What should lining be for ivf




















During an IVF attempt the uterine cavity is evaluated to ensure that proper development of the lining occurs. Studies suggest that a uterine lining thickness of 6 mm or less results in fewer pregnancies. Therefore, most providers would prefer to have a uterine lining of at least an 8 mm. Likewise, the sonographic pattern of the uterine lining is evaluated by ultrasound multiple times during the IVF cycle. A tri-laminar or triple line pattern on ultrasound is suggestive of a uterine lining that has developed appropriately in response to increasing estrogen levels during the IVF cycle.

Unfortunately, not all patients achieve an adequate uterine lining thickness or tri-laminar pattern. This has lead many providers to look for ways to improve the appearance of the uterine lining with adjuvant therapies.

Days 5 and 6 embryos are the best, they are biopsied and frozen. We have higher success rates with genetically normal frozen embryos than with the fresh ones. There are some patients that are very hardworking and you are one of them. I respect you a lot for this. Your blastocyst rate is very low. This is something that we see in egg donation cycles when the eggs are amazing. If patients have lower blastocyst rate, we have to see why.

Embryology says: if embryos are fragmented, then between day 0 and day 3 it is the problem of an egg. So this is something that we have to work on to improve the blastocyst rate. Sometimes patients work on things very hard, take vitamins, DHA, some of them are even on a growth hormone protocol, but we still do not generate quality eggs that are good enough to develop more blastocysts. Even though your blastocyst rate is low, you still generate 1 genetically normal and healthy embryo and you still have the same pregnancy rate as everybody else.

In order to answer this question I would need to know how old you are. I still believe that when you are older than 35 years old, there is no time anymore for experiments. That is something nobody knows. We know that results in the blood are not as sensitive as in the lining. We have quite a good study that we use. We have a protocol when patients are putting colony stimulating factors with subcutaneous injections every day in the first week after the transfer. And then twice a week, from the second week until the week 8.

The results with recurrent implantation failure are quite promising. So majority of our patients undergo immune modulation with this medication after a couple of unsuccessful transfers. No, there is not.

What we usually do is we monitor the first scan after a patient starts with estrogens day 7 — day 10 of a cycle to see how thick the lining is. There is a formula to follicles that they grow 2 millilitres every 2 days. There is a formula in gynaecology about hCG, the pregnancy test. If hCG doubles every two days, it means that the pregnancy develops correctly. But if we expect endometrium to be seven millimetres on day 7 or day 10 of a cycle, the lining has to grow ,5 millimetre every day.

Yes, it does. What we do is we grow the lining with estrogens. We want the result to be more than 7 milimeters. I know that progesterone will freeze the lining, it will stop the growth. So yes, progesterone will stop the growth of the lining. No, not at all. We do not choose genetically close eggs. The donor has to be matched specifically to certain cases and certain patients. Definitely yes. Secondly: the implantation window biopsy.

Thirdly: proper thickness, meaning a proper adjustment of estrogens to your body to achieve lining of more than 7 millimetres. There are no more secrets. Usually, the receptivity assay is valid for a year. What is changing the receptivity assay results? We have to see if the fibroids have an impact or they do not have an impact.

How do I confirm or exclude something in medicine results? I have to work to prove that it is the truth. So, in this case, we have to do hydrosonography.

If we see that fibroids do not have an impact, we do the uterus lining receptivity to see your implantation window and then we transfer. If we see that fibroid has an impact, they have to be surgically removed. This is anatomy. Then there are the embryos, they have to develop to the blastocyst stage. With the second egg donation, I would test them genetically.

Then we have to see if your immunology is average. It means that you either accept HLA of majority donors or we have to match them to you specifically. When blood is too thin, it creates problems. If there are too low platelets, because you have ITP and haematological issues, then we send you to a specialist with blood diseases.

And then we know what to do with you. Then you have to take Heparin until the end of pregnancy. So blood clotting it super easy to confirm or exclude through blood tests.

Sometimes BA embryos look amazing but they are genetically abnormal. Sometimes even genetically normal embryos do not implant because they are too weak to make it through.

I would go for one more transfer. With healthy, good quality embryos you have a chance to be pregnant in the next cycle. If somebody has had a miscarriage or if somebody has abnormal uterine bleeding or if embryos are genetically abnormal and we see that we have to terminate the pregnancy, this changes the implantation window. As I say, through genetic pre-testing of embryos I erase your age.

I would like to avoid that because twin pregnancies are always high-risk pregnancies for you. Your cervix can dilate. You can stay in bed till the end of pregnancy and I have to do the C-section. So these are the reasons why we recommend single embryo transfer. Informations published on myIVFanswers.

Services provided by myIVFanswers. Necessary cookies are absolutely essential for the website to function properly. A live birth was defined as one or more live babies delivered after 28 weeks of gestation. The primary outcome included the live birth rate, gestational week at the delivery and newborn birth weight. The secondary cycle outcomes included the implantation rate, clinical pregnancy rate, early miscarriage rate, and ectopic pregnancy rate.

Statistical analysis was performed using the Empower Stats software base on R language. Smooth curve fitting was performed to assess if there was any non-linear relationship between endometrial thickness and pregnancy outcomes. Then a segmented regression model was used to analyze the threshold effect between endometrial thickness and pregnancy outcomes.

All patients were grouped according to their endometrial thickness on the ET day. Patient demographics and characteristics are shown in Table 1.

