The endometrium in assisted reproductive technology: How thin is thin?

Abstract

A thin endometrium is encountered infrequently (2.4%) in assisted reproductive technology cycles. When it does occur it is a cause of concern as it is associated with lower implantation rate and pregnancy rate. Though pregnancies have been reported at 4 and 5 mm it is apparent that an endometrial thickness <6 mm is associated with a trend toward lower probability of pregnancy. Hormone replacement therapy – frozen embryo transfer (FET) cycles appear to give better results due to an improvement in endometrial receptivity (ER). The etiology of thin endometrium plays a significant part in its receptivity. A number of treatments have been tried to improve endometrial growth, but none has been validated so far. Confirming ER of a thin endometrium by an ER array test before FET offers reassurance.

Role of dilatation and curettage performed for spontaneous or induced abortion in the etiology of endometrial thinning

“…Furthermore, more than half of the patients with an endometrial thickness of <6 mm did not have Asherman's syndrome and almost all of these patients had a history of previous D&C. Although a definitive conclusion requires a prospective randomized study of a larger number of patients, the results of the present study suggest that D&C performed for spontaneous or induced abortion should be included as a possible cause of endometrial thinning. In 2016, Mahajan and Sharma classified the causes of thin endometrium into three categories: inflammatory, iatrogenic, and idiopathic causes . According to their classification, iatrogenic causes include repeated or vigorous curettages on the basal layer of endometrium.…”

“…In 2016, Mahajan and Sharma classified the causes of thin endometrium into three categories: inflammatory, iatrogenic, and idiopathic causes. 11 According to their classification, iatrogenic causes include repeated or vigorous curettages on the basal layer of endometrium. Their review is compatible with the findings of the present study.…”

Fertility preservation with successful pregnancy outcome in a patient with transplanted heart and non-Hodgkin’s lymphoma – a case report

“…When choosing the best method for fertility preservation a multidisciplinary team should consider the patients’ age, pubertal status and maturity level, cancer type, prognosis, staging and existence/risk of metastasis, time available for fertility preservation intervention before initiating treatment and the indication and limitations for each fertility preservation method applied to each specific patient. Options for fertility preservation in cancer patients include oocyte and embryo cryopreservation as established methods and ovarian tissue cryopreservation, in vitro maturation of oocytes and artificial ovary as experimental methods [13]. …”

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“…As the low thickness of the endometrium causes problems in endometrial glandular growth and angiogenesis, and by doing these changes, the vascular endothelial growth factor (VEGF) is reduced. In other words, the implantation and vascularization are weaker than the effects of low endometrial thickness, which causes early abortion 15 .…”