SCRC is dedicated to spreading fertility awareness through hosting and attending community events. Stay tuned for special features including events, awareness initiatives and surprise posts from our fertility community. Wendy Burch is an Emmy-winning journalist, acclaimed professional writer, and inspiring motivational speaker. Some causes include: Estrogen deficiency Poor blood flow to the uterus Uterine fibroids Adhesions or scar tissue in the uterus, caused by trauma or infection Hydrosalpinx Chronic endometritis infection of the endometrial cells If your doctor determines that there is a specific anatomical issue that could be contributing to a thin endometrium, they may recommend treating the problem before trying to get pregnant.
Take estrogen supplements. Focus on blood flow. Partake in regular, moderate exercise. Most of us have relatively sedentary lives these days, with desk jobs which keep us sitting for hours. During that time, blood flow slows and the reproductive organs are compressed. If you are trying to improve your uterine lining, moving your body is very important. When you raise your heart rate you multiply the number of times that fresh, oxygenated blood flows through your body.
Eliminate or limit substances which may restrict blood flow. Caffeine and nicotine are not good for your circulation: you should quit smoking and cut back coffee to one cup a day. Certain seasonal allergy medications and cold remedies which are designed to stop nasal swelling can also constrict your veins. Check with your doctor about which over the counter remedies you should avoid at this time. Look into acupuncture. Awaiting Natural Ovulation: Blood work or urine-based ovulation predictor kits OPKs can predict when a woman will naturally ovulate.
In this case, the IUI occurs either later that day or the next morning. Anovulatory Patients: Can start medication at any time. In this case, a 7 to 10 day course of progesterone like provera or aygestin can be given to cause the onset of a period and clomid or letrozole would be started thereafter. Unexplained Patients: Can start medication on day 3 or 5 of the cycle.
If the patient is having her treatment cycle monitored, she will come in on day 3 for bloodwork and an ultrasound. On ultrasound, the doctor will be checking to make sure that no follicles have already started the process of growing because once one follicle is already growing, it is unlikely that others will also start growing in response to clomid or letrozole.
The doctor will also look at estrogen levels through blood work to confirm this. Once the patient has started taking clomid or letrozole, they continue for 5 days, and 4 days thereafter the woman may return to the office for monitoring and blood work.
Increase dosing if no follicles are growing or switch to gonadotropins if no follicles are growing and the patient has reached the maximum dose for clomid mg or letrozole 7. Continue waiting if the cycle looks promising. Patients may return the next day for insemination if the follicles are large 18mm or in 2 - 3 days if follicle growth is slower. The patient comes in on day 3 of her cycle for blood work and ultrasound to make sure that all of the follicles are resting none have started down the developmental path toward ovulation and that the lining of the uterus is thin which means the lining is ready to start growing in preparation for a possible pregnancy.
She will begin the injectable medications later that night. She will continue the same dose of medication for 4 nights and then come back to the office for an ultrasound and bloodwork to monitor her progress. During vascularization, the endometrial lining becomes enriched with blood. Ovulation prepares the lining to receive a fertilized egg and supports the placenta. The placenta grows during pregnancy to supply the fetus with oxygen, blood, and nutrients.
Endometrial thickness is vital during pregnancy. The lining must be the right thickness for the best chances of a healthy, full-term pregnancy. The lining gets thicker as the pregnancy continues. A simple exam using X-ray technology can help a doctor measure the uterine lining. Thin linings are classified as less than or equal to 7mm. Low estrogen levels and insufficient blood flow are the most common reasons for a thin endometrial lining.
Fibroids, abnormal periods, pelvic inflammatory disease, and long-term use of birth control can also affect the lining. A thick lining also impacts pregnancy. If the lining becomes too thick, endometrial hyperplasia can occur. Several studies have shown a correlation between pregnancy and endometrial thickness. Seven studies provided data on EMT in relation to pregnancy. There was no evidence of a difference in EMT between women who conceived and women that did not conceive women, MD random : 0.
The overall quality of the included studies was low to moderate. We found considerable to substantial heterogeneity in the comparisons, hampering firm conclusions.
As a consequence, canceling IUI cycles because of a thin endometrial lining may negatively affect clinical care. Although we found some evidence for very small differences in EMT when comparing various drugs, we cannot make inferences on their effect on pregnancy chances since these differences may be coincidental. IUI with ovarian stimulation IUI—OS is perceived as a simple, non-invasive and non-expensive first-line treatment for women diagnosed with unexplained or mild male subfertility Ombelet et al.
These drugs not only stimulate the growth of multiple follicles, but also proliferate the endometrium. The effect of this proliferation on the chances of conception is unclear. Data on endometrial thickness EMT and pregnancy rates are scarce and conflicting. In contrast, a prospective cohort study of IUI—OS cycles with gonadotrophins found no correlation between EMT and cumulative pregnancy rate after three treatment cycles De Geyter et al.
Another prospective study evaluating women treated with CC observed no difference in EMT in women who did or did not conceive Kolibianakis et al.
