Thin lining

[bicyclesandbeyond]

Wondering if anyone on here wants to swap stories on their experience with thin endometrial lining?

I did a freeze all cycle in May and was lucky to get 4 blasts frozen.

FET 1 - medicated, lining got to 7.3mm on CD11, ended in ectopic
FET 2 - medicated, lining only got to 6.7mm by CD18 so cycle abandoned
FET 3 - natural, lining only got to 5.4mm by ovulation so cycle abandoned

I've got a consultant appointment tomorrow to discuss next steps.

So far I've tried Vit E, l-arginine, pomegranate, beetroot, extra exercise, less exercise etc etc.

As far as I can tell options are going to be:
a) Another medicated FET with a shed load more oestrogen from the start
b) FET with low dose stims
c) Tamoxifen at the start of the cycle

Would love to hear from anyone going through similar, has had success, or experience of the above options! It's a frustrating issue to have with 3 blasts waiting in the freezer... thanks to anyone who has some thoughts on this! X

When you say you had a Medicated cycle, what oestrogen were you on for building lining? My clinic's standard protocol is 3 x 2mg oestrogen tablets for the ten days. I had a rubbish response to this as I suspected I would because my natural lining is thin. Abandoned that cycle and pushed for oestrogen patches for the next try. I went on 100mg patches every other day along with the tablets and had a lovely lining for the next two cycles (first FET didn't stick but the second one did 😊).

Meant to add, at the advice of my fertility acupuncturist I also took daily Spatone iron supplements for a few weeks before and during the cycles.

Thanks @SamoyedFan123
In my 1st medicated cycle I was on 2mg progynova three times daily and got to 7.3mm. On my 2nd medicated I started on this dose but only got to 6mm so increased to 2mg four times daily plus patches, then 2mg five times daily plus patches before we gave up at 6.7mm in CD18. I wonder if I just need to start on top dose straight away...

Ah okay you were on the patches then. I asked this same question about taking extra tablets and they said that an extra 2mg tablet a day would be insignificant compared to the 100mg the patches were putting out (makes sense!) I think it was more about the absorption from the patches to be honest in my case. Not sure what the next best step would be for you i'm afraid then, but I really hope you find the answer soon xxx

Thank you @SamoyedFan123
I think the patches actually release 100 micrograms per 24 hours, rather than 100mg, but I get your point - different routes may result in better absorption. Fingers crossed for next time...

Cycle 1 - I got to 7mm on my ivf cycle - that was with 42 follicles, I had to have an extra week of stims to get my lining up.
Cycle 2 (FET) - double dose oestrogen I got to 4.2mm after 2 weeks - cycle cancelled due to Covid
Cycle 3 (FET) - they threw all the oestrogen at me. I had double dose, pessaries and patches. My lining got to 7.5mm. Transfer was unsuccessful though.

Just about to start my next FET which will be the same as cycle 3.

I supplement with:
L’argine, vitamin e, red leaf tablets, conception vitamins plus pomegranate juice.

Thanks for the reply @Mancbear88
Sorry to hear your recent cycle wasn't successful. Do you mind me asking how much oestrogen you were on for it? My clinic want me to start on 2mg four times a day this time, rather than three times a day like last time. Did you start higher than this? Did they put you on patches straight away?
Also interested to know what dose of l-arginine you took? I've read It starts with the egg and that suggests 6g daily! Seems like a lot! Is this what you took? Sorry for all the questions. I hope your next FET goes well xx

Yep I was on 4mg three times a day, plus patches of 150mg every other day from the start and 4 pessaries twice a day (10mg). It was two weeks last time then added on progesterone. So really quite a bit above standard, but got to 7.5mm.

I’ve been taking 2 1000mg tablets per day. I’ll be honest that’s not with any medical input I just read it was good and bought a bag online, so maybe take that with a punch of salt!!

Wow that does seem like a high dose but at least it did the job! I'm convinced my lining is resistant to oestrogen due to many years on the contraceptive pill, although my consultant isn't so sure about that theory. Fingers crossed for both of us on our next rounds! X

@bicyclesandbeyond I think the fact that your lining did increase is a good sign. Before I was referred my consultant did a test where I was on oestrogen and my lining increased, not massively but to about 5mm. He said that was a good sign as if it doesn’t increase at all it’s a bad sign, but any increase then it’s most likely just about getting the dose right. So fingers crossed by increasing the dose your lining will get there!
Good luck

Thank you @Mancbear88 you've made me feel more hopeful

@bicyclesandbeyond - I've had 2 FETs cancelled due to thin lining. Highest I've ever got is 6.4mm during stims. During both FETs my lining did increase initially but then decreased as time went on. I've been referred for a hysteroscopy now.

There's nothing in my history to cause a thin lining but I've been referred to check for scarring.

It's so frustrating! Last protocol I was on higher dose of progynova and patches - I really thought that would do the trick but it never got higher than 5.4mm.

Sorry to hear you are having the same issue @BewilderedBee, I agree it's very frustrating! Like you I don't have any reason for scarring etc - no history of d&c etc. Are you with the NHS or a private clinic? And it is your IVF clinic doing the hysteroscopy or have you had to arrange a separate gynaecology referral?
I've read about using tamoxifen or giving low dose stims to grow the lining so it might be worth asking your clinic about these?

Out of interest did you have a long time on the combined pill? I'm convinced this the cause for me - I was it it for 15 years and reckon my lining just doesn't respond to oestrogen any more.

We have had our treatment with a private clinic, while on the nhs waiting list. We're in wales and our private cycle doesn't affect our nhs funding. But the nhs were due to call me up this month but it's been put on hold as they also agree I need the hysteroscopy! So I've been referred for a hysteroscopy on the NHS. Unfortunately the private clinic don't do the procedure so I've also got a private consultation beginning of Feb. What's your next step? I have heard of that drug before actually. I'll def have to ask about it. I've also heard of using blood thinners.

