Thin endometrium in Ovulation induction protocol -Causes & what can be done

1-10-19 :

Step A) Thin Endometrium causes& Treatement:-If next cycle after first or second letrozole cycle(present cycle)  ,if the concerned couple is  young then  another cycle letrozole with  antioxidants may be tried.

Step B:- Later Tamoxifene but all depends on her age ,

Step C :-Supplementary Tr are :-Progynova, Sildenafil, NTG Patches,

 The problem of thin endometrium is generally because of three things...A) poor estrogen,

 B) Poor blood supply or

C) a permanent/temporary, repairable damage to endometrium.  Poor E2 can be diagnosed by  for the first you can do blood values...but if one  finds  one-Two DFs...one  can believe it to be right....even then give supra dose of oestrogens ...A) Progynova 2 mg BD/TDS/QID (depends)...follow up with  the improvement...... for the second see the Doppler blood flow...not convincing data so can start..  if ET still low persistently do E) hysteroscopy to look for adhesions ,check for TB, just do a gentle curette to stimulate. Avoid CC for next cycle... peripheral anti estrogenic effects can't be reversed by exogenous estrogen. Start with estrogen if no response this cycle then sildenafil next cycle

 B) sildenafil 25-50 mg per day for 5 days or

C) NTG PATCHES.(nitro glycerin patches) one can watch for  improvement...

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Step D :-If > 28 yrs then skip all these & proceed for hMG 2-3 cycles with IUI. But even with hMG is thin ET persists then persistent thin Et then To find other causes of thin ET e.g. PRL, Androgen Excess disorders. In absence of these two common syndromes , I think one should plan for hMG cycle with antagonist protocol ensuring that DF do nor rupture and purchasing enough time to ET to grow at least to 7 mm but as mentioned Preg rate with 4 mm ET only there is some hope Preg rate is of about 10% . 

Step D:- investigate as suggested PRL, AMH, Hysteroscopy.(IUA-intrauterine adhesions).

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 Evidence suggests that conception Rate  increases steadily as endometrium 4 to 10 mm and then plateau,  if ET still low persistently do E) hysteroscopy to look for adhesions ,check for TB, just do a gentle curette to stimulate. Avoid CC for next cycle... peripheral anti estrogenic effects can't be reversed by exogenous estrogen. Start with estrogen if no response this cycle then sildenafil next cycle  if ET still low persistently do E) hysteroscopy to look for adhesions ,check for TB, just do a gentle curette to stimulate. Avoid CC for next cycle... peripheral anti estrogenic effects can't be reversed by exogenous estrogen. Start with estrogen if no response this cycle then sildenafil next cycle.          

:  Low should be the endometrium when we give hcg in a iui cc induced cycle. if the follicle is 19-20 mm and the endometrium is not triple layered what to do

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 Endo shod be more than 8 mm, add

1) Progynova   2) or sildenafil

 If the endometrium is too bad than iui should be defer 

3) Should have started estrogen at follicle 16 mm if a but it was not like triple line.

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