Endometrial RejuvenationDr Chinmayie R

Endometrial Rejuvenation is a solution for women who struggle to become pregnant because of poor endometrial thickness. Such women can now conceive naturally and give birth with the help of some medical intervention, such as endometrial regeneration.

Pregnancy requires a healthy embryo and a healthy and mature endometrium, which ensures the implantation of the embryo and the onset of your long-awaited pregnancy. If the endometrium isn’t thick enough, the embryo will not attach itself to the uterus wall and, thereby, does not get the required nourishment to sustain and grow.

Endometrial Rejuvenation is the process used to enhance the quality of Endometrium for successful embryo implantation by improving the endometrial thickness & blood supply, which in turn helps the embryo implant and receive proper nutrition.

The membrane lining the uterus is called the endometrium, and it thickens during the menstrual cycle – in preparation for the implantation of an embryo. If the implantation has not occurred, the membrane is shed; shedding and regenerating its functional layer every cycle is the unique capacity of a healthy endometrium. This process is regulated by hormones, progenitor cell populations, and inflammatory mediators. The functions of the endometrium are to ensure that the conditions are optimal for the implantation of an embryo within the uterus.

However, if any of those factors are disturbed, it can lead to endometrial disorders with intrauterine scar formation, dysregulated proliferation, and heavy menstrual bleeding. Without a healthy endometrium, pregnancy is impossible. The condition of the endometrium determines the likelihood of a successful pregnancy. If the endometrium is not thick enough, the embryo will not attach to the uterus wall. The minimal endometrial thickness required for embryo transfer is about 7 mm – by the end of a natural or medically induced follicular phase. But 7 mm is the lower limit, and most clinicians prefer to have the thickness much more than this. Along with the thickness, the blood flow to the endometrium is also a key aspect, and this is determined using doppler ultrasound scans.

Poor endometrial thickness is one of the most common reasons for infertility. Thin endometrium (having thickness below 7 mm) can be due to

• Low levels of Estrogen hormone

• Trauma to the uterus (cesarean sections, repetitive curettage),

• Previous anti- tumoral treatments (radiotherapy, chemotherapy, surgery)

• Asherman’s syndrome,( formation of adhesions (scar tissues) inside the endometrial cavity either post-D&C or because of pelvic infections. )

• Chronic infections (Endometritis, Pelvic Inflammatory Disease)

• Conditions that cause inadequate blood flow (stress, malposition of uterus, fibrosis)

• Clomiphene citrate if used excessively (a drug used for ovarian stimulation)

• Patients with low estradiol values

• Post hysteroscopic surgeries are done for removal of polyps, fibroids & adhesions – mainly because of excessive use of electric cautery.

• Chronic Endometritis, polyps, endometrial hypoplasia

• Uterine synechiae

• Women who have experienced several failed IVF programs because of the uterine factor.

• Women who are diagnosed with Asherman´s syndrome.

• Women who are diagnosed with female infertility caused by uterine hypoplasia

Several treatments are proposed over the years to enhance endometrial thickening.

• Platelet Rich Plasma (PRP) affects endometrial cell proliferation. PRP increases proliferation not only on fibroblasts but also on mesenchymal cells, which are progenitors of various types of cells, including endometrial cells. Fresh whole blood collected from the same person is used to prepare Platelet Rich Plasma (PRP) – also called autologous PRP, which is then processed to separate platelets from the other blood c Infusion of PRP into the uterus helps improve endometrial growth and implantation chances. Since autologous blood is used for PRP, concerns regarding immunogenic reactions and disease transmission are eliminated. Patients considered for a PRP application must undergo haematological evaluation (blood tests) to exclude blood disorders or platelet dysfunction. Bone Marrow Mesenchymal Stem Cells (BM-MSCs) provide an alternate source for regenerating the endometrium and repairing endometrial injury according to recent studies.

• Supplements of Estrogen & Progesterone hormones.

• Granulocyte colony-stimulating factor (GCSF), a protein that stimulates bone marrow, is infused into the uterus to produce more blood. Pretty effective, as it’s directly infused into the uterus, the part which needs blood.

• Sub Cutaneous infusion of GCSF – the same as above, but instead of infusing into the uterus, it's injected into the skin. It should be given in regulated quantity because if an excessive amount of White Blood Cells (WBC) are pulled into reproductive organs, there might not be enough left in the body to fight the infection.

• Vasoactive medicines like aspirin, vitamin E, l-arginine, sildenafil. These activate the blood vessels to extend flow towards the uterus, endometrium.

• Intrauterine infusion of Platelet Rich Plasma during which patient’s plasma is extracted from her body, enriched with platelets then infused back into the uterus.

• New research giving good results in the improvement of Endometrial Thickness is perivascular stem cell therapy. It can generate endometrial cells. However, it's still in the research stage.

• Hysteroscopy is done for diagnosis of endometrial infection, removal of fibroids, polyps, adhesions to enhance the endometrial surface quality & then Endometrial Rejuvenation Programme is started till the time effective results are achieved.

• To avoid post-surgical adhesions & improvement of cell growth in endometrial tissue, Intra-Uterine Contraceptive Device (IUCD) is kept in a few cases.

• Associated treatments to enhance the blood supply of Endometrium includes acupuncture, stress management, exercise, nutrition plan, yoga, fertility massage and castor oil packs.

Endometrial Rejuvenation Treatment is successful if:

• Endometrial Thickness increases above 9 mm, with good blood supply, is formed after treatment.

• There is a sub-endometrial blood supply up to Zone 4 (the zone which is closest to the embryo).

Doctors and biotechnologists have developed an innovative and highly effective treatment to resolve the problem of poor endometrial health. Endometrial Rejuvenation Treatment helps in improving the chances of successful embryo implantation. Pregnancy may be achieved through natural fertilization IUI or IVF.

Endometrial regeneration provides a true alternative to surrogacy for ladies who have infertility because of uterine factors – who struggle with conditions like Asherman’s syndrome, endometrial hypoplasia, uterine synechiae, and poor endometrial thickness.