What is thin endometrium ? what are Various medical therapeutic strategies that can be used !
Trying to define an optimal endometrium in which to transfer a good embryo has been a goal for researchers. Since ultrasonography became available, both endometrial thickness and pattern have been intensely evaluated. Early research quickly identified that the hypoechogenic endometrium was more receptive than the iso- or hyperechogenic endometrium . However, no agreement has been reached on endometrial thickness. Although most clinicians empirically prefer endometria >7 mm, available evidence does not support any specific thickness, as pregnancies with similar success have been described from 5 mm to more than 15 mm.
The most frequent cause of refractory endometrium lies in its surgical origin through the development of intrauterine adhesions. Patients receive radiotherapy below the diaphragm owing to malignancies such colon cancer or endometrial cancer can suffer different side effects, resulting in the lack of a functional uterus. . Chronic endometritis may hamper endometrial receptivity and may cause infertility.
Various medical therapeutic strategies that can be used are :
- High oestradiol doses
- HCG injection in the proliferative phase: Recent observations have suggested that HCG is also produced by endometrial epithelial cells in the secretory phase, where HCG/LH receptor mRNA and protein have been identified ( Paiva et al., 2011 ). HCG would play a local paracrine role in differentiation and endometrial receptivity by regulating different cytokines and growth factors. Licth et al. (2007) demonstrated that an intrauterine injection of 500 IU of HCG inhibited insulin-like growth factor binding protein-1 and macrophage colony-stimulating factor, and stimulated the secretion of leukaemia inhibitory factor, vascular endothelial growth factor (VEGF) and MMP-0.
- Granulocyte-colony stimulating factor (G-CSF)
- Autologous platelet-rich plasma
- Platelet-rich plasma (PRP) collected from a peripheral vein, through activating platelets by clotting, releases cytokines and growth factors, including VEGF, transforming growth factor, platelet-derived growth factor and epidermal growth factor
- Acetylsalicylic acid (ASA) steroids, vitamins and supplements
- Low-dose aspirin might enhance endometrial growth and embryo implantation via a triple mechanism of action: reducing subendometrial contractility, minimizing inflammation by inhibiting cyclooxygenase and prostaglandin biosynthesis and improving uterine endometrial blood flow
- Pentoxifylline : Pentoxifylline is a synthetic derivate of methlyxanthine that inhibits phosphodiesterase by increasing intracellular cAMP. It has a vasodilating effect and increases red cell membrane flexibility, while reducing blood viscosity by inhibiting red cell aggregation.
- α-Tocopherol, or vitamin E, is an exogenous liposoluble molecule with antioxidant effects as it blocks oxygen free radicals, as well as acting as a vasodilator
Surgical strategies :
- If intrauterine adhesions are suspected, hysteroscopy assessment and treatment must be performed. Hysteroscopic scissors are preferred to electrosurgery to avoid thermal endometrial damage. To prevent adhesion recurrence after adhesiolysis – several methods have been proposed, such as intrauterine device, intrauterine balloon stent, hyaluronic acid and anti-adhesions barriers, hormonal treatment, stem cells and G-CSF.
- Mobilizing endometrial stem cells from bone marrow Endometrial reconstruction has been recently suggested as a promising option for achieving pregnancy in the uterus of women with severe endometrial damage, such as those with Asherman syndrome or atrophic endometrium. Sources for endometrial cell reconstruction which have been proposed are bone marrow-derived stem cells, Human embryonic stem cells
- Uterine transplantation : It is considered in cases of absolute uterine factor infertility which includes non-functioning or non-existing uterus cases, such as uterine agenesis (Mayer-Rokitansky-Küster-Hauser syndrome; MRKH) or hypoplasia, previous hysterectomy and severe intrauterine adhesions.
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