There were significant differences between the age, infertility duration, BMI and percentage of primary infertility of the women in each group, but there was no difference in the number and type of embryos transferred. Table 1. In order to control the impact of age, the duration of infertility, BMI and the infertility type primary or secondary on pregnancy outcomes, we performed multivariable logistic regression analysis to evaluate the association between endometrial thickness and pregnancy outcomes.

After making adjustments based on the above factors, significant associations were found between endometrial thickness and implantation rate adjusted odds ratio [aOR]: 1. The associations between endometrial thickness and early miscarriage rate, ectopic pregnancy rate, gestational weeks at delivery and newborn birth weight were not significant Table 3.

All adjusted for age, the duration of infertility, body mass index, infertility type, and the number type of embryos transferred. For continuous variables such as endometrial thickness, the implantation rate, clinical pregnancy rate and live birth rate, the fitted curves are presented in Figs 1 — 3 , respectively. With the increase of endometrial thickness, the implantation rate, clinical pregnancy rate and live birth rate initially went up and then down Figs 1 — 3.

The solid-dotted red line represents the smooth curve that fits between variables. All were adjusted for age, the duration of infertility, body mass index, infertility type, and the number and type of embryos transferred. The threshold effect analysis of endometrial thickness and the implantation rate, clinical pregnancy rate and live birth rate are presented in Table 4.

The endometrial thickness is a non-linear significant predictor of clinical outcomes, and its turning point is 8. Between the endometrial thickness on the transfer day compared with the thickness at the starting of progesterone day, endometrial thickness had no changed cycles, the increased and compaction cycles accounted for Endometrial receptivity is the key factor affecting the pregnancy outcomes of embryo transfer cycles [ 9 ]. It has the advantage of: being non-invasive, simplicity, convenience, cost-effectiveness, repeatability as well as other advantages.

Using transvaginal ultrasonography to measure endometrial thickness is often used to help assess the timing of endometrial transformation and the endometrial receptivity [ 9 , 10 ]. However, there is no consensus on the relationship between endometrial thickness and pregnancy outcomes.

The endometrial thickness was measured at different time points during previous studies, such as on the day of hCG administration, on the day of oocyte retrieval or on the day embryos transferred [ 11 — 14 ].

In addition to this, the published studies also varied in other factors, for example, controlled ovarian stimulation protocols, FET protocols, number of embryos transferred, and the type of embryo transferred cleavage stage embryo or blastocyst [ 14 — 17 ].

Many factors could affect endometrial receptivity in fresh IVF cycles and natural cycle FETs, such as excessive estrogen levels, elevated endogenous progesterone, and LH surge. Since such factors can be confounding and affect the reliability of the study results, the relationship between endometrial thickness and IVF outcomes has been a subject of much debate for several decades. Recently, a meta-analysis including 22 studies concluded that there seems to be no justification for using to use endometrial thickness as a tool to help people decide on cycle cancellation, freeze-all or refraining from further IVF treatment [ 18 ].

Another meta-analysis that included 4, cycles from 14 studies was not able to draw a convincing conclusion on the relationship between endometrial thickness and the pregnancy rate in IVF [ 19 ].

As far as we know, previous studies only focused on whether endometrial thickness affects clinical outcomes or not. The study of K. Liu et al. As with most of the previous studies, in the study of Zhiqin Bu et al. Patients who had thin endometrial thickness in Group A had significantly lower rates in clinical pregnancy and live birth than those in Group B or C [ 9 ]. In our study, we found significant associations between endometrial thickness and the rates of implantation aOR: 1.

The curve fitting analysis further revealed a quantitative relationship between endometrial thickness and clinical outcomes. The cut-off value of the endometrial thickness was 8. With every millimeter increment of endometrial thickness up to 8. It is noteworthy that this study is the first to report a minimum threshold of endometrial thickness for optimal pregnancy outcomes.

Several studies in the past merely reported a relatively broad range of endometrial thicknesses that were considered optimal for pregnancy outcomes while the classification of endometrial thickness in their studies was arbitrary, being mainly based on clinical experience or references [ 5 , 9 , 14 ], while the range of endometrial thickness in each group was also very large, thus making these studies unlikely of being able to provide good guidance for clinical practice. The result of threshold effect analysis showed that 8.

When the endometrial thickness was larger than 8. The live birth rate at this point was considered optimal, and thus the range of endometrial thickness relating to the optimal live birth rate could therefore be obtained. Combining the threshold effect analysis results and the curve-fitting pattern, our data showed that the live birth rate would be optimal when the endometrial thickness was within the range of 8.

In the group whose endometrial thickness had reached beyond So, in my last IVF that turned out as a chemical pregnancy, my endometrium was 7. However, 2. Because at that time I already had bid leading follicles, my doctor wanted to triger that night. He then injected into the uterine cavity, using a catheter, ug of filgrastim G-CSF , since there are two papers from Dr. Gletcher that mention it as a possible treatment for thin lining. My RE explained to me it was experimental and I agreed to try it.

Still not ideal, of course, but the best I got in a long time, so my RE advised us to carry on with the transfer 2 beautiful 8-cell empyos. I know my age is a factor, but I have been taking Coq10 for nearly a year now. What could have caused mine to go from 7. Taking my history into account, what would you recommend for my next FET in order to be suscessful in overcoming thin lining? Should I start to look into surrogacy? As always, I really appreciate your time and expertise, and most of all the beautiful work you do here at your blog for which I am a subscriber : C.

From Brazil. Hello C. Let me answer your questions in sequence to make it easier.



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