by Dr.Agilan Arjunan, Fertility Specialist & Gynaecologist, KL ( Malaysia)
The journey towards motherhood is an exciting and a wonderful experience. However, at least 1 in 7 couples may face challenges in their journey. Common causes for infertility are age-related low ovarian reserve, male infertility issues (ie sperm count and quality) and fallopian tube issues. Infertility due to abnormalities of the uterus or womb are not as common. However, one of the uterus problems relating to infertility are conditions affecting the uterus lining ( ‘endometrium’).
In this article , I am going to talk about issues affecting the endometrial lining.
Uterine polyp
A uterine polyp is not necessarily dangerous to a woman. The polyp may be present in many women without any symptoms. Depending on its location and size, the uterine polyp may affect the embryo implantation process leading to reduction in pregnancy rate. Therefore, before an embryo transfer is done in an IVF procedure the uterine polyp needs to be resected.
Submucosal Fibroid
Submucosal fibroids grows from the uterine wall into the endometrial cavity. This type of fibroids has been shown to affect embryo implantation and a reduced pregnancy rate. The usual advice is to remove the fibroid before an embryo transfer procedure. This type of surgery is called Transcervical Resection of Myoma (TCRM) . It is done vaginally using a specialised telescopic system.
Endometrial Hyperplasia
Picture taken from : Osmosis.org
Endometrial hyperplasia refers to the endometrial lining which ‘overgrow’ and contain abnormal cells. This condition is not very common among younger women who are trying to get pregnant. However, I have diagnosed several of my patients with this condition and they are in their mid 30s’. Oral progesterone therapy can be used to treat this condition. At the same setting, a proper evaluation is important to rule out endometrial cancer, which is very rare in this age group.
Thin Endometrial lining
This condition usually happens in a woman with previous surgery to the endometrial lining such as repeated dilatation and curettage (D&C). The lining may also be affected by infections such as tuberculosis or other bacterial infections. A woman needs to have an endometrial thickness of at least more than 6.5-7mm to have a successful embryo implantation.
The treatment options for a thin endometrial lining varies from medical therapy with progesterone and oestrogen to surgical therapy to release the intra-uterine adhesions formed by infection. This surgery is done using a telescope called hysteroscopy. Sometimes, platelet-rich-plasma (PRP) is used to help to thicken the endometrial lining.
A patient of mine had a very thin endometrial lining during my assessment. Hysteroscopy done for her did not reveal any intrauterine adhesions. She required a prolonged high dosage oestrogen therapy to reach a maximum 6mm endometrial thickness. Finally, the embryo transfer resulted in a successful pregnancy. Therefore, even with a thin endometrial lining, pregnancy is achievable with proper evaluation and therapy.
In summary, fertility problems related to endometrial lining is not common. However, a systematic evaluation is needed to find a solution for these problems leading to a successful pregnancy and attainment of motherhood…