thin uterine lining
7 Replies
teri-chan - July 13

Dear Dr. Jacobs,

In an earlier message, you said, "there are numerous studies reported in the professional literature that the uterine lining needs to be GREATER than 7 mm thick at the time of ovulation or day of hCG for successful pregnancy." And Dr. Smith (the embryologist on the other expert Q&A forum at this site) said, "several stuides have shown that the likelihood of implantation is decreased when the endometrium is less than 8mm [on the day of the hCG shot]."

Q1: Do you know how much the likelihood is decreased in cases in which the uterine lining is 7mm? 6mm? 5mm? less?

Q2: In a donor IVF or FET cycle, how much control does one have over the development of the endometrium? And how closely correlated is that with E2 levels? How exactly should the endometrial lining be monitored during these cycles? (I ask because I recently had a donor cycle in which I had only one scan. My uterine lining measured 7 mm on that day, which was intended to be the day that the donor took her hCG shot, but which turned out to be the day BEFORE the donor took her hCG shot. My E2 was in the 600s. In cycles in which I was the one taking the gonadotropins, my uterine lining seemed to be ample. For example, in the case of one IUI, two days before I took the hCG shot my lining was at 5.4 mm (with E2 of 664) and then on the day of the hCG shot it was at 9.0 mm (with E2 of 1046). And it may be that given the extra day that I had in my donor cycle, my lining got up to 8mm, but I have no way of knowing. Would it be reasonable in my case, if I have another donor cycle, to ask that the development of my lining be monitored more closely in the days coming up to the donor's hCG shot, so that adjustments in my medications can be made, if necessary, to encourage more endometrial development?)

I am very thankful for your generosity with your time and knowledge.

 

B. Jacobs, M. D. - July 13

I am sorry that I do not have data to answer your first question, but basicly, Dr. Smith and I have provided the same information. I do not know the protocol being used to prepare your endometrium for embryos from donor egg. I do not measure serum estradiol levels when preparing the endometrium for donor or frozen embryos. I do use a progressively increasing dose of estrogen for 2 weeks, and, so far, the endometrium has been greater than 8 mm thick, at the apprpriate time.
Good luck.

 

teri-chan - July 13

Here was my protocol. I leave out the precautionary use of Z-pak, since it's not relevant to the uterine lining issue.
6/6/06
began lupron, 10 units per day
6/13/06
suppression confirmed (E2 = about 20)
sonohystogram done (fine)
trial transfer done (fine)
lupron dose lowered, 5 units per day
PLACED 1 VIVELLE DOT PATCH (0.1 mg)
6/15/06
REPLACED 1 VIVELLE DOT PATCH (0.1 mg)
6/17/06
donor began stimulation medication
REMOVED 1 VIVELLE DOT PATCH (0.1 mg)
PLACED 3 VIVELLE DOT PATCHES (0.1 mg)
6/19/06
REPLACED 3 VIVELLE DOT PATCHES (0.1 mg)
6/21/06
REPLACED 3 VIVELLE DOT PATCHES (0.1 mg)
6/23/06
REPLACED 3 VIVELLE DOT PATCHES (0.1 mg)
6/25/06
REPLACED 3 VIVELLE DOT PATCHES (0.1 mg)
6/26/06
labwork (E2 in the 600s), scan (lining 7mm)
added estradiol tablet (2 mg) as a vaginal suppository, 1 daily at bedtime
6/27/06
REPLACED 3 VIVELLE DOT PATCHES (0.1 mg)
continued estradiol tablet (2 mg) as a vaginal suppository, 1 daily at bedtime
6/28/06
ADDED 1 VIVELLE DOT PATCH (0.1 mg) TO THREE ALREADY PLACED
continued estradiol tablet (2 mg) as a vaginal suppository, 1 daily at bedtime
6/29/06
donor's retreival (14 eggs, only 3 mature: donor probably took hCG late)
REPLACED 4 VIVELLE DOT PATCHES (0.1 mg)
continued estradiol tablet (2 mg) as a vaginal suppository, 1 daily at bedtime
added progesterone suppository (100 mg), 2 times a day (morning and bedtime)
added progesterone in oil (25 mg), IM shot, daily
6/30/06
only 1 egg fertilized
continued estradiol tablet (2 mg) as a vaginal suppository, 1 daily at bedtime
continued progesterone suppository (100 mg), 2 times a day (morning and bedtime)
continued progesterone in oil (25 mg), IM shot, daily
7/1/06
the single embryo continued to develop
REPLACED 4 VIVELLE DOT PATCHES (0.1 mg)
continued estradiol tablet (2 mg) as a vaginal suppository, 1 daily at bedtime
continued progesterone suppository (100 mg), 2 times a day (morning and bedtime)
increased progesterone in oil to 50 mg, IM shot, daily
7/2/06
the single embryo continued to develop
continued estradiol tablet (2 mg) as a vaginal suppository, 1 daily at bedtime
continued progesterone suppository (100 mg), 2 times a day (morning and bedtime)
continued progesterone in oil to 50 mg, IM shot, daily
7/3/06
the single embryo not doing very well
REPLACED 4 VIVELLE DOT PATCHES (0.1 mg)
continued estradiol tablet (2 mg) as a vaginal suppository, 1 daily at bedtime
continued progesterone suppository (100 mg), 2 times a day (morning and bedtime)
continued progesterone in oil to 50 mg, IM shot, daily
7/4/06
nothing to transfer
stopped all meds
7/7/06
began to shed my uterine lining

Needless to say, this was quite heartbreaking. One goes with a donor in part so that one can feel confident that there will be a transfer. At least my clinic is not going to charge me for my next donor cycle. It's important to me that we do what we can to address the issue of the 7mm uterine lining. The people at my clinic seem not to find it too worrisome, since they see pregnancies in women with 6-10 mm linings regularly. However, they do only about 400 IVFs a year, so if the studies you refer to cover more cases, they are certainly to be given a lot of weight. I would like to know what other REs do in situations like this. Having this information would help me to make decisions so that I feel that I am optimizing my chances on the next cycle.

 

B. Jacobs, M. D. - July 14

I would expect the estrogen dose should be enough to grow your endometrium adequately. I do not know why you did not develope a thicker lining. I suppose you might be a bit hypothyroid.
Good luck.

 

teri-chan - July 14

Thank you for the suggestion to check into my thyorid function. My TSH was 0.965 (units?) on CD 2 in September 2005. I was told that was normal. Does it seem low? Do these things change much over time? What are symptoms of having hypothyroidism? Is it something that is generally fairly easy to manage?

Thank you VERY MUCH.

 

B. Jacobs, M. D. - July 14

TSH is the hormone that stimulates the thyroid gland to secrete thyrois hormone. If yor TSH were low, you would be hypothyroid. Your TSH is in normal range.

 

teri-chan - July 17

Hmmm. I thought that a high TSH would indicate hypothyroid. As I understand it, TSH is thyroid stimulating hormone, which is HIGH when your thyroid is UNDERproducing the hormones it should make.

 

B. Jacobs, M. D. - July 17

Oops! My error. That's what happens when I get interrupted. Yes, elevated TSH means your thyroid is not making enogh hormone. I am sorry for the confusion I caused.

 

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