Estrogen Supplement For Thin Lining

Question:

Hello, I am from Canada and I have been seeing a fertility specialist since January 2009. My husband and I have been TTC for 1.5 years and experienced a miscarriage in September 2008, when I had a D&C. My lining has never been above 4.5 mm and is normally about 2-3mm thick. I have been put on 8 mg Estrace daily for the past 2.5 weeks. Ultrasound today showed no change in thickness, and suppression of the follicle size. What is your experience with thin lining and pregnancy success Is there anything else that you would suggest for me to do to thicken my lining?

Answer:

Did you use the Estrace orally or vaginally? If you have not tried it vaginally, that is a more efficient delivery method for the endometrial lining. Orally is the worst. The second best would be estrogen patches.

If you are using them vaginally and your lining is still not developing, that is a problem. It should be getting to a minimal width of 9 mms. Did you have a hysteroscopy to make sure you didn't have scar tissue after the D&C? That could be a cause of a thin lining that doesn't respond to estrogen. Most people will form an adequate lining with estrogen supplementation, so you would be a rare entity. If the hysteroscopy shows evidence of scar tissue then you must proceed to have that removed prior to starting any infertility treatments. It is difficult to do, so you must find a competent specialist to do it who will then schedule an operative hysteroscopy as an outpatient surgical procedure.

I have seen in the literature, reports of people trying nitroglycerine tabs vaginally, Levitra and Viagra to increase blood flow to the uterus and thereby try to increase the lining. They have not worked universally.

Sincerely,

Edward J. Ramirez, M.D., FACOG

Executive Medical Director

The Fertility and Gynecology Center

Monterey Bay IVF Program

Monterey, California, U.S.A.

www.montereybayivf.com

Blocked Fallopian tubes and Disabled sperm?

Question:
Hi Edward,

I have two quick questions for you.....
　　
The first is, how likely is it for Fallopian tubes to block for no reason? I fell pregnant November 07 but miscarried in January 08 and have been trying to fall pregnant since but to no avail. I am currently attending a fertility Clinic in ireland and despite 3 IUI's and 4 months on Clomid with a very good response to meds each time and my husbands's samples being good I have still failed to fall pregnant and was wondering could it be possible that one or both of my tubes are blocked? I had a lap and dye done but that was back in March 07 before I fell pregnant.

My second question is this, myself and my husband are now going down the IVF route - I am starting on the meds on 29th September. My husband in the past has used Viagra on occasion to help with producing samples. At the time the fertility clinic had no problem with him using Viagra but over the past few weeks I did a bit of research re the use of Viagra when trying to conceive and there are some findings just recently saying that Viagra can actually have a negative impact when trying to conceive as it can prevent the sperm from penetrating the egg successfully.....do you know if this is the case? The reason I ask is because you are based in the States and normally the States are one step ahead of Europe in terms of medical findings, research, etc. and having the most up to date info. I would hate for my husband to use Viagra to produce his sample during our IVF procedure only to find that the swimmers cannot penetrate any of the eggs. It's a very expensive procedure as you know so don't want to take any chances. Any advice greatly appreciated.

Answer:
Hello Katie from Ireland,
　　
Tubes don't usually get blocked without a reason. Something has to block them. I would recommend you consider doing an HSG (hysterosalpingogram) to check them out. Sometimes a woman can develop mucous plugs in the tubes. The HSG can be used as a treatment for this and the pressure can push the plugs out, resulting in pregnancy thereafter.
　
I have not seen any research in our fertility journals stating that Viagra disables the sperm. However, if this is a concern, then you have the option of requesting that ICSI be performed to be sure that the sperm penetrate the egg, rather than doing natural fertilization where the risk is that fertilization does not occur. Most of my patients will elect this anyway, because they would hate to have a cycle fail because fertilization did not occur. ICSI is where individual sperm is taken and injected into each egg.

I hope this helps,

Sincerely,

Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
http://www.blogger.com/www.montereybayivf.com
Monterey, California, U.S.A.

for additional information check out my blog at http://womenshealthandfertility.blogspot.com/ check me out on facebook and twitter with me at @montereybayivf.