Is it do-able to increase lining thickness in a few days?

[GlummyMummy]

Day 8 scan today and lining is only 6.4mm

Egg collection on Monday-is there anything I can do over the weekend to bring the lining up a bit? Have read several things about thickening lining but most of these refer to things to do after egg collection and before embryo transfer.

Also, is it best to freeze any embryos we get if lining is going to remain thin?

Hi GlummyMummy - I've tried various things for lining in past ivf cycles but not sure how quick the effects are.

Best thing I've found is selenium supplements - you can find them in Holland and Barratt and places like that. I've also read that dairy is supposed to help, so full fat milk, etc (although I think that's more protein to help the eggs).

I'm sure some more experienced ladies will be along to help, but I'd defo try the selenium. Good luck! X

Ooh and your clinic will likely advise on whether you should freeze - I think they all have varying minimum levels you need to get to before they'll do a transfer but mine was 7mm x

Hi Glummy Mummy, I'm in similar situation to you but post EC. Had EC on Wednesday and our embryos are on Day 2 today. My lining is at 5.4 so unless I can thicken it by my scan/potential ET on Monday I'll be freezing everything. I also had some fluid in my uterus which is almost gone but lining is the issue now. My acupuncturist advised me to put a hot water bottle on my lower abdomen, lots of leafy greens and red meat. I've also been drinking pomegranate juice and Brazil nuts. I've been taking Progynova for a few days now and the delightful tablets you stick up your bum and today they've given me 2 patches to wear and then 2 to wear on Sunday. But let's see - I can't imagine it'll thicken up in time so I'm really disappointed. Had so many issues during my first cycle it's been such a roller coaster. If doesn't thicken and we freeze thinking about having a hystoscopy (think that's what it's called) and then we'll do FET when we can sort my other issues out!! You've got time so fingers crossed you can use those tips and all goes well for you. Thinking thick! xx

In my second IVF cycle I had lining of 5.5mm at EC

Oestrogen tablets took me to 8.5mm by day 4 and we transferred the following day - got my BFP 9 days later

Sadly I miscarried, and currently facing a cancelled FET unless I've had a miracle lining turnaround, but on my fresh cycle in Jan I definitely saw a significant turnaround in the space of 4 days

Good luck

And yes if the endometrium is suboptimal definitely best to freeze all

My lining scan at day 4 was to decide if we would transfer the following day or the embryo(s) would go straight into the freezer

My consultant said he wouldn't risk transferring unless he was confident in the quality of the endometrium

His absolute minimum was 7mm, preferably 8mm, ideally 9mm

My lining scan tomorrow will confirm if we have to cancel this FET or not - my lining was 6mm and not triple line on Tues, having had no movement whatsoever in 12 days - so unless it's a decent thickness and trilaminar, we won't risk transferring into a suboptimal uterine environment

Fingers crossed for you banana fish! What are you doing to help? I'm having a scan on Monday (day5) to see if improved and thickened up/ got triple layer. If it hasn't then into the freezer the embryos will go. I'm already on my second warm water bottle of the day!! But not holding out much hope to be honest.

I know viagra is used by a lot of private clinics to increase the lining - maybe request next time (hoping there won't be a next time of course). People who cycled at the same clinic as me doubled their usual lining with it.

Not heard of that but I'll ask! They have given me the option of a hystoscopy ( or something that sounds like that). To see if there's any polyps or anything on my lining which may also explain the fluid. Have you had one? I'm just being impatient really and so wanted to go for ET. You feel like the whole IVF process gears up for that and when it's taken away it's so upsetting. But have to do what's best I know. X

We abandoned an attempt at a normal medicated FET as I didn't respond to the oestrogen pills or patches

Dr said some women don't respond to artificial oestrogen on its own, but do when their body's own natural oestrogen is in the mix

So we're now trying an ovulation induction FET - stimming me very gently (on an ovulation induction dose of Gonal-F, rather than an IVF dose) to try and stimulate follicles to produce natural oestrogen to thicken my lining that way. At my day 8 scan there was no movement so we added in progynova x 3 times daily

At my day 12 scan, despite three mature follicles, there was no movement

I'm expecting the cycle to be cancelled tomorrow when I go in for a scan

I've tried all the usual interventions for lining over and above oestrogen (viagra, l-arginine, vitamin E, selenium, Pomegranate juice, red raspberry leaf tea, iron rich foods, heat packs, acupuncture, mayan abdominal massage etc etc) - however as these all work on increasing uterine blood flow, and colour Doppler has shown my uterine blood flow is fantastic, they don't make any difference.

My issue is an oestrogen issue. We know my lining CAN thicken up when there's a shitload of natural oestrogen in the mix

Jan fresh cycle : 17 follicles plus progynova = 8.5mm + BFP
May fresh cycle : 28 follicles = 11mm (freeze all for PGS)

I expect the cycle to be cancelled tomorrow and would guess our next step is to do full IVF stims to grow more follicles - as apparently I don't produce enough oestrogen from just a small handful

BTW I've had a HyCoSy and hysteroscopy to check for adhesions, and thankfully my endometrium wasn't left with scarring post ERPC

Just desperately hoping we can get my lining to respond next cycle with higher stims.

(Obv hoping for a miracle at tomorrow's scan but that's not likely to happen!)

Also plan to ask my consultant about a G-CSF uterine wash as a rescue treatment, but as it's very experimental, I can't see him recommending it

BTW lolly your lining won't have triple layer at this stage - once you've started progesterone the lining starts compacting and changes appearance, so you're only looking for triple stripe before EC. Good luck!

