Infertility and Endometrium / Lining Issues

[funkymonk]

Please join here if you are experiencing infertility as a likely result of lining issues... Support and chat needed...

[Salamamder80]

Hello,

I know this post is a little bit older but I am hoping may be some of you are still around as I belong to the thin lining party and after three years of various icsi cycles am evaluating my last options.

Background: I am 38 and my husband is 62. He had a vasectomy 20 years ago. He has.2 children from previous relationship. Me never been pregnant and never tried before I met my husband. Always had a copper coil. This is our cycle history. Me no know issues at the time we started 3.5 years ago.

Cycle 1: long protocol. poor response. Decide not to cancel. 4 eggs 1 fertilised with Tesa sperm. One 2 day embryo frozen due thin lining 4.2 before trigger. Hrt patches and oestrogen pill bring it to 4.8 at EC.

Natural cycle to transfer frozen. Cancelled due to 3.9 lining on day of positive ovulation test.

Medicated fet: lining reaches just 6. Embryo thawed a bit fragmented but carries on diving on day 3. Negative test.

Cycle 2: short protocol increased meds. 7 eggs. 0 fertilisation with Tesa sperm. Immature sperm is blamed.

No more Tesa sperm left. Vasectomy reversal. Successful but low sperm volume albeit good quality.

New clinic and fresh sperm. We banked 20 vials just in case.

Cycle 3: long protocol. 5 eggs. 3 immature 2 fertilise. 2 make it to excellent quality blast and are frozen as lining barely above 5.

Medicated Fet. Cancelled due to thin lining.

Natural fet: lining reaches 5.8 and we decide go ahead with one of blasts. Poor that with a lot if fragmentation after thaw. Negative test.

Natural fet cancelled due to lining not getting above 5.

Natural fet lining reaches just 6. Second blast defrosted beautiful. Negative test.

Cycle 4: long protocol. Cancelled as no response. Amh test shows drop from 9 to 3.

Cycle 5: short protocol only 2 follicles. No eggs at retrival but lining is an 6.8 before collection.

Start taking DEHA

Cycle 6: short protocol
.different medicatiom. 6 eggs retrieved. As per today we have 3 embryos trying to grow. 2 good one slow. Given our 100 percent blasto conversation rate I am hopeful to have 1 or 2 of them this time as we are doing pgs to get certainty if it is the embryos who are the problem or if it is really the lining which means we will have to start considering surrogacy.

We 've tried various things with all cycles and fets. Viagra, aspirin, high progesterone and scratch. Also tried fet with steroids just in case of immune issues and accupuncture.

I had a hysteroscopy after cycle 1 which showed nothing unusual and the obgyn said she does not see any problems for a pregnancy.

To sum it up I will be expected to make many eggs with the low amh which I am fine with of it takes a few more rounds. It seems my eggs are of good quality and we can make blasts. But because I am now 38 I do not want to loose anytime anymore. We are on a 2 cycle programme and my thinking was to try once more a transfer in a natural Fet with a normal embryo and if that does not work I feel like surrogacy is our only option. I could do more tests such as the era etc but I believe we will not learn anything from it.

I talked to our consultant about tamoxfin and gsf wash. He is sceptical. He feels because I have regular cycles and ovulation and don't respond to the artificial oestrogen that natural Fet is my best option.

Sorry for the long post. I am just hoping some of you previous postete have a read and maybe some advice and thoughts for me or even found the magical solution to the thin lining issue.

[Trups1234]

Hi, Is it fine to do acupuncture while taking prognova or Estradiol tablets.
I also had a thin lining in last period cycle hence they didn't transfer.

[Brewski]

Hi, is anyone still using this thread re thin lining. I have been struggling with my lining for 2 years. I had 1 failed FET presumably due to 5mm lining. I've tried it all, viagra- aural and vaginal, LArginine and vit E. Loads of fish oils. Masses of oeastrogen. Accupuncture for years and finally stem cell treatment. nothing has worked for me. Has anyone had any luck. I never took the pill but had a coil, but there seems to be no physical explanation for it. Any story's welcome.