And yes I have been on the pill for a long time, perhaps 5 years off it though in the last 17 years (2 and a half years TTC) x

My next step is another attempt at a medicated FET but with a higher dose of oestrogen + 75mg aspirin daily. If that doesn't work it might be a cycle with mild stims.

This is the tamoxifen study: www.researchsquare.com/article/rs-12047/v1

I'm in a similar position to you - doing private IVF but waiting on NHS list. I do wonder if I need a hysteroscopy although I really can't imagine they'll find anything helpful... X

Just thought I'd post an update that I have now had a hysteroscopy and nothing found to explain a thin lining. They did an endometrial scratch at the same time and I'm now doing another FET.

Hi @BewilderedBee
Hopefully with close monitoring and some long-overdue good luck the FET can proceed this time.

I’m glad you posted today to bring this thread back up @BewilderedBee

There’s a nice article here about various ways to treat a thin endometrium: www.sciencedirect.com/science/article/pii/S1110569017302947

From what I’ve read some women just don’t respond to oestrogen.

I only just found out that my endometrium thickness is an issue, me and DH were TTC for 12 months my original scan showed a lining of 5.4mm and that was 9dpo (but it was missed so I only just found out). I’ve had an unsuccessful fresh cycle and then an unsuccessful FET. In the FET I got up to 7mm on 2mg oral estradiol three times a day which made me vomit, then they put me up to 2mg 5 times a day. I got up to 8.1mm, I later found out that the doctor doing my transfer thought the lining looked very thin, so it looks like it’s shrinking when I start progesterone.

I’m doing a mock cycle for an ERA right now, this time I’m on 100mcg patches every 72 hours and 2mg orally three times a day. I’m also on aspirin 75mg. I’ve added in 800mg of vitamin e and L-arginine 1g a day.

Diet wise I’m going to try to have:

• a smoothie with spinach, spirulina, flaxseed, date, banana and strawberry for breakfast.
• 5 x Brazil nuts
• 350mls pomegranate juice
• 350mls beetroot juice
• a grain dish with fresh veg for lunch
• anything I want for dinner

I’ll see how I get on with that when the nausea starts! I’m also planning on doing castor oil packs and trying to keep as warm as possible, I have raynauds so I worry that the small blood vessels are affected. I’m also due to see an acupuncture specialist this Tuesday.

My first fet I was on 2 patches a day, my lining got to 7.1mm.. they tripled it up and a few days later it was 7.9 but was cancelled due to catching covid. My second fet I was only had 6.4 at my first lining check with 3 patches to begin with. They then doubled it up, added 2mg of estrogen pills twice a day and viagra suppositories and I took aspirin the whole time. The next appointment I got to 7.1 but they started noticing a little bit of fluid. Cycle was delayed and I came back 3 days later to have the mucus aspirated. But now there was toooo much to aspirate. My focus then went from increase lining to get rid of fluid in 3 days. Cue the mucinex, orgasms and abs all that jazz plus they reduced my estrogen because the estrogen caused the fluid. They also started me on progesterone as a Hail Mary and told me to anticipate a failed cycle. I went back 3 days later and the fluid had cleared and my lining was 8.7!!... so yeah that's my story

I am pregnant following an FET with 6.1mm lining (I was on tablets, patches and aspirin but responded badly). The consultant said that triple layer appearance was the most important thing and 6mm was the absolute minimum they would do the transfer so it can work even with very thin lining. Good luck all xx

Hello everyone!

@BewilderedBee thanks for the update. How did you find the hysteroscopy? I'm having one in a few weeks - sounds like it's just done in outpatient clinic with no sedative. I'm hoping it's not too painful. Is this how they did yours?

@Gardenlady543 sounds like you've found all the things I have! Got my fingers crossed for you - keep us updated!

@paitentlywaiting blimey what a rollercoaster of a FET! I hope you've been successful.

@MabelG this is excellent news and gives me some hope! My clinic also says that triple layer appearance and blood flow are most important. Wishing you all the best for your pregnancy!

@bicyclesandbeyond I’m starting to think about a hysteroscopy too, I can see that they’re only recommended if there is an underlying issue. On my original ultrasound it says I have a small 1cm fibroid adjacent to the endometrium, which I assume means submucosal and an arcuate uterus, which they say is abnormal variant, but where there’s something else going on I don’t know. A structural abnormality impacting on the lining appears to be one of the only things left that I haven’t looked into.

I’ll have to see how I get on in the mock ERA/EMMA/ALICE cycle I’m doing right now first, they’re going to try and take a measurement on day 21 and I’m hoping if I can get the endometrium as thick as possible prior to the progesterone starting, then even when it compacts, it should hopefully still be thick enough.

@Gardenlady543 it sounds like your clinic is being really thorough which is great. My clinic really don't seem interested in my concerns about thin lining. They insist that anything above 6.5mm is fine and I've probably just been unlucky. They suggested that 80% of failed transfers are due to embryo quality, and at my age (36) you'd expect half my embryos to be abnormal. It suggests we need to just keep chucking embryos in but I don't want to waste them if lining is actually the problem!

Do you have the ERA done after 5 days of progesterone? Does this involve a hysteroscopy maybe as they take samples of the endometrium? Or do they just poke a biopsy catheter through the cervix 'blind'? Do you mind me asking how much your clinic charges for this? I don't think my clinic does it. I hope you get some helpful information from it.

I'm luckily having my hysteroscopy on the NHS as part of my fertility work up prior to (hopefully) NHS funded IVF. They agreed that with my failed (private) rounds it was worth having a look inside, although all my ultrasounds have been normal so they're not expecting to find anything.