Poor uterine lining, possible cause of infertility

Unexplained infertility occurs in about five to 10 per cent of infertility cases. It is now recognised that what may be described as ‘unexplained infertility’ will have a known cause with better investigative tools or more recent advances in medical science.

One of such is poor endometrial lining; while others include immunological factors affecting embryo implantation. The advancement in ultrasound technology and molecular biochemistry has unraveled this hitherto unexplained infertility. I will illustrate the endometrial issue with the story of Mrs. J.A. as narrated by her.

“I got married to my husband, Tunde, when I was 23 and he was 27. We were not concerned that we did not get pregnant for the first three years of our marriage, as we were both still young and wanted to enjoy our freedom. We hoped to build a solid family and financial foundation for our life together. But by the time I was 26 years old, we thought enough was enough, we have had our fun and needed to start making babies.

“Besides, our parents were becoming restless, impatient and wanted to bounce their grandchildren on their laps. Then we decided to really try to get pregnant. At first, I thought, ‘What could be easier than having sex and getting pregnant?’ Getting pregnant was something we had worked hard to avoid while we dated for the two years prior to our marriage and even three years after marriage. After one year of consistently trying to get pregnant and nothing happened, I became worried.

“Six years later, when I was not still pregnant at the age of 33, I was now desperate. Tunde and I had been visiting fertility clinics for about four years before I heard of the Medical Art Centre with good success rate.

“On getting to MART, the first thing the medical staff did was to give me a full medical examination to determine exactly what was wrong. They discovered that I had a polycystic ovary and I was placed on Glucophage tablets for two months. After that, I was put on Clomid tablets. I apparently ovulated, which I was not doing before and I soon became pregnant. An ultrasound scan confirmed it.

“You can imagine the celebration in our house. Tunde and I were overjoyed, but that joy was short-lived. I was scheduled to have another ultrasound scan at the clinic in six weeks, so that the doctors could pick up the baby’s heartbeat. But before my appointment, I began to bleed until I lost the baby. I was sad and depressed, but I was grateful and my confidence had been raised that I could at least get pregnant, which I had doubted before. At least, my family/friends and, particularly, my in-laws, saw that I could get pregnant. That meant a lot. There are some women who don’t achieve pregnancy at all.

“With renewed confidence and hope, Tunde and I decided to give it another try. Again, I got pregnant but lost the pregnancy within six weeks. At this point, the doctors decided to do more intensive investigation. This time, it was not to investigate why I could not get pregnant but to investigate why I could not keep the pregnancy further than six weeks.

“They told me that one reason that I could be losing the pregnancies might be due to problems with my endometrium, which is the inner lining of the womb (uterus). The medical staff explained to me that some women have poor endometrial lining and as a result, they get pregnant but are very prone to early miscarriages.

“They scheduled to measure my endometrial thickness on day 12 of my menstrual cycle. During the medical examinations, they confirmed that my endometrial lining was not increasing beyond 6.3mm on day 12 of my cycle. Such a measurement was considered very poor and not conducive to support a pregnancy. I was told it could be a major cause of miscarriages both for natural pregnancies and pregnancies from IVF and other assisted reproductive technologies.”

A poor endometrial lining is due to several factors such as inflammation of the lining of the uterus, which can happen when a woman has a sexually transmitted infection, an abortion or a miscarriage in an infectious environment so that the uterus becomes infected.

The condition may also be due to adenomyosis, which is an overgrowth of the muscle of the uterus or by multiple fibroid tumours of the uterine wall. Also, when a mother has been overexposed to diethylstilbestrol, which is a synthetic hormone, she can develop weak endometrial lining. This overexposure can be due to her use of DES as a birth control pill or if she has been treated with DES for estrogen deficiency.

A woman can also develop poor endometrial lining due to bad management of her infertility. For example, if she is given Clomiphene citrate (Clomid, Serophene, a drug used in the treatment of infertility) for at least three months in a row without a resting cycle, it could result in poor endometrial lining.

However, under proper management, this effect can be reversed within four to six weeks of discontinuing Clomiphene.

It was not until 1997 that doctors were successfully able to improve the lining of a woman’s uterus by prescribing nitroglycerine skin patches to women with poor endometrium. These patches were able to promote the production of nitric oxide, which dilates blood vessels of the uterus and, in so doing, dramatically improves the blood flow to the uterus.

This breakthrough really helped many women with poor uterus to make the successful journey from being infertile to having a family. Unfortunately, it had some very unpleasant side effects such as severe headaches, nausea, and fluctuations in blood pressure so that this treatment was not well tolerated by many women.

Mrs. J.A. continues, “I was lucky that by the time I came to Medical Art Centre, the centre was using another protocol that had been developed by a pharmacist, Dr. Sher, and his co-workers in 1998.

“They used Viagra (Sildenafil) which, like nitroglycerine, also triggers the production of nitric oxide and improves blood flow to specific organs, which is the same mechanism for penile erection and has led to its successful use in the treatment of male impotence.”

To be concluded.