[GlummyMummy]

This thread has been quiet of late, how is everyone? I'm hoping for some advice. Currently on medicated fet cycle, went in for scan today after being on high dose hrt for 9 days, was expecting great things as last time round my lining reached 8mm after a weeks hrt, but was really disappointed as it's only got to a measly 4mm 😞

Can't understand why I would respond so slowly to estrogen when I responded so well only three months ago.

Only things I've done differently this time are no endometrial scratch and no acupuncture....could either of these have made a big difference to lining thickness?

Feeling a bit despondent, kind of think if it's not thickening after over a week in drugs, it's not going to. Clinic just say wait til next week, their protocol is to only really scan after 2 weeks on hrt, I only got an early scan cause I responded so quickly last time.

Anyone else been in same situation or any suggestions on what I should do?

[GlummyMummy]

Thanks! I couldn't seem to find anyone else online on that high a dose!

[bananafish81]

I was on 6mg a day plus patches

Didn't work as I don't respond to artificial oestrogen

So now we do ovulation induction FET

High doses of HRT for FET are pretty standard

Good luck!

[Blondeshavemorefun]

Hi no side effects and yes lining think was 11mm. I always seem to have good linings.

Clinics vary but usually anything over 8mm is ok for fets

For our 5th one we ended up being on 6g a day for over a week longer so actually 30days instead of usual 19/20days for a fet as on holiday and lining still 11mm when came home

Clinic did say it may be too thick and would abanden but all fine and this was the cycle that worked

I always wonder did the extra weeks worth make a diff even tho lining still the same

[GlummyMummy]

Hi Blondes. Did you get any side effects, and did your lining thicken up nicely on it?

[Blondeshavemorefun]

I was on 6g a day for both my fets

[GlummyMummy]

Hi all, this thread has been quiet for a while, hope everyone is doing okay.

I have a question for any of you who have been on progynova. What dose were you on? I've been put on the highest dose for my forthcoming frozen transfer - 10mg, rising to 12mg per day.

[coconut779]

thank you

[bananafish81]

My Dr didn't down regulate me for a FET, there wasn't any need. He doesn't generally do long protocol FET as he doesn't see the need to put patients through unnecessary down regulation, he says a short protocol FET is more patient friendly

Down regging shouldn't make any difference to the lining, it's just to remove any possibility of ovulation, so the clinic has more control over the cycle, AFAIK

[coconut779]

Hi Banafish

Sorry if I am asking something you have already written about. Have you done down regulation? what did you use for this? Did it help with the thickness of the lining?

Thank you

[bananafish81]

The ERA is done in the secretory phase though ie after the initiation of progesterone, when the lining has started compacting. The measurement of the lining at this point is basically irrelevant

The measurement of the lining for transfer is done before you start progesterone, and it's this which counts - ie when it's proliferative

So if the scans were done earlier in the cycle then the biopsy was the ERA biopsy, I wouldn't be surprised if the thickness was inconsistent....

Saline ultrasound is known as an SIS or saline hysterogram (SHG) - worth getting done as it gives a much clearer picture of the endometrium than a standard scan.

[coconut779]

Thank you banabafish81. ...I tried to do the ERA biopsy which is what brought about these inconsistencies ....what is the saline flush and saline ultrasound? I need to research that before we meet with Care and ARGC....Thank you

[bananafish81]

I'm with an independent consultant who works with CARE London - I see him for all my scans and he is responsible for my treatment, but EC/ET are at CARE and it's their lab.

I've got no experience of being treated directly by CARE, but I've been v v happy with all my dealings with them xx

[bananafish81]

Hmm, that’s interesting about your lining being different on the biopsy coconut - if your lining is consistently 8-10mm over multiple different scans, that does seem pretty consistent. But definitely worth pursuing with a new clinic and a Dr who can answer your questions!

