QuestionI am 41 yrs old and live in Spain with my husband. We have just been to another fertility clinic after we had one failed ICSI attempt and the new clinic said I need to use an egg donor and the doctor said my endometrium lining was bad - too thin. How many mm does it need to be to implant an egg successfully? Also, with my ex-partner when I was 25 I did not get pregnant after 12months. That was 16 years ago and he has since got married and had two children. This makes me think even when I was young this was the problem why I did not conceive back then. Once your endometrium lining is thin - is it ALWAYS thin i.e for life or does it deteriorate with age? Your answer is very much appreciated.
Vanessa
AnswerHello Vanessa from Spain,
Your endometrial lining sheds and regrows every month. It does not stay thin forever. The minimum thickness of the endometrial lining should be at least 7 mms, although most clinics prefer that it is at least 9 mms at the time of HCG trigger. It should also have a "trilaminar" (three layer) configuration. I don't think that your "thin" lining was the reason you did not achieve pregnancy at 25, but can offer no explanation at this time.
In terms of a thin endometrium, we try many things to increase the endometrial lining. I add supplemental estrogen vaginally and have my patients use low dose aspirin and low dose heparin to increase blood flow. Some clinics will try other medications to increase blood flow.
I am a little curious as to why your doctors would recommend donor eggs at 41. Certainly, because of your age, donor eggs would be better with a higher chance for pregnancy, but is that the only reason? Were you a poor stimulator, had only few eggs retrieved, had poor fertilization, etc? These would be additional reasons. In the U.S., we don't necessarily push for donor eggs at 41 because we are achieving pregnancy rates of greater than 30% in your age group (43% in my clinic). You'll have to determine and ask specifically why they are recommending this.
Good Luck,
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
