Endometrial Enhancement

The endometrium is the dynamic innermost lining layer of the uterine cavity, which, during the menstrual cycle and under the influence of female sex hormones, experiences morphological and functional changes and gradually grows into a thick (>5.50mm), blood vessel-rich and glandular tissue layer. If pregnancy does not occur, the endometrium sheds in a circular process known as menstruation (period).

The endometrial cavity is the location of the uterus where the fetus is implanted and developed during pregnancy. The most crucial phenomenon during the endometrium growth is the ‘implantation window’ which is the short period of time during which the uterus is ready for implantation and it is the result of the programmed sequence of the action of the hormones (estrogen and progesterone) on the endometrium.

One of the most common causes of implantation failure in IVF treatments is the lack of synchronization between a functionally component and receptive endometrium and the transfer of a healthy embryo i.e. the transfer of a healthy embryo is performed outside the ‘implantation window’.

Therefore, recently molecular tests have been developed based on the transcriptomics of human endometrium receptivity (Endometrial Receptivity Array, ERA test), so as to accurately calculate the time of embryo transfer increasing the successful pregnancy rates to 73% in women with multiple implantation failures.

However, there is a group of women who cannot reach the critical point of 6mm in endometrial thickness, even with the administration of combined high doses of synthetic and natural estrogens, vaginal sildenafil (Viagra), antibiotics, vitamins and anticoagulants. These women present an increased rate of repeated implantation failures, which corresponds approximately to 29.4%, according to existing literature and the majority of them cannot reach the stage of the embryo transfer.

Intrauterine infusion of autologous platelet-rich plasma (PRP) is a new promising approach that can enhance the development of thin endometrium. Plasma with high concentrations of platelets and growth factors, such as the vascular endothelial growth factor (VEGF), the epidermal growth factor (EGF), the platelet-derived growth factor (PDGF), the transforming growth factor (TGF) and other cytokines, which is isolated from fresh full peripheral venous blood of the infertile woman, appears to stimulate the proliferation, healing and growth of the endometrium during their repeated administration into the endometrial cavity up to 48 hours before the embryo transfer. The method appears to be safe, without any side-effects such as immunological reaction or increased risk of infection. The infusion into the endometrial cavity is painless and the catheter used from the clinician is the same to the intrauterine insemination. Although there are no large multi-center studies yet on the effectiveness of the method, several observational studies highlight the significant difference in success rates related to the implantation and live birth rates in women undergoing treatment with PRP.

Do not hesitate to contact with the specialized obstetrician-gynecologist in IVF, Dr. Melina Stasinou (info@cybele.gr) for more information and an advice regarding your own individual case.