This review did not include comparisons with other stimulating drugs, for example gonadotrophins. A medical librarian J. This enables the retrieval of papers that mention EMT in the full text but not in the title or abstract.
We used no language or other restrictions. The search included an iterative process to refine the search strategy through adding search terms to identify new relevant citations, i. Two reviewers M. The reviewers checked cross references of the detected articles. The reviewers extracted the data from the included articles by using standardized data extraction forms.
To assess study quality we used the risk of bias in non-randomized Sterne et al. We then extracted study data and if data were missing, we contacted authors by email.
Disagreement between the reviewers was resolved through discussion with a third reviewer M. Risk of bias per study was expressed in the forest plots as colored dots, with red dots meaning high risk of bias, yellow unclear risk of bias and green low risk of bias.
Pooled evidence was scored using Grade Profiler 3. In case of randomized cross-over trials, we only used pre-cross-over data. There was no limit for female age. The articles had to be written in English with full text available. We excluded trials in which estrogen was added to OS with CC.
We extracted data on ongoing pregnancy and clinical pregnancy. We defined ongoing pregnancy as a fetal heartbeat seen on ultrasound by 12 weeks of gestation and clinical pregnancy as a vital pregnancy seen on ultrasound.
We registered all outcomes per woman. We performed a meta-regression analysis to evaluate whether there were differences between the cohort studies and the randomized studies and to evaluate if the drugs interacted with the estimated effect of EMT.
As no cut-off values for EMT were available, the pre-planned summary receiver operating characteristic sROC curve to assess the accuracy of EMT in the prediction of pregnancy could not be made Reitsma et al. Flow chart of search and selection strategy for studies in a systematic review of endometrial thickness during IUI with ovarian stimulation.
The largest study included women De Geyter et al. Two studies reported live birth rates Revelli et al. All other studies reported clinical pregnancy rates.
Since ongoing pregnancy rates were not available, we used clinical pregnancy rates as the outcome measure. In three studies data on EMT and pregnancy were available in the articles Tsai et al. We contacted the authors of the remaining studies to provide the missing data on the EMT in pregnant and non-pregnant women, and four of them were able to supply these data De Geyter et al.
Five of these seven studies were cohort studies and two were RCTs. We asked all authors if they could provide the number of pregnant and non-pregnant women above and below a certain EMT cut-off value. None of the studies could provide these data and therefore ROC curve analysis was not feasible. We cannot exclude that cycles were canceled when a low EMT was measured. We assume this was not common practice as none of the studies mentioned canceling a cycle on the basis of EMT.
In all 23 studies data on type of drug and EMT were available. The other 17 studies were RCTs. All studies used HCG-injections to trigger ovulation. Five studies used a form of luteal phase support, either by administering progesterone suppository or injections Barroso et al. Endometrial thickness in pregnant versus non-pregnant women. Red dots mean high risk of bias, yellow unclear risk of bias and green low risk of bias. To overcome the statistical heterogeneity across studies, we also performed a sensitivity analysis leaving out the one study that found a significant difference between groups Esmailzadeh and Faramarzi, The MD was not statistically significant MD: 0.
We found nine studies that compared CC plus gonadotrophins with letrozole, eight RCTs and one cohort. In this meta-analysis we found no evidence for an association between EMT and pregnancy rates.
The combination of CC plus gonadotrophins resulted in a slightly thinner endometrium than letrozole, and letrozole alone resulted in a slightly thinner EMT than gonadotrophins alone. Some limitations of this review need to be addressed.
The average quality of the included studies was low to moderate and mean EMT values differed across studies resulting in considerable statistical heterogeneity. Furthermore, EMT was not a primary outcome in any of the studies. It seems likely that EMT had not been measured in all women.
The number of missing values for this outcome was not reported in the included studies. A limitation of our study is that the included studies did not report data on ongoing pregnancy rates and therefore we chose to use clinical pregnancy as outcome measure.
CC versus gonadotrophins, and letrozole versus gonadotrophins were compared in two studies only. Another limitation is the fact that we could not perform our planned sROC curve to determine the accuracy of EMT in the prediction of pregnancy, since the included studies did not deliver the necessary data.
Our review confirms the finding of one other review that evaluated EMT and pregnancy rates, but was limited to letrozole and CC cycles in women with unexplained subfertility Liu et al. This finding was not confirmed by a study in a similar IUI population published a few years later, as these authors found pregnancies occurring at the lowest measured EMT of 4 mm Hock et al.
The small differences in EMT that we found in relation to type of drug are counterintuitive. Biologically it seems possible that OS with gonadotrophins alone results in thicker endometrium than stimulation with CC and stimulation with letrozole whereas the combination of CC with gonadotrophins gives thinner EMT than letrozole. We cannot exclude that the observed differences in EMT are due to heterogeneity across the included studies.
Also, previous studies have reported that there can be an interobserver variability in measuring EMT by transvaginal ultrasound with a MD: 1. In IVF, the impact of the thickness of the proliferated endometrium on pregnancy rates has been studied in a review pooling the results of 13 studies that showed that no pregnancies occurred if the EMT was below 5 mm Friedler et al.
Based on the Friedler et al.
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