During natural cycles, cycle monitoring, IUI, IVF & FET
Uterine (or endometrial) lining thickness is a useful predictor of embryo implantation and miscarriage prevention. It is measured via ultrasound during cycle monitoring, IUI, IVF, and frozen embryo transfers. A thin lining can halt the entire fertility process, and not seeing any growth in thickness, despite medical efforts, can be really frustrating.
Uterine lining thickness varies depending on the phase of your menstrual cycle and hormonal influence.
On your period: 2-4mm
Follicular phase (before ovulation): 5-7mm
Ovulatory phase: 7-11mm
Luteal phase (after ovulation): up to 16mm
A lining < 8mm is associated with implantation failure, poor receptivity, and low pregnancy rates. The numbers aren’t the only measurement that matters. The endometrial pattern is also relevant; the most receptive lining is called triple-line or tri-laminar (due to its 3 layer appearance).
The most common pharmaceutical approach to a thin lining is supplementation with synthetic hormones; conjugated estrogen, progestin, or a combination of both like the oral contraceptive pill. Viagra is also used to increase pelvic blood flow (it ain’t just for men!) Not all women respond to these options, but thankfully there are natural alternatives. Naturopathic medicine and fertility supplements can be used in conjunction with hormones or alone to optimize your lining.
A 2017 study showed that 12 weeks of low-dose vitamin E supplementation in women with prior implantation failure increased endometrial thickness by 2mm and decreased inflammatory cytokines.
A pilot study in 2010 used high-dose L-arginine to increase endometrial thickness and pelvic blood flow.
NAC is a super-fantastic-marvelous supplement. It has proven to improve endometrial thickness (pertinent here) as well as: induce ovulation, recruit mature follicles, reduce insulin sensitivity, and break down endometriomas! Woah!
Fruit: lemon, lime, orange, pomegranate, watermelon
What do all of these fruits have in common? They are nitric oxide producers. Nitric oxide dilates your blood vessels so more blood can be delivered to your uterus to build up that lining. Viagra works the same way, which means pomegranates are nature’s Viagra!
Acupuncture (including electro-acupuncture)
Fertility acupuncture is used to support embryo implantation and promote pelvic blood flow. It supports endometrial thickness by reducing stress on the uterine artery. Multiple studies have shown a statistically significant increase in pregnancy rates with acupuncture before embryo transfer and on the day of transfer.
When all else fails, remember that lifestyle makes a huge difference! Simple strategies like drinking at least 2L of water daily and moving your body with gravity can increase endometrial thickness.
Book an appointment to support your uterine lining!
Jimenez, P. T., Schon, S. B., Odem, R. R., Ratts, V. S., & Jungheim, E. S. (2013). A retrospective cross-sectional study: fresh cycle endometrial thickness is a sensitive predictor of inadequate endometrial thickness in frozen embryo transfer cycles. Reproductive Biology and Endocrinology, 11(1), 35.
Zhao, J., Zhang, Q., & Li, Y. (2012). The effect of endometrial thickness and pattern measured by ultrasonography on pregnancy outcomes during IVF-ET cycles. Reproductive Biology and Endocrinology, 10(1), 100.
Al-Ghamdi, A., Coskun, S., Al-Hassan, S., Al-Rejjal, R., & Awartani, K. (2008). The correlation between endometrial thickness and outcome of in vitro fertilization and embryo transfer (IVF-ET) outcome. Reproductive Biology and Endocrinology, 6(1), 37.
Hashemi, Z., Sharifi, N., Khani, B., Aghadavod, E., & Asemi, Z. (2017). The effects of vitamin E supplementation on endometrial thickness, and gene expression of vascular endothelial growth factor and inflammatory cytokines among women with implantation failure. The Journal of Maternal-Fetal & Neonatal Medicine, 1-8.
Takasaki, A., Tamura, H., Miwa, I., Taketani, T., Shimamura, K., & Sugino, N. (2010). Endometrial growth and uterine blood flow: a pilot study for improving endometrial thickness in the patients with a thin endometrium. Fertility and sterility, 93(6), 1851-1858.
Nasr, A. (2010). Effect of N-acetyl-cysteine after ovarian drilling in clomiphene citrate-resistant PCOS women: a pilot study. Reproductive biomedicine online, 20(3), 403-409.
di Villahermosa, D. I. M., dos Santos, L. G., Nogueira, M. B., Vilarino, F. L., & Barbosa, C. P. (2013). Influence of acupuncture on the outcomes of in vitro fertilisation when embryo implantation has failed: a prospective randomised controlled clinical trial. Acupuncture in Medicine, 31(2), 157-161.