Thin Uterine Lining

To implant successfully your uterus, an embryo needs rich, nourishing uterine lining – not too thick and not too thin. Low estrogen, scar tissue from D&C procedures, fibroids and other issues can cause your uterine lining to thin out, or prevent your uterus from getting the blood flow it needs to thicken up. As a result, egg implantation is difficult.

How it’s tested

Your doctor may suspect thin uterine lining if you’re having trouble getting pregnant and have one (or more) of these traits:

  • low estrogen levels
  • a condition that affects blood flow to the uterus, such as fibroids or a “tilted uterus”
  • a condition that affects the health of your endometrial tissue, such as pelvic inflammatory disease or scar tissue (Asherman’s syndrome)

How it’s treated

If your endometrial thickness (ET) is less than 7mm, embryo implantation may be hard. There are reported pregnancies for embryo transfers into a uterine lining as little as 4mm, but it’s so unreliable and risky that we generally recommend freezing your embryos and waiting for a thicker endometrium in a future cycle instead of transferring them right off the bat.

Of course, that advice isn’t very helpful if your ET is always less than 7. Here are steps we take to improve your ET thickness – but remember that not all of these steps will be right for you, and that you should give any lifestyle change (e.g. exercise) or interventions (acupuncture, vitamins) 2 months minimum and 6 months maximum before expecting results.

  • Maximize your natural blood flow with acupuncture or regular, moderate exercise. Higher blood flow should bring more egg-friendly nutrients to your uterine lining.
  • Minimize anything that could hurt your blood flow. Try cutting caffeine to one cup (or less!) per day, not smoking, and avoiding seasonal allergy meds or over-the-counter cold remedies that stop nasal swelling. (Don’t worry, regular or extra-strength Tylenol are fine.)
  • Take estrogen – either exogenously (oral tablets, vaginal tablets, patches) or endogenously (rFSH treatments like Gonal F and Puregon).
  • Put on some weight: it’s great at promoting pelvic blood flow. You’ll want a BMI over 18.4, and ideally over 19.0. In other words, a little weight gain is a good thing – those fat cells generate natural estrogens. Talk to a nutritional counselor for advice.
  • Don’t rule out folklore. Because this condition hasn’t been heavily researched, we don’t know everything yet. Increasing your red meat intake to 1-2 times a week or drinking red raspberry leaf tea are both seemingly harmless suggestions that may assist you.
  • Don’t rule out scientific hunches either. These supplements aren’t proven as effective, but might help: antioxidants like vitamin C (up to 1000mg/day) or vitamin E (up to 400IU/day), or CoEnzyme Q10 up to 800mg/day.

There are also experimental approaches out there, but they may or may not be available, and definitely aren’t guaranteed to work:

  • Multiple endometrial biopsies
  • Neupogen infusion
  • Trental 400mg three times daily with Vitamin E 400iu once daily during pretreatment (birth control pill or barrier contraception cycles)
  • Stem cell infusions


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