Have you had a saline ultrasound? That will enable much better visualisation of the uterine cavity, and show up any uterine anomalies that might suggest a hysteroscopy to diagnose and treat

I had my hysteroscopy yesterday evening, Dr was very pleased, said he was feeling much happier having seen the endometrium was looking so healthy. There were some very very minor filmy adhesions, but these went as soon as he flushed with saline, nothing needed resecting. There was a small calcified area, but again this went with saline flushing, no instruments needed. Copper coil is in, biopsy is done: he said I’d probably feel quite battered as he flushed the uterine cavity out so many times (think he said something like 7?!) and he jacked my cervix open a fair bit

We knew I didn’t have Ashermans syndrome, but we didn’t know quite what to expect when he got in there. So very relieved to hear it’s looking healthy, and we’re at least starting from a solid base. The key test will be if I get a decent period in 3/4 weeks after my first HRT cycle 🙏

Now the coil is in, we’re doing one month of cyclo-progynova and see if I get a bleed. Probably repeat again then take IUD out.

Hopefully then we will do a mock FET. We’ll do endometrial biopsies to see what the lining is actually doing from a histology POV, not just what the scan says it’s doing - one in the first half of the cycle in the proliferative phase, then after starting progesterone he’s recommended we do the ERA biopsy (the one which looks at the lining during the implantation window to see how receptive it is).

Depending on how they go, whether we have to try different combinations of FET drugs if I still don’t respond well to oestrogen (e.g. Tamoxifen), maybe a few months down the line we could be in a position to actually do a treatment cycle for real and put one of our PGS tested frozen embryos back. Until then it’s back onto the bench of boredom I go…

The universe has a funny sense of humour that HRT and contraception are supposed to help me to get and stay pregnant….!

[coconut779]

thank you....we are looking at ARGC and Care Fertility London...anyone on here have experience with either?

[LHReturns]

Coconut, I can promise you that you will NEVER find advice better than Banana's (on most IVF subjects but especially about lining).

So sorry you are struggling but a new clinic plus a print out of Banana's advice with you at your consultation will be a good start!!

[coconut779]

thank you Bananafish81 - my Dr has never tried the dopler ultrasound...we are changing clinics so i will bring it up with the new clinic

I have started Vit E and L'arginine...only taking 3g will increase to 6g.

they always say y lining is 8-10mm but we recently did a biopsy and the lining was quite thin despite the measurements and our consultant cant explain why the significance difference....another reason to change clinics

Good luck with your cycle :-)

I am doing FET

[bananafish81]

BTW what lining are they transferring at?

My Dr's absolute minimum (which the literature seems to back up) for ET is 7mm at trigger / initiation of progesterone. That's an absolute lowest, and really the goal is at least 8mm

[bananafish81]

Hi coconut

Sorry you find yourself here - sadly I have persistent lining issues and have ended up as a bit of an amateur endometrium specialist!!

My consultant measures thin lining exactly the same way as a thick lining - standard TVS (aka dildocam!)

Mine also always checks the uterine blood flow using the colour doppler ultrasound - he just flips a switch on the ultrasound machine and turns it into doppler mode! Checks the uterine artery and helps establish if your issues may be due to compromised blood flow

Are your failed transfers fresh or FET?

I had issues in both fresh and FET: in fresh cycles it was a case of adding in extra oestrogen on top (Progynova tablets) to give my lining a boost

In FET, unfortunately we found that I just didn’t respond well to pills or patches: my Dr said some women don’t respond to artificial oestrogen, but do to their body’s own natural oestrogen. So we had a crack at an ovulation induction FET - using low dose stims to just encourage a couple of follicles to develop, to get my body producing natural oestrogen to thicken my lining (as in a natural cycle), and added some Cetrotide and progynova in on top. Unfortunately my lining is REALLY stubborn, and I didn’t respond well to this, so we had to take very extreme measures - but I am literally the only patient my Dr has ever had where he’s had to do full IVF strength stims just to put back a frozen embryo, so I would ignore this option

The other things we tried were more experimental treatments like a G-CSF wash and vaginal viagra pessaries

These were very much at the more extreme end!

