October 13, 2010 Blog Post
Most fertility treatment focuses pretty intently upon the sperm and the egg. Unmistakably, these are essential factors in initiating a pregnancy. But even the best quality embryos cannot survive more than 7 days outside of the womb. Therefore, a healthy uterus is an essential bridge between conception and delivery. In fact, more recent studies suggest that even impaired implantation can result in a pregnancy but one that may be fated to problems avoidable complications. So taking steps to optimize uterine receptivity—the term used to describe how inviting the environment is for the embryo—represent a critical link to take full advantage of your fertility treatment.
Since many fertility treatment centers don’t focus on uterine issues, it is uncertain what percentage of patient’s have a “uterine factor” as their sole obstacle to conception. However, most centers do use ultrasound to measure the endometrial thickness as an estimate of receptive the woman’s uterus is to implantation. In a seminal paper [G1] published in the journal Human Reproduction in 1991, Dr. Geoffrey Sher demonstrated that when this thickness was less than 9 mm, the chance for a successful pregnancy was dramatically reduced—typically to less than 10%. He later went on to demonstrate [G2] that for many women (~70% in our clinic) this failure of endometrial receptivity is due to poor blood flow. This identified a treatable problem that can potentially be reversed with the use of well-known erectile dysfunction drug name Viagra. By implementing the Viagra Protocol, we have been able help many women successfully carry their own pregnancy even when they had previously been told that this was not possible. Even with a thick enough endometrial lining, some additional attention to receptivity may be warranted.
Multiple studies [G3] have demonstrated that the medications used to optimize egg development can cause a hormone imbalance that interferes with endometrial receptiveness. In fact, some studies [G4] suggest that the very high estrogen levels often associated with IVF cycles may have a negative impact upon implantation even while promoting the number of embryos produced. Various strategies have been created to overcome these obstacles and since there is no simple answer, I feel that it is best to inform patients and offer them options when creating a treatment plan. Here’s what you should consider when you discuss this with your doctor:
- Ask about your endometrial thickness. If it is less than 9 mm, discuss the possibility of freezing your embryos and/or consider the Viagra Protocol.
- Talk to your doctor about your highest estrogen level. If it was above 3500 pg/mL discuss whether or not it may be in your best interest to freeze all of your embryos. Doing so may not only improve implantation but can also reduce your risk of developing Ovarian Hyperstimulation Syndrome (OHSS).
- Consider the use of a steroid. There have been several studies that demonstrate that various forms of the hormone called cortisol, can off-set the impact the impact estrogen has upon your immune system. The end result may be a greater chance that your immune cells will welcome an embryo and foster its implantation.
- Request “luteal support” through the use of progesterone. The process of IVF can reduce implantation unless steps are taken to support implantation. Whether it is because of an imbalance between estrogen and progesterone, residual effects of medications used to block ovulation or due to a loss of hormone producing cells at the time of egg retrieval remains a subject of debate. But it is pretty widely accepted [G5] that the use of progesterone helps improve your chances of becoming pregnant. Which form of progesterone to use (injections, pills or suppositories) and how long [G6] to use it for are another topic that can/should be tailored to your unique situation.