How can I improve my uterine lining for IVF?

Well, while doing IVF, we add estrogens at the end of the stimulation protocols or after the oocyte pickup to try to improve or get a little bit more dose of estrogen circulating in the blood to get a thicker endometrium. We basically do that if we see in the last ultrasound a really thin endometrium while doing the IVF protocols while doing the medication but most of the time the endometrium gets thicker on its own, so it’s a matter of just having a strict control with the ultrasound.

So yes, there are factors that can have a bad influence on implantation. Starting from the structural changes like polyps, submucosal fibroids, adhesions, they have to be removed before the transfer but they are very delicate molecular changes, like the change in the proportion of these stemetil decidual cells, decidual cells and the natural killer cells. I’d like to talk a little bit about the endometriosis because it is a recurrent disease, which really compromises the implantation. The problem is that the endometriosis foreside is invisible in ultrasound when they are located out of the uterus and out of the ovaries. But we definitely know that the endometrium differs from the endometrium in patients without endometriosis by expression of some proteins. And one of these proteins is the BCL 6. It was shown by an American scientist that overexpression of this protein in the endometrium around implantation would cause progesterone resistance and the development of endometriosis. So with this logical expression the live birth rate will be according toBruce A. Lessey studies, like 7%, if we would treat it for two months with GnRH agonist releasing hormone (A gonadotropin-releasing hormone agonist). So then we can improve our live birth rate up to 55%. So that is why we also widely use the immune system against a chemical examination of the endometrium for expression for the BCL 6. Also, we make the detection of plasma cells and use hysteroscopy to exclude the chronic endometritis because it’s also known that the chronic inflammation of the endometrium can compromise the implementation and the antibacterial treatment of chronic endometritis can improve our success rate of implantation clinical pregnancy.
A few words about subendometrial contractions; these contractions occur during the whole menstrual cycle, with higher frequency in their follicular phase and the uterus usually calms down at the moment of implantation. But if we have a high level of these subendometrial contractions and the moment of implantation, so the uterus can just push out this embryo, there can be the expulsion of the embryo out of the uterus. Normally, we do not see this contraction. To detect them we need to make a four or five minutes record, then we have to replay this video at five times quicker speed, and only afterward, these contractions will be visible. So if we have three and more such contractions on the day the embryo transfer is going to be performed, we administer additional medications to calm down uterus. Usually, it is antagonists of oxytocin and we see a better result of such type of treatment

The endometrium is the inner part of the uterus where the embryo implants. When we talk about good endometrium we know that the thickness is 7 mm or more. But not all patients may have that thickness. The main causes why endometrium may not be that thick are several ones. The first one is infections that the endometrium could have in the past that may affect the innermost layer. Some other alterations such as teratogenic caused by several curettages that can affect that layer as well. But, in most cases, we know that there are no specific reasons why the endometrium is not so thick.

If we want to make that endometrium thicker, there are several options. The most common ones are the natural cycle, a cycle using estrogens and gonadotropins. Let’s talk a little bit about the natural cycle. It’s quite common to try to thicken the endometrium just by using natural hormones that the patient secretes. So in such a cycle we will take advantage and use the natural production of hormones to make the endometrium thicker. The idea is just to follow how the follicle grows and due to that growth, the endometrium will be affected by the estrogens the follicle will create and will become thicker.

On some occasions, we prefer to use estrogens as we know that the endometrium is a hormone-dependent tissue. Normally the estrogens are taken by the patient vaginally, orally or sometimes using hormonal patches. It’s quite common to have good endometrium due to the estrogen’s action.

In some other cases, when the endometrium does not react properly, we need to use different treatment options such as gonadotropins. So we try to stimulate the ovaries with a low dose of gonadotropins trying to affect the endometrium in a good way and trying to thicken it. So in the end the estrogen that is produced by the follicles that are growing will be affecting the endometrium.

But, sometimes, things are not so easy. On some specific occasions, we need a different way because the endometrium is not as thick as we need. Then, we need to use different treatments. Some of them are commonly used and known such as Aspirin. We know that its active agent may help to increase the blood flow in the endometrium. It’s quite useful treatment and is quite often used in patients where the endometrium is not thick enough.

A different treatment is vitamin D and Pentoxifylline that are known as anti-oxidant agents and can cause vessel dilation. In the end, what we need to see is that there is an increased blood flow in the endometrium. Normally, this type of treatment is added to the most common ones to try to improve the endometrial thickness.

A different treatment that is one of the newest is the granulocyte colony-stimulating factor (G-CSF) which is also known to increase blood flow and affect the endometrium in a good way. The main problem with this last option is that there is some controversy about it. There are some studies that show good response in the endometrium and that it could affect it but some other don’t show that effect. In the end, it’s not very clear if it could be helpful or not.

In the end, if we have a patient with thin endometrium, we try to do our best and try to add several treatments trying to improve that endometrial thickness. The same happens with Viagra (Sildenafil) which is a treatment that is sometimes added to other treatments such as estrogen to try to increase the blood flow as well. The effects are quite helpful normally but it always depends in the patient. Not all patients will have the same effect with such treatment.

How can you improve your lining for IVF? What is a good lining? That’s the most important question. 7-8 millimeters I would say is the best but even with 4-6 millimeters women get pregnant but the chances are lower, of course. To get a higher chance of getting pregnant you need a perfect endometrium. What is perfect? Not too thin, not too thick. At least 7-8 millimeters but not more than 15 millimeters, I would say, that would be perfect.

How to get it perfect? How to get a perfect bed for the baby? I will tell you things that can decrease the quality of your endometrium. First of all, this is what I am doing my research now is endometrial microbiota. This is bacteria. If you have an infection in your uterus then it has to be treated with antibiotics before you proceed with preparing your endometrium. There are different bacteria and viruses that can live in your uterus and cause chronic inflammation so-called chronic endometritis. The best way to check it is to do a PCR test, not culture but PCR. This is the best way to check whether you have bacteria in your womb or not. We do it in our EGV clinic. We can check your endometrial and microbiota and if you have some sexually transmitted diseases like chlamydia, trichomonas, etc., virus, or any bacteria in your uterus, it can be treated. First of all, infection-free.

If there is no infection, another thing is fibroids. Fibroids also can reduce the blood flow here in your endometrium and, therefore, the thickness will not be good enough.

The next thing is liquid in the tube. It’s called hydrosalpinx. Surprisingly, it’s not your uterus but if you have some liquid in your tube then it can affect your endometrium quality. I recommend to the tube to be removed before you have your embryo transfer.

The next thing is blood flow. Blood flow is everything. To improve your blood flow you need to exercise and your uterus needs to exercise. What is the best exercise for your uterus? Good sex, of course, and your overall core body training, hiking, some yoga classes that will also improve your mood, make you calm. I always say to my patients “you have to be calm and no stress, you have to trust your doctor, of course, you have to trust your body and just leave some space for a miracle to happen. Trust God and give him chance to do His work.” Not only medicines, not only what we do but also something extra can help you get pregnant. With medications, of course, it’s estrogen treatment. Your doctor will prescribe you the best way to take estrogens either transdermally, there are different patches or gels you can use over your skin, you can take it orally, you could put them vaginally, and also there is Viagra (sildenafil) that you can put vaginally in the form of pill and it also improves endometrial quality very well. There are many ways. There are microelements, there is Omega, there are medications to improve blood circulation. Low-dose aspirin so-called heart aspirin also improves circulation and improves endometrial quality so your doctor will choose the best way for you to have the perfect bed for your embryo. Good luck!