Modern management of thin lining

Abstract

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.

Keywords

• Thin endometrium
• Endometrial thickness
• Endometrial pattern
• Pregnancy rates
• G-CSF
• Stem cell therapy