The uterine cavity plays an important role in the reproductive function. Moreover, the uterus is where the implantation and life happens. Therefore, to evaluate the women’s fertility function, uterine cavity examination cannot be ignored.
Before infertile couples start the artificial assisted reproduction (ART) treatment, we usually arrange hysteroscopy (H-scopy) to check whether the endometrium synechiae or polyp problems. The reason is that even a high quality embryo cultured by artificial assistance, the probability of pregnancy could be affected if the uterus environment is not good.
The thickness of the endometrium is also one of the key points for a successful pregnancy. If the endometrium is too thin (less than 8mm), it is not only cause pregnancy difficulty, and the possibility of miscarriage and ectopic pregnancy will also increase. If the endometrium is too thick, it may be endometrial hyperplasia or a symptom of disease. According to the research, the most appropriate endometrial thickness for embryo implantation is 10 mm ± 2 mm.
At present, we Stork Fertility Center usually do frozen embryos transfer. With high doses of estrogen, endometrium thickens and we keep rechecking the thickness before transferring. Clinically, vaginal ultrasound is the most convenient tool used to assess the endometrium thickness, and it is also the most practical and simple method.
The following are methods for improving the thickness and environment of the endometrium before embryo transfer:
1. Extend and enhance the use of estrogen during the treatment: for those whose endometrium is difficult to reach appropriate thickness by oral estrogen, there are other options. For example, Divigel and Premarin Cream, which are applied by and absorbed through skin, can also be used to thicken endometrium.
2. Ovulation stimulation: Using ovulation stimulating medication to raise the estrogen concentration in the blood while the follicles grow. Estrogen in the blood will help thicken endometrium.
3.Viagra: In addition to treating male erectile dysfunction, Viagra has been proven to promote uterine blood circulation and thicken the endometrium. Its mechanism is to enhance the vasodilation function caused by nitric oxide. By this way, the blood circulation of the endometrium will be improved and increase the possibility of pregnancy.
4. Immunotherapy: use non-steroidal anti-inflammatory drugs, such as low-dose aspirin, or immunosuppressive drugs such as intravenous immunoglobulin (IVIG), and heparin, etc. These kinds of drugs can increase blood circulation in the uterus and help embryo implantation.
5.Platelet-rich plasma injection therapy (PRP): Use patients' own blood to separate the platelets, and then extract the growth factors contained in the platelets, such as VEGF/Vascular endothelial growth factor; PDGF/platelet derived growth factor, etc, then inject it into the uterine cavity. These factors promote the growth of the endometrium, thereby the endometrium thickens.
Implantation has always been one of the most difficult problems in fertility. The medication may be helpful in increasing the endometrium thickness, however, to those whose uterus had been severely injured and the endometrium cannot proliferate, the improvement is limited. If it is surely the uterus problem that makes the embryo unable to implant or develop, surrogacy is another choice. However, surrogacy is currently illegal in Taiwan, seeking assistance overseas is suggested.
Assuming that the endometrial problems can be detected earlier, medication could be used to improve endometrium condition at the appropriate time earlier or before starting the artificial reproductive treatment. By doing so, it is believed that the chance of embryo implantation and the possibility of pregnancy can be increased.