I am now having a copper IUD put in and going on a couple of months on cyclo-progynova to try and work on my lining. Sigh.

I will be taking the 1000u (600mg) and 6g of l-arginine as well. The l-arginine comes in 1g tablets which are like horse pills so with 6 of them that’s a lot of pills!!!

xx

[coconut779]

Hi All

Great to find this thread....my clinic cant seem to get the right measurement of my endometrium and we have had 3 failed transfers. I suspect it is due to a thin lining.

What can i take to improve the thickness of the lining? already taking 800 units of Vit E per day...How much of L'arginine?

Does anyone know how their consultants measure a thin lining? Is it with the normal transvaginal scan?

Thank you

[bananafish81]

Thanks lovely. Wasn't expecting this one to be viable but you can't help but hope?

I'm just really sad. It's the second chromosomally normal embryo that hasn't made it and so it's my body that can't look after them. And I don't know how we fix it. We know the uterine environment looked good on a scan but obv something isn't right. Yes I had a bleed before this cycle (which is why we cancelled the hysto and started a treatment cycle), but we don't know why I didn't properly shed the 11mm of lining I grew in my May cycle - why I just got a day of black clots, and although lining thinned, I never got a bleed. 

There's other questions which we'll discuss in the follow up. Given I did successfully propagate a pregnancy into crappy lining with no immunes, but didn't into supposedly decent lining with pred / intralipids, question is whether they left me over suppressed. Prof Quenby and Brosens at the Coventry implantation / RM clinic say if uNK cells are on the low end (even if peripheral blood levels are high) that you need some inflammation for successful implantation, and that in some cases pred and intralipids can do more harm than good. I'm not sure that going to their clinic for the endometrial biopsy for uNK cells would add any clarity - from stalking the Quenby threads on FF it seems it could raise more questions than answers. Quite a few women get wildly different levels of uNK cells from one month to the next - which of course doesn't get you any closer to identifying whether pred would or wouldn't be beneficial in a treatment cycle. I'm minded to use my own history as a diagnostic - we know the embryos were both normal, so given I had decent implantation without immunes but didn't with immunes, I think if / when we eventually get to another treatment cycle 

Hoping if I’ve stopped the progesterone on Fri I will get some kind of period next week. The hCG was low so there can’t be much to pass, I’d have thought?

Follow up consult is arranged for a week on Friday - hopefully I’ll have had a bleed by then, but if not then we can see what’s going on when he scans me and take it from there. He’s put us in for the last appt of the day so we can take as much time as we need, he said he wanted to meet up so we could review everything step by step, and discuss where we go from here.


If I get a bleed then I will restart progynova (plus pentoxifylline and vitamin E) on day 2, to start to prepare the lining for a hysto & potentially a coil.

If I don’t get a proper bleed that’ll be a pretty important diagnostic tbh (as well as the quality of whatever bleed I do get)

I don’t think I will be able to cycle again for a while, as we really need to work on the endometrium - we can’t keep doing rounds of stims with EC just to put back a frostie, and we need to get me menstruating properly. Ideally if we do the IUD plan I imagine we’d want to have another crack at a dummy medicated FET, to see if I respond better to HRT. We’d also mooted the idea of a Tamoxifen cycle, so that’s on my ever-growing list of questions.

Back onto the bench of boredom I go!!

[GlummyMummy]

Aw Banana, just seen your update on another thread - totally gutted for you, after you pulled out all the stops too for this one. Hope you are managing to stay positive, thinking of you.

My clinic have a waiting list for FET so looks like starting November on long protocol so be around Christmas time before anything really happens (Happy Christmas to me.....mince pies and HRT!!!!)