Infertility/Fertility/Uterine lining

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QUESTION: Hi there, I am writing from Orange County, California.

My husband and I have been TTC for 9 cycles with no luck yet. I had a pelvic ultrasound today at cycle day 24, 10 days past ovulation, and my uterine lining was a 5.7mm. My doctor said this was on the low side of normal, however, when I look this up, it seems quite low. Is it even possible to get pregnant with this lining?

Would treating it with progesterone possibly help? I had bloodwork done to check that today. I am curious what you might recommend.

Thank you so very much,
C

ANSWER: Hello Caitlin from the U.S. (California),

An endometrial lining of 5.7 mms if too thin.  The lining needs to be a minimum of 7 mms and more ideally 9 mms for implantation to occur.  Endometrial lining thickness is based on estrogen, not progesterone.  Progesterone stops the lining from continuing its development and changes the architecture of the lining to put it into the next phase for implantation to occur.

In order to thicken the lining, we usually will use supplemental estrogen vaginally.  First, however, I would need to know what kind of treatment protocol you are on.  I'm not sure what it is that you are doing to make a specific suggestion as to a supplemental protcol.  Are you using Clomid?

Good Luck,

Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com

Monterey, California, U.S.A.

for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf.  Skype and internet comprehensive consultations now available via my website for those who want a more extensive evaluation that this site can accommodate


---------- FOLLOW-UP ----------

QUESTION: Hi Dr. Ramirez,

Thank you so much for your response to my question, it is appreciated. I am going to check out your blog and look into a consultation.

I have had conflicting information regarding my lining number - because it was taken on CD24 instead of before ovulation, some doctors are telling me that the number doesn't really mean anything, while others are saying it does. Is it possible that my lining was thicker around ovulation, and when implantation did not occur, it thinned out before my period came on CD27?

I am not currently on any treatment protocol - no drugs at this point. The RE I saw suggested Clomid and IUI, but I was wary of Clomid since I read it can thin lining, which I obviously already have a problem with!

I am so unsure of if I should seek help and treatment at this point (TTC for 9 cycles), or if we should try on our own for the full year.

Thank you again for your help,
C

Answer
Hello Again,

It is correct that if the lining was looked at on CD#24, then the number is of no value and no conclusions can be made.

If you have only been trying for 9 cycles, then I don't see a reason to proceed with Clomid and IUI, but of course, I do not have the benefit of reviewing your medical record.  I don't know what the doctor is seeing or thinking.  If there are no issues, then certainly we do not recommend any evaluation or treatment until you have been trying on your own for at least 12 months.

It is true that Clomid can cause a thin lining but I wouldn't rule that out just yet since you don't really know if a thin lining is a problem, since you have not been looked at/evaluated properly yet.  There are other medications that can be used to accomplish the same thing.

Good Luck,

Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com

Monterey, California, U.S.A.

for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf.  Skype and internet comprehensive consultations now available via my website for those who want a more extensive evaluation that this site can accommodate

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Edward Joseph Ramirez, MD, FACOG

Expertise

I am a specialist in infertility and advanced gynecological care. I can answer questions about infertility, gynecology related ills, menopause...virtually anything that affects women's health. PLEASE tell me where you are writing from as I am always interested.

Experience

I have been practicing as an Ob/Gyn and Infertility Specialist for over 23 years. Gynecology, advanced laparoscopic surgery, basic infertility, IUI's, IVF, reproductive surgery, and ovulation induction are all areas of my expertise. I am Board Certified. I have been doing In Vitro Fertilization in my clinic for 19 years.

Organizations
American College of OB/GYN, American Board of Obstetrics and Gynecology, American Society of Reproductive Medicine, Society of Assisted Reproductive Technology, American Association of Gynecologic Laparoscopists, Fellow of The American College of Obstetricians & Gynecologists,Resolve-National Chapter, Open Path - Northern California, Board of Directors Monterey Medical Society

Publications
American Journal of Obstetrics and Gynecology, Wall Street Journal, Monterey Herald, SERMO, Women's Health and Fertility Blog

Education/Credentials
Medical Degree from Stanford University, Residency at Tripler Army Medical Center, Reproductive Training at Pacific Fertility Center, San Francisco

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