period stopped on the 7th and I went back today and my lining was 1.2 with 4mm of fluid present Largest follicle was a 8 .Labs are not back yet. Transfer window is the 25-30. The plan is to trigger with ovidrel then transfer 7 days later. Do I still have hope? Any ways to get the fluid to resolve? Will it resolve on its own? Do we still have time?

  32. Miracle says:

    Hello Dr, I’ve had 2 (IUI) that failed, so we decided to do (ICSI). Today is my day 9 of stimulation ( day 11 of my circle) with menopur, I went for scan today and have 6-7 follicle altogether at 18, 16, 15,14mm. Endometrium 5.5mm. My question is. Is it possible for the endometrium to be more thicker before transfer, and with 6-7 follicles is there any chance of retrieving enough eggs for fertilization? Thanks.

  33. Miracle says:

    I will be 39 in dec. I’m currently going through ivf, I’ve done 3 (IUI) in which I had BFP in the 1st one that later resulted in m/c at 8wks when I was 36yrs 3 month old. Later discovered that I had asherman’s syndrome (intrauterine adhesions/scarring) due to missed miscarried. I had an operation concerning this and immediately got pregnant one month later in feb. 2013 m/c due to thin endometrium 4mm. Since then I’ve been Trying with 2 other (IUI) but no success. Now I’m undergoing my 1st ifv. My FSH is 8 and I was given 300UI with orgalutran from day 5 of stimulation in which we retrieved 9 eggs, 7 matured all fertilized and all have 8 cell at day 3 of retrieval with grade 1 embryo, the embryologist told told me to do the day 5 transfer due to the growing of the cells. I’m ok with whatever they ask of me but my problem is my endometrium. My endometrium at the day of trigger shot was 8mm. So this is my question 1. Is it possible to get more blastocyst from day 5 due to my age? 2. Is it advisable to do the transfer this cycle due to my endometrium 8mm. 3. If I eventually do the transfer at day 5 with good blastocyst, how many should I transfer and what is the percentage of me getting pregnant due to my age? Thanks in advance for replying me.

  34. Anonymous says:

    I measured 7.7m uterine lining on day 10. Planning a natural fet cycle. Is this lining adequate? Will it grow more in time for embryo transfer?

    • Your comment seem sot be incomplete.
      What is your question?
      Could you please send it again?
      Sincerely
      Dr V Karande

      • Commenter says:

        Dr. Karande
        I am 36 years old,,, I was due for my period on 10/25/2014 I had sex on the 10/22/2014. And on the 10/24/2014 I spotted very light and light red… I spotted for a few days,,, I did a pregnacy test came back, Neg. I went to my OBGYN. 11/12/2014 The pregnacy test they did also neg. She did a papsmear everything fine send me for blood work and ultra sound which were perform on 11/13/2014. The ultra sound tech told me i had a thick layer like ready for menstrual then ask me if I was trying to conceive,, I said yes,,, she also told me I had a 1 inch cyst I ask what it was she said that it could be ovulation,,, I haven’t got my period still,,, also on 11/15/2014 I had a clear mucussy,,discharge,,, I am still waiting for results,,, am very anxious… Please help is the cyst she saw actually a baby to be??? Today I have been having alot of diarrhea very watery,,, i have been experiencing tender breast,, discharge of my breast when squeeze,,, nausea, no vomitting, sensittive to smell, bloating, pain on the left side lower abdomine, Dr. please help a my pregnant????
        Sincerly Beba

  35. Commenter says:

    sir, my endometrium thickness after 7dyas of my period was 5mm, before that period i took I pill. my doctor said there is less chances for you to get pregnant due to thin endometrium thickness, but i missed the period in the next month and now i m 14 weeks pregnent, i consulted other doctor now but im not informed her about this issue. sir now shall i tell my problem to my new doctor, i had already done with 2 UCG’s one is Dating Scan and another is NT Scan, Doctor said everything is normal. sir but i have a doubt shall i give birth to my baby. sir i discuss this with my doctor, sir please suggest me. sir please solve my doubt can i give birth to my baby or it will get aborted.

    • Congratulations on achieving a pregnancy!
      I am glad you have had ultrasound that confirm the baby is normal.
      Please discuss other tests with your doctor. These include a quad test and blood tests for fetal genetic screening.
      The chances of miscarriage after 14 weeks are less than 3%.
      Good luck!
      Sincerely
      Dr V Karande

About Dr. Vishvanath Karande

Dr. Karande is Board Certified in the specialty of Obstetrics and Gynecology as well as the subspecialty of Reproductive Endocrinology and Infertility. He is a Fellow of the American College of Obstetricians and Gynecologists and Member of the American Society for Reproductive Medicine.

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