ENDOMETRIAL RECEPTIVITY: Explaining Unexplained Infertility.
WOJUADE KEHINDE SAMUEL
Fertility Scientist at ABIMS FERTILITY & GAMETES BANKING SERVICES (ANDROLOGY)
ENDOMETRIAL RECEPTIVITY: Explaining Unexplained Infertility.
Many infertility patients wonder why conception fails, after taking all doctor’s prescriptions and recommendation that guides the process of getting pregnant.
There is a silent area which is vital in fertility investigation, many of us don’t really pay attention to. This is endometrial thickness of the womb (uterus). Our most concern in follicular tracking is the size of the follicles and which of the ovaries are actively functioning. A matured follicle is considered to be between 18-22mm in size, which can be released at any time. The thickness of the endometrium at this time plays major role in implantation of embryo. If your endometrium thickness is low post-ovulation, this poses a failure to achieve conception.
The endometrium or uterine lining plays a key role in reproduction since the embryo must implant into the endometrium to initiate a pregnancy. Endometrial thickness is a commonly measured parameter during gynecological imaging. It is an important factor for diagnosing the causes of abnormal uterine bleeding. Also, the thickness of endometrium changes every month throughout a woman’s fertile years.
The endometrium undergoes various morphological and functional changes during menarche. As the level of sex hormones changes in the body during ovulation, the thickness of the endometrial lining also changes to enable the implantation of the fertilized egg. If fertilization doesn’t happen, then the endometrium lining (functional layer) sheds, leading to menstrual flow. The morphology and thickness of the endometrium remain constant before puberty and in menopause.
When you have follicular tracking done, always pay attentions to your endometrium thickness value, rather than size of the follicles and the ovary that harbors the egg. If your endometrium thickness is less than 7mm, you need to cross check your progesterone hormone, this could lead to luteal phase defect.
The normal thickness of endometrium varies at different stages of the menstrual cycle in premenopausal women. The normal endometrial thickness measurements are: (i). During menstruation 2 – 4mm, (ii). Early proliferative phase (day: 6-14) 5 – 7mm, (iii). Late proliferative/Preovulatory phase Up to 11mm, (iv). Secretory phase (ovulation) Up to 16mm.
Study has shown that, the rate of implantation, clinical pregnancy, and ongoing pregnancy was higher among women who had an endometrial thickness between 8-14mm. The pregnancy rate was negatively affected among the women with stripe’s thickness less than 7mm. Endometrial thickness can also be used as a predictor for normal intrauterine pregnancy if there are vaginal bleeding and sonographic diagnosis of pregnancy of unknown location.
If your endometrial thickness is poor, do 14th day progesterone and 21st progesterone if your cycle is 28 days. If your cycle is not 28 days, chat me I can help you count/determine your 14th day and 21st day from your menstrual cycle. The result of this hormone will give an indication how poor or bad is your luteal phase. The luteal phase begins as the egg starts traveling down the fallopian tube. This phase ends when your next period begins. A normal luteal phase can last anywhere from 11 to 17 days. In most women, the luteal phase lasts 12 to 14 days.
Your luteal phase is considered to be short if it lasts less than 10 days. In other words, you have a short luteal phase if you get your period 10 days or less after you ovulate. A short luteal phase doesn’t give the uterine lining a chance to grow and develop enough to support a growing baby. As a result, it can be harder to get pregnant or it might take you longer to conceive. A long luteal phase may be due to a hormone imbalance like polycystic ovary syndrome (PCOS). Or, a long lapse since you ovulated could mean that you’re pregnant and you just haven’t realized it yet. The length of your luteal phase shouldn’t change as you age. But your progesterone levels during this phase may drop as you get closer to menopause.
You can see the relationship between progesterone level in connection with luteal phase and the growth (thickness) of your endometrial lining for conception to occur. There is medication that can enhance the supportive ability of endometrium and adjust your luteal phase defect.
(Read my write-up on luteal phase defect for more information.)
References:
1.https://www.healthline.com/health/womens-health/luteal-phase.
2.https://www.momjunction.com/articles/endometrial-thickness-pregnancy_00471817/
3.Role and functional anatomy of the endometrium; Universities of Freiburg, Lausanne and Bern.
4.Dr Henry Knipe, Dr Yuranga Weerakkody, et al.; Endometrial thickness.
5.Yu Wu, et al.; Endometrial thickness affects the outcome of in vitro fertilization and embryo transfer in normal responders after GnRH antagonist administration.
6.Moschos E, Twickler DM; Endometrial thickness predicts intrauterine pregnancy in patients with pregnancy of unknown location; NCBI (2008)
WOJUADE KEHINDE IS THE CEO/MD OF ABIMS UNIQUE MEDICAL LABS SERVICE/ ANDROLOGY
37 AKINREMI STREET ANIFOWOSE IKEJA. Whatapp/call: +2348023026235. +2348077047724. www.abimsuniqe.com [email protected].