Thin endometrial lining during frozen embryo cycles: a case-control study of risk factors and natural history

Objective: To identify predictors of thin endometrial lining in the first frozen embryo transfer cycles and to characterize the natural history of this condition over subsequent cycles. Design: Retrospective case-control study Conclusions: This study shows that prognosis after a diagnosis of thin endometrial lining is favorable. Lower weight and thinner fresh cycle lining are predictors of thin endometrial lining in FET cycles. Most importantly, women with a diagnosis of thin endometrial lining have similar live birth rates as those with adequate endometrial lining, although their time to achieve live birth is slightly longer

Thin endometrial lining:is it more prevalent in patients utilizing preimplantation genetic testing for monogenic disease (PGT-M) and related to prior hormonal contraceptive use?

STUDY QUESTION: Is a thin endometrial lining before ovulation triggering more prevalent in patients utilizing preimplantation genetic testing for monogenic disease (PGT-M) compared to the regular IVF/ICSI population and is this associated with prior hormonal contraceptive use? SUMMARY ANSWER: Thin (1 year prior to treatment). Endometrial thickness was routinely measured on the day of hCG triggering or 1 day prior. The prevalence of an endometrial lining or 8 mm (20.0% vs 1.7%, mean difference 18.3%, 95% CI: 2.3, 34.3%). A trend towards lower birth weight and gestation- and gender-adjusted birth weight (z-score) was also found in this group. No statistically significant differences were detected in pregnancy rate, live birth rate, or incidence of preterm delivery or SGA. Within the control group, no statistically significant differences were found in outcomes between patients with an endometrial lining 8 mm. LIMITATIONS, REASONS FOR CAUTION: The study is retrospective. Various types of hormonal contraceptives were reported which possibly exert different effects on the endometrial lining. In relation to pregnancy outcome measures, numbers were very limited; therefore, no firm conclusions should be drawn. WIDER IMPLICATIONS OF THE FINDINGS: This study provides further insight into the role of prior hormonal contraceptive use as a possible contributor to the occurrence of thin endometrial lining during ART treatment. Future studies should provide more information on its clinical relevance, to determine whether PGT-M patients can be reassured, or should be counselled to stop hormonal contraceptive use and change to an alternative contraceptive method prior to PGT treatment. STUDY FUNDING/COMPETING INTERESTS: No specific funding was used and no conflicts of interests are declared. TRIAL REGISTRATION NUMBER: N/A

Hysteroscopy Findings in Women with Thin Endometrium Scheduled for In Vitro fertilization in Niger Delta Region, Nigeria

The effect of endometrial thickness on in vitro fertilization (IVF) outcome is still a subject of debate. It is unclear why a thin endometrium reduces IVF success rates. Our objective was to analyze the hysteroscopic findings in women scheduled for IVF who had an endometrial thickness less than 7 mm. Relevant data of patients scheduled for IVF cycles and found to have an endometrial thickness (ET) of <7 mm on transvaginal ultrasound scan (TVS) between April 1, 2010 and March 31, 2017, at a private fertility and minimal access surgery unit in the Niger-Delta region of Nigeria, were retrieved and documented. A total of 41 patients had ET <7 mm during the study period. These patients accounted for 2.8% of the 1487 IVF cycles performed during the same period. All 41 patients had office hysteroscopies performed, constituting 4.1% of the 1,002 hysteroscopies performedduring the study period. The age range of the patients was 23 – 50 years with a mean of 39.9 ± 6.9 years, and the duration of infertility ranged from 3 to 13 years with a mean of 7.2 ± 2.5 years. Most of the patients (32, 78.1%) had secondary infertility. Sixteen patients (39.0%) had intrauterine adhesions. A thin endometrium, though infrequent during IVF treatment cycles, might be associated with undiagnosed intrauterine adhesions. Keywords: Thin, endometrium, hysteroscopy, IVF, infertility, adhesions L'effet de l'épaisseur de l'endomètre sur le résultat de la fécondation in vitro (IVF) est toujours un sujet de débat. On ne sait pas pourquoi un endomètre mince réduit les taux de réussite de la IVF. Notre objectif était d'analyser les résultats hystéroscopiques chez les femmes devant subir une FIV qui avaient une épaisseur endométriale inférieure à 7 mm. Données pertinentes des patientes programmées pour des cycles de IFV et ayant une épaisseur endométriale (ET) <7 mm à l'échographie transvaginale (TVS) entre le 1er avril 2010 et le 31 mars 2017, dans une unité de chirurgie privée de fertilité et d'accès minimal à la région du Niger-Delta au Nigeria, ont été récupérées et documentées. Un total de 41 patients avaient ET <7 mm au cours de la période d'étude. Ces patients représentaient 2,8% des 1487 cycles de IVF effectués au cours de la même période. Les 41 patients ont subi une hystéroscopie en cabinet, ce qui représente 4,1% des 1 002 hystéroscopies réalisées au cours de la période d'étude. La tranche d'âge des patients était de 23 à 50 ans avec une moyenne de 39,9 ± 6,9 ans, et la durée de l'infertilité variait de 3 à 13 ans avec une moyenne de 7,2 ± 2,5 ans. La plupart des patients (32, 78,1%) avaient une infertilité secondaire. Seize patients (39,0%) avaient des adhérences intra-utérines. Un endomètre mince, bien que peu fréquent pendant les cycles de traitement de IVF, pourrait être associé à des adhérences intra-utérines non diagnostiquées. Mots-clés: Mince, endomètre, hystéroscopie, IVF, infertilité, adherence

