Thin Endometrium

Specialized care for improving endometrial conditions.

What is Thin Endometrium?

Even with a good embryo prepared, if the endometrial and uterine cavity environment is not adequate, the implantation process may be affected.

The Thin Endometrium Clinic evaluates not only thin endometrium but also
uterine cavity adhesions, congenital uterine anomalies, and structural abnormalities of the endometrium and uterine cavity
to assess the uterine environment for implantation.

Thin Endometrium

When the endometrium repeatedly fails to grow sufficiently during embryo transfer cycles.
Implantation is not determined by endometrial thickness alone; previous cycle changes
and uterine cavity conditions are evaluated together.

Uterine Cavity Adhesions

Adhesions where the inner walls of the uterus stick together can occur after delivery,
post-miscarriage curettage, or intrauterine procedures. They may present with
decreased menstrual flow or thin endometrium, requiring uterine cavity evaluation.

Congenital Uterine Anomalies

Cases where the uterine shape differs from birth, such as uterine septum,
bicornuate uterus, or unicornuate uterus. The need for further evaluation
and treatment is determined based on uterine shape, pregnancy, and miscarriage history.

Other Endometrial/Uterine Cavity Abnormalities

We also check for lesions that can deform the uterine cavity such as endometrial polyps
or submucosal fibroids, and other causes that may affect endometrial condition.
Treatment decisions depend on lesion location, size, and pregnancy plans.

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Screening

Endometrium Screening Steps

Evaluate uterus and endometrium via transvaginal ultrasound

Endometrial thickness, shape, fibroids, adenomyosis, and overall uterine condition are assessed. Previous embryo transfer cycle endometrial thickness changes can also be compared.

Assess uterine shape with 3D ultrasound if needed

When congenital uterine anomalies are suspected, 3D ultrasound can be used to examine the uterine contour and cavity structure in greater detail.

Check for intrauterine lesions and adhesions

When endometrial polyps, submucosal fibroids, or uterine cavity adhesions are suspected, saline infusion sonography or hysteroscopy may be considered as appropriate.

Review pregnancy, delivery, procedure history and transfer records

Whether menstrual patterns changed after first delivery, history of miscarriage or curettage, and how the endometrium responded in previous transfer cycles are reviewed together to interpret the current status.

Screening

Endometrium Screening Steps

Evaluate uterus and endometrium via transvaginal ultrasound

Endometrial thickness, shape, fibroids, adenomyosis, and overall uterine condition are assessed. Previous embryo transfer cycle endometrial thickness changes can also be compared.

Assess uterine shape with 3D ultrasound if needed

When congenital uterine anomalies are suspected, 3D ultrasound can be used to examine the uterine contour and cavity structure in greater detail.

Check for intrauterine lesions and adhesions

When endometrial polyps, submucosal fibroids, or uterine cavity adhesions are suspected, saline infusion sonography or hysteroscopy may be considered as appropriate.

Review pregnancy, delivery, procedure history and transfer records

Treatment

Treatment Directions for Thin Endometrium

Rather than addressing thin endometrium with a single treatment, we first distinguish whether the cause is structural, adhesion-related, or repeatedly thin endometrium.

When endometrium is repeatedly thin

We re-evaluate endometrial response from previous transfer cycles, hormone protocols,
and check for intrauterine abnormalities
to adjust endometrial preparation methods for the next transfer cycle.

Endometrial response re-evaluation → Uterine cavity check → Next transfer cycle plan

When uterine cavity adhesions are confirmed

After confirming the location and extent of adhesions, if they are deemed to potentially affect pregnancy, hysteroscopic adhesiolysis or other treatments may be considered.

Adhesion extent evaluation → Treatment necessity assessment → Uterine cavity recovery confirmation

When congenital uterine anomalies are present

Not all uterine anomalies require surgery.
Uterine shape and pregnancy/miscarriage history are evaluated together
to individually determine the need for corrective treatment.

Uterine shape confirmation → Pregnancy history evaluation → Treatment consultation if needed

When polyps, submucosal fibroids or other lesions are present

We assess whether lesions deform the uterine cavity or may affect implantation, considering location, size, symptoms, and pregnancy plans to determine whether hysteroscopic treatment is needed.

Lesion location/size check → Uterine cavity impact evaluation → Treatment decision

When endometrium is repeatedly thin

We re-evaluate endometrial response from previous transfer cycles, hormone protocols,
and check for intrauterine abnormalities
to adjust endometrial preparation methods for the next transfer cycle.

Endometrial response re-evaluation → Uterine cavity check → Next transfer cycle plan

When uterine cavity adhesions are confirmed

After confirming the location and extent of adhesions, if they are deemed to potentially affect pregnancy, hysteroscopic adhesiolysis or other treatments may be considered.

Adhesion extent evaluation → Treatment necessity assessment → Uterine cavity recovery confirmation

When congenital uterine anomalies are present

Not all uterine anomalies require surgery.
Uterine shape and pregnancy/miscarriage history are evaluated together
to individually determine the need for corrective treatment.

Uterine shape confirmation → Pregnancy history evaluation → Treatment consultation if needed

When polyps, submucosal fibroids or other lesions are present

We assess whether lesions deform the uterine cavity or may affect implantation, considering location, size, symptoms, and pregnancy plans to determine whether hysteroscopic treatment is needed.

Lesion location/size check → Uterine cavity impact evaluation → Treatment decision

Before the next embryo transfer, we re-evaluate the uterine environment

If implantation has been repeatedly difficult despite no issues with embryo quality or other infertility factors, we can re-evaluate whether the endometrium and uterine cavity are ready to receive the embryo. If a cause is identified through examination, that area is managed first, then the timing and endometrial preparation method for the next embryo transfer are planned.

Q & A

Thin Endometrium

Endometrial thickness is one factor considered when planning embryo transfer, but thickness alone cannot determine implantation possibility. Previous cycle endometrial changes, uterine cavity condition, and embryo quality are evaluated together.

Uterine cavity adhesions can develop after retained placenta, intrauterine procedures during delivery, or curettage after miscarriage. If menstrual flow has decreased or pregnancy has become difficult, uterine cavity evaluation may be considered based on medical history.

Not necessarily. The significance varies depending on the type and shape of the anomaly, previous pregnancy history, and miscarriage history. If needed, 3D ultrasound can confirm the shape and surgical necessity is determined individually.

Hysteroscopy may be considered when uterine cavity adhesions, polyps, submucosal fibroids are suspected on ultrasound, or when direct visualization of the uterine cavity is deemed necessary after previous procedures.