Modern management of thin lining

Objective: To define “thin” endometrium in fertility treatment, and to critically explore the available treatment options. Design: A review of the scientific literature. Setting: N/A. Methods: An electronic literature search pertaining to patients with “thin” endometrium undergoing fertility treatment was performed through April 2016. Results: Adequate endometrial growth is an integral step in endometrial receptivity and embryo implantation. Whether idiopathic or resulting from an underlying pathology, a thin endometrium of <7 mm is linked to a lower probability of pregnancy; however, no reported thickness excludes the occurrence of pregnancy. Several treatment modalities have been studied and include extended estrogen, gonadotropin therapy, low-dose hCG, tamoxifen, pentoxifylline, tocopherol, l-arginine, low-dose aspirin, vaginal sildenafil, acupuncture and neuromuscular electric stimulation, intrauterine G-CSF, and stem cell therapy. All treatment modalities except vaginal sildenafil, intrauterine GCF, and stem cell therapy were inconsistent in showing significant improvement in pregnancy rates. Early results of stem cell therapy trials seem promising. Conclusions: EMT <7 mm is associated with lower probability of pregnancy in ART. Vaginal sildenafil appears to be a reasonable first line therapy option, and G-CSF appears to be a potential second option, while stem cell therapy seems to be a promising new treatment modality

In Vitro Fertilization Versus Mild Stimulation Intrauterine Insemination in Women Aged 40 and Older

The objective of this study was to compare clinical pregnancy rates (PRs) and pregnancy outcomes (POs) in patients undergoing in vitro fertilization (IVF) and a specific controlled ovarian hyperstimulation (mild-stimulation or mini-stim) and intrauterine insemination (IUI) protocol in women older than 40. It is a retrospective chart review of 770 cycles of all women aged 40 and older who underwent a first cycle of either IVF or mini-stim IUI between the years 2007 and 2012 at a single infertility center. The PR in all women aged 40 and above was 12% (65/531) for IVF and 5% (13/239) for mini-stim IUI ( P = .004). When divided into age-groups, the PR of IVF at age 40 was superior to that at age 41 and above (15% vs 7%, P = .002), while the PR of mini-stim IUI remains similar (3% vs 7%, P = .307). When comparing the outcomes of the 2 treatments in the different age-groups, it showed that in women aged 40, IVF PR was superior to that of mini-stim IUI (15% vs 3%, P = .032); while in women aged 41 and above, IVF and mini-stim IUI have similar PR (7% vs 7%, P = .866). When POs were compared, the rate of live birth per cycle initiated was 9.2% for IVF versus 1.28% for mini-stim IUI ( P < .001). While IVF and mini-stim IUI were found to have similar PRs in women aged 41 and above, POs are significantly better in IVF. A larger study is required to clarify the above results