You are currently browsing the Dr Licciardi blog archives for August, 2008.

Dr. Licciardi on TV 2

This week I was on live national television; The Early Show on CBS. One segment was Monday and one segment was Tuesday. You can view the pieces by going to:
http://www.cbsnews.com/sections/earlyshow/main500202.shtml
On the left margin look for Videos, and then click health. You will see videos, click more videos. The 2 segments are “Being a Mom with Breast Cancer” and “Pill Giving Women a Chance”.
I would just give you the video’s URL, but for some reason it is not working for me.

Dr. Licciardi

The Endometrium Part III

Last time we went over some of the conventional methods used to increase the lining thickness. What about the less conventional?

Well there’s Viagra. I had a patient try it and she had a baby. I have had many others try without success. The linings measured no thicker on Viagra than off. As with many things there was some initial interest when it was first described, but we never were able to conclude that Viagra does anything. I do not suggest it to my patients.

What about baby aspirin? The studies are also limited, but the results are not compelling enough to convince us that baby aspirin is worth anything. I have heard that some doctors have all of their patients take it regardless of history. Why I don’t know. It seems benign enough, and is probably used by many women who keep it a secret.

What about using blood flow as an indicator? Why look for bad news? If someone could tell you it’s almost impossible to get pregnant with a certain blood flow, fine, but they can’t, so why torture yourself. We don’t know enough about this.

Is there a minimal acceptable thickness and is thicker better? My colleagues and I did a study looking at donor egg recipients and compared pregnancy rates in women with thin and thick linings. The pregnancy rates were the same in women with linings less than 6 mm compared to women with linings 7 mm or greater. Dr. Noyes also did a study looking at recipients and found that there were plenty of pregnancies in women with thin linings, but the rates were a little higher when the lining was greater than 9 mm. Other authors have shown there is no correlation between thickness and pregnancy rates, and others have shown that the pregnancy rates are higher with a thicker lining.

I do not think the pattern matters. The odds of pregnancy don’t seem to be different if the pattern is ring (or triple) or homogenous. I have found that if the uterus is sharply retroverted, the pattern is commonly homogenous, probably just having to so with angle of the ultrasound waves.

If I had to summarize the general feelings of most infertility doctors, I would say that we are a happier then the lining is thicker, and we may try things to thicken things up a bit, but in the end we take what we can get. Many patients have told me they heard that the target lining is over 9 mm. This I can say is not the case at all.

So let’s say for example I have an IVF patient whose maximum lining is 6 mm. I am not overly worried about this, but will review things and see if there is anything that can be done. I may mention to her that the lining looks a little thin, but would also say it’s not a cause of great concern. Any thicker does not even get a mention. Thinner will get more of a discussion. If her cycle does not work I will try to get it thicker next time, probably using estrogen patches early in the cycle. In many cases the lining remains the same.

For IVF, some doctors freeze all of the embryos and try to get the lining thicker in a high dose estrogen frozen cycle. I have never done this because I do not think it helps. I think you may hurt some embryos with the freeze, and I doubt the lining will get much thicker or much better in the frozen cycle.

This all sounds OK until we have a patient who is not getting pregnant, and also has a thin lining. Question: is it really the lining? Maybe yes and maybe no. I currently have a woman who has tried IVF 5 times with average embryos and a 9 mm lining. Why isn’t she getting pregnant? The point is some women have a thin lining, but a different reason for not getting pregnant.

Some women bail out and go to a gestational carrier, and are successful. In their case it seems the problem was the lining. But few women want to or can afford to go with a carrier.

In summary, the thickness of the lining is not as important as many doctors and patients make it out to be. However, there are some women with thin linings who cannot get pregnant, and for some of them, the lining is the reason for their infertility. Because the treatment of infertility is a game of odds, trying, even when it looks like there are factors against you, is the best thing to do. After that, it’s time for third opinions and opening up to the less conventional options.

That’s it for now,

Please read disclaimer 5/17/06.

Dr. Licciardi

  • Margalioth EJ, Ben-Chetrit A, Gal M, Eldar-Geva T. Investigation and treatment of repeated implantation failure following IVF-ET. Hum Reprod. 2006 Dec; 21(12):3036-43.
  • Y. Shufaro, A. Simon, N. Laufer, M. Fatum. Thin unresponsive endometrium: a possible complication of surgical curettage compromising ART outcome. J Assist Reprod Genet, 25 (2008), pp. 421–425.
  • Laufer N, Simon A. Recurrent implantation failure: current update and clinical approach to an ongoing challenge. Fertil Steril. 2012 May; 97(5):1019-20.
  • Hsieh YY, Tsai HD, Chang CC, et al. Low-dose aspirin for infertile women with thin endometrium receiving intrauterine insemination: a prospective, randomized study. J Assist Reprod Genet 2000; 17:174–177.
  • Chen MJ, Yang JH, Peng FH, et al. Extended estrogen administration for women with thin endometrium in frozen-thawed in-vitro fertilization programs. J Assist Reprod Genet 2006; 23:337–342.
  • Sher G, Fisch JD. Vaginal sildenafil (Viagra): a preliminary report of a novel method to improve uterine artery blood flow and endometrial development in patients undergoing IVF. Hum Reprod 2000; 15:806–809.