Endometrial imaging

The endometrium demonstrates a wide spectrum of normal and pathologic appearances throughout menarche as well as during the prepubertal and postmenopausal years and the first trimester of pregnancy. Characteristic morphologic changes take place in the uterus and endometrium over time.peer-reviewe

Pentoxifylline as a Therapy for Thin Endometrial Lining in Infertility

Objective: To evaluate the effect of pentoxifylline as a single regimen therapy for thin endometrial lining in infertility. Method: A cross-sectional retrospective research was held in Yasmin Clinic - Kencana, Dr. Cipto Mangunkusumo Hospital from 2010 until 2011. Our respondents were women with infertility problem. Result: There was significant improvement of endometrial lining in respondents who received pentoxifylline in the first month (

Autologous Platelet-Rich Plasma Infusion to Improve Pregnancy Outcome in Suboptimal Endometrium: A Review

Over the past decade, platelet-rich plasma (PRP) has been used in several fields of medicine to promote cell growth and expedite wound healing for the treatment of arthritis, nerve injury, tendinitis, bone regeneration, cardiac muscle repair, and oral & plastic surgery. Recently, researchers have been applying autologous PRP to bolster the growth of endometrial lining in patients with a history of endometrium-related failed embryo transfers. Evidence reveals that PRP is a rich source of active cytokines and various growth factors, which come from an autologous source that can be easily attained from peripheral blood without risk of disease transmission to the patient. In this review, several studies were analyzed that involved patients 18–42 years of age undergoing hormone replacement therapy (HRT) in preparation for embryo transfer and serial transvaginal ultrasound in conjunction with PRP infusions into the endometrium via an intrauterine insemination (IUI) catheter. Exclusion criteria included patients with endometritis, polyps, or adhesions. Embryo transfers (ET) were performed when the endometrial lining achieved a thickness of >7 mm. The database indicates that PRP infusion therapy is a promising low-cost treatment for HRT patients that significantly increases endometrial thickness and improves pregnancy success in a previous suboptimal ET patient population

Secondary dysmenorrhea due to a rudimentary, non-communicating functional uterine horn

Unicornuate uterus with a rudimentary horn is a rare congenital Müllerian anomaly, which may lead to many obstetrical and gynaecological complications. This pathology occurs in approximately 1/100 000 women. A rudimentary horn forms due to insufficient development of the Müllerian duct. The diagnosis of this anomaly is usually delayed, as it remains asymptomatic until adolescence and its main symptom is dysmenorrhea

Uterine Pseudoaneurysm: A rare cause of delayed postpartum haemorrhage managed with uterine artery embolisation

MEDICAL IMAG

EFFECT OF VAGINAL SILDENAFIL ON IN VITRO FERTILIZATION SUCCESS RATES IN WOMEN WITH PREVIOUS FAILED IN VITRO FERTILIZATION ATTEMPTS

Objectives: Endometrial thickness of <9 mm is a predictor of in vitro fertilization (IVF) failure, although neither pregnancy rates nor the pregnancy outcomes are dependent on the endometrial thickness alone. The impact that uterine artery blood flow has on endometrial growth is dependent on nitric oxide which concentrations could be altered by halting a cyclic guanosine monophosphate-mediated pathway with a phosphodiesterase type 5 selective inhibitor such as sildenafil.Methods: In this clinical trial, 72 patients aged below 45 years which have had at least two earlier failed IVF attempts were randomly split into two groups each consisting of 36 patients. Both groups were started on a long IVF protocol. The case group was also administered 100 mg vaginal sildenafil suppositories daily, starting on day 3 of menstruation which was continued until human chorionic gonadotropin administration. Endometrial thickness was measured using ultrasonography in both groups plus pregnancy rates were assessed in both groups.Results: The mean age of the patients in Group A who received sildenafil; in this clinical trial, 72 patients aged below 45 years which have had at least two previous failed IVF attempts were randomly split into two groups each consisting of 36 patients was 33.8±4.8 in contrast to Group B (control group) with the mean age of 33.8±4.8. Mean endometrial thickness of 8.6±0.1 mm was recorded in Group B compared to 9.0±0.7 mm in Group A (p=0.03). Of all the 36 participants who received sildenafil citrate during the IVF cycle, 12 (33.3%) patients had successful pregnancies while 24 (66.7%) failed to get pregnant. In the control group, out of the 36 participants, 10 (27.8%) patients got pregnant while 26 (72.2%) failed the cycle (p=0.9).Conclusion: This study showed that although using vaginal sildenafil during the IVF cycle does improve endometrial thickness before implantation, this does not necessarily lead to higher pregnancy rates