Ah ok. Well I didnt have it before EC then! Sooo annoying this lining situation. Going for a walk to acupuncture now. Waiting for the call about how our embryos are doing today (Day 3) X

thanks for all the info folks. My clinic haven't offered me anything to take or to check blood flow levels, so I'm just relying on diet and hot water bottles at the moment! My clinic say anything over 7mm is okay for them but think I'd prefer it a bit thicker to be honest!

Drinking lots of full fat milk, water, pom juice and eating plenty protein, brazil nuts etc. Fingers crossed! Anyone had a BFP with lining of 7mm?

If we get a top quality embryo, it seems a shame to potentially "waste it" if lining is the thin side of normal according to clinic.

I've read most of Pubmed studies on thin lining and the consensus is that 7mm is the lower end that clinics should transfer at. Plenty of clinics transfer at 7mm so there will be many many BFPs at 7mm! The studies said pregnancies have been recorded as low as 4mm, but the odds obv decrease the thinner the endometrium

It also depends on the appearance - for some Drs a strong triple line is more important than an extra mm

If they're scanning you it should be easy enough to check the blood flow - my Dr just flips a button on the ultrasound doodah to use colour Doppler to check the blood flow. It's not a special test - it's just another thing to look at during the scan

Are they not willing to give you any oestrogen pills or patches at all?

If you're paying for treatment, I'd have thought it was in their interests to give you additional lining support to increase the chances of success. Can you push for some progynova if they're being difficult?

Good luck! Xx

Going to ask them for progynova - have others found that helps?

Also, does anyone happen to know, does the lining continue to thicken by itself between egg collection and embryo transfer or does it just stay at the same level once eggs are removed?

Mine thickened up from 5.5mm at EC to 8.5mm at day 4 thanks to Progynova

I'm praying that mine thickens like banana fish! It was 5.4 at Day 2. Been taking Progynova and they also gave me these patches to wear as well. I've had acupuncture, red meat and leafy green and also raspberry leaf tea and Brazil nuts. It's day 5 tomorrow - having a scan in the morning to see whether it's thickened enough for ET. Seems unlikely the doc said but I'm so praying.

That's quite an increase with progynova...I'm guessing it won't thicken beyond egg collection by itself then, without medication?

The lining stops thickening by itself by trigger - it's oestrogen that thickens it, once it's under the influence of progesterone it will compact and get thinner (and lose its triple line appearance)

Unless you're taking supplementary oestrogen it won't thicken after trigger, no

My FET got cancelled

We are trying a G-CSF uterine wash as a rescue treatment - even if the wash does work to thicken it up, we still won't transfer, as we don't want to risk transferring into a suboptimal uterine environment and risking another miscarriage. But if it is effective then we may end up adding in the uterine wash to the protocol next time

And if nothing else it serves as a two for one, as a saline ultrasound, so the Dr can have a better look at the uterine cavity and examine the endometrium more closely, in order to decide next steps.

Will report back on how the G-CSF wash goes!

oh no, banana - that's a shame. Sounds like your Docs are doing everything to help though. That's useful, so essentially eating specific foods to help lining after EC is basically pointless then?

Honestly I don't know about lining thickening foods - I only know about the hormonal side of things. I just know that endometrium is in the proliferative phase under the influence of oestrogen, which is what causes it to thicken, and then under the influence of progesterone it compacts and enters the secretory phase, where it becomes receptive to implantation

I have no idea how food plays into the different phases or by what mechanism they're supposed to work

I'm sure food can't hurt - my lining has always needed rather more drastic intervention than avocado and Brazil nuts sadly!!

So it basically reaches the thickest it's going to be at egg collection, and then after that is compacting and ultimately thinning after embryo transfer?

Wonder if the supposed thickening foods might actually prevent it compacting properly and ultimately have a detrimental effect on implantation?!?

If the foods do anything at all, it's to help blood flow. Which will help the lining at any stage.

It comes back to the original question of why the lining is struggling

• poor blood flow?
• not enough oestrogen?
• structural issue eg following a D&C or C-section

Raspberry leaf tea and avocado - if they do indeed do anything at all - can presumably only help with the first of these

I'm sure they won't do any harm!

But really for thickening lining for a transfer the clinic should be able to give you the necessary support - Brazil nuts are great but I don't believe they're going to be any match for oestrogen pills or patches

I can only think the lining is struggling due to a structural issue following childbirth in 2014. Might explain why lining is still no thicker despite having double the number of eggs.

Asked clinic about patches etc but they maintain my lining is fine and they are perfectly happy with it! They are very much "one size fits all", even if you offer to pay for extra things. They also said my lining will continue to grow after EC - bit sceptical though it did grow 2mm between EC and ET last time round.

Have you had a saline ultrasound or (gold standard) hysteroscoy to check out the uterine environment?

Great that your clinic aren’t concerned - hoping your lining plumps up that little bit extra before ET

not been offered a hysteroscopy at all Bananafish - they aren't very good at offering anything to be honest!!

Had ET today so lining made it up to 8.6mm from 7.5 at EC. Thinner than both our previous attempts so not holding out much hope (though I did have the endo scratch this time). Clinic said lining looked fine and had the triple layer etc. The good news is I have an embryo to freeze though so if this doesn't work we can concentrate on thickening lining. I am convinced I have a mild-ish form of Ashermans so not sure if there's much they can do for that.