# Hypertrophic - What does it mean?



## Lara200 (Aug 26, 2006)

I have been making enquiries about embryo donation abroad and one of the doctors I emailed said that one of the reasons implanatation didn't occur in previous cycles is because the endometrium may have become hypertrophic.  I simply told her that my lining grew to about 16-18mm.  I will go back to her to ask her to explain but I wondered if any of you had come across this.  I couldn't find anything else on the message boards and the info on the internet is too technical and mostly seems to relate to heart conditions.  I would really appreciate your help as I am in such a quandary as to what to do next, try agian, give up.  I know you understand as so many of us have been there.  Thanks for your help.

Lara


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## daisyg (Jan 7, 2004)

Hi Lara,

I don't really know much about this, but a quick search of the net has indicated that this can mean your endometrial lining was too thick. 16-18mm is very thick and may indicate abnormality or an over response to progesterone possibly (?) and therefore is not a conducive environment for implantation.

It definitely needs looking into by a specialist as soon as possible for further confirmation and information in order to inform you for your DE cycle.

Apologies if I have muddied the water. If you google hypertrophic endometrium etc. you will find more information.

Daisy
x

There is a study of endometrial thickness and ivf success here:-

http://humupd.oxfordjournals.org/cgi/reprint/2/4/323.pdf

This post contains an unconfirmed link and readers are reminded that FertilityFriends.co.UK or its owners are not responsible for the content of external internet sites


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## Lara200 (Aug 26, 2006)

Hi Daisy

Thanks very much for the info.  I am very annoyed that this had not been considered before and it is just by chance that it has been raised now.  I will raise it with my clinic tomorrow.
I have another question for you if you don't mind.  I see that in your last successful cycle you had lots of steroid support, presumably after implantation.  I am hoping to have one final go with my own eggs before going down the donor route.  I have told my consultant that it is the last go and he has suggested the prednislone and clexane you had.  He didn't say anything about the higher dose folic acid.  What is this for and should I ask him for this too?  I have had lots of blood tests done, including thrombophilia screen and a lap and dye and I am also going to have a hysteroscopy before this next cycle.  I want to do whatever I can to maximise my chnaces.  I am also on this cycle moving from Menopur to Puregon.  It seems that the doctor is simply suggesting different drugs to see if they get a better response.  Any help you can give would be greatly appreciated.  Many thanks.

Lara


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## britgrrl (Apr 15, 2006)

HIgher dose folic acid is prescribed if you carry the MTHFR mutation - the rule is 2mg extra for each copy of the mutation. So those who are homozygous, like me, we get the special 5mg a day dose. This is because the  mutation reduces the bioavailbility of folate.


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## daisyg (Jan 7, 2004)

Hi Lara,

As britgrrl says, I took folic acid and b vits 6 & 12 because I had MTHFR, which can cause blood clotting and neural tube defects due to the body's inability to absorb and process folic acid and vitamin b.  I was on 5mg folic acid, 50mg b6 and 1,000mg b12.

You could take these without any harm on a 'just in case' basis as you haven't been tested or diagnosed with MTHFR.  Basically, it won't do you any harm to take these, but you may not need them. 

Also - very important that the steroids are taken BEFORE implantation - ie. about day 6 of your cycle.  It is too late by implantation as the damage caused by any auto immune reaction will already have happened.  The point of starting steroids before implantation (before transfer basically), is to prepare the uterus and quieten down any possible immune reaction and therefore make a conducive environment for the embryo to implant properly.

The other additional thing I used on my successful cycle (just for info.) was progesterone in oil (Gestone) as I had had problems absorbing cyclogest (pessaries).  Gestone delivers lots of progesterone and it considered the gold standard in the US - just a thought if you want to try everything!  

Britgrrl - just to say that I was advised to take vitamin b6 and b12 in addition to the folic acid as this mix is essential for those with MTHFR and miscarriage history.  I just bought the tablets from Holland and Barratt.

Good luck to you.

Daisy
x


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## Lara200 (Aug 26, 2006)

Thanks for all the fantastic info re folic acid.

I rang my clinic today and they said that my lining in my last cycle was 15.1mm when they triggered me and also that it was a good thickness and wasn't excessive at all.  I'm not sure what to think.  I don't have much time left to do this and my next cycle will be my last with my own eggs.  I don't feel qualified to argue this point with my consultant and wondered if you know of anyone else who has come across this.  Any help would be greatly appreciated.

Lara


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## daisyg (Jan 7, 2004)

Hi Lara,

You mention in your first post that it was the doctor from the DE clinic that mentioned hypertrophic endometrium.  Can you ring her and get her to clarify exactly what this means?  I would think this would be a place to start.

Also, are you happy with your current clinic in terms of their success rate for your age group?  Have you had an other blood tests to check for things like blood clotting issues, sperm issues, karotyping etc. that may cause implantation failure etc etc.

Having been through 3 ivfs with my own eggs at age 44-44.5 I wish I had had these tests before as I was found to have clotting issues and by the time they were addressed it was too late with my own eggs.  Having said that, I have gone on to have 2 beautiful babies by donor embryo so I am not complaining!  I just always think one should have as many eliminatory tests as there is no time to waste.  Your GP can do many of these blood tests.  Has your DH been tested etc.?  Have you had a hysteroscopy to look at your womb etc etc.  

Daisy
xxx


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## Lara200 (Aug 26, 2006)

Hi Daisy

Thank very much for all your help on this.  I have stuck with the same clinic throughout my treatment and don't know if it would be better to move.  My consultant there is willing to try new things and without going anywhere else, I don't know if anyone else would do things differently.  I am changing medication this time and taking additional steroids as well.  I am single and doing this on my own and given my age, there are very few places which will treat me.  I am with the Bridge in London and the only other place with reasonably good results in my area and which will treat me is the Lister Hospital.  One of the reasons I originally went to the Bridge was because they had their own sperm bank, not that that matters now as they say they don't have sufficient supplies and I have had to import sperm.  The sperm issue should therefore not be a problem in my case.
My current plan is to try again with my own eggs (one last time) and if that does not work then try embryo donation abroad.  I have had a lap and dye, that was fine, I have also had lots of blood tests.  I had a full thrombophilia screen  and that too was OK.  What is karotyping?  I have not had a test for MTHFR.  How is that tested?  One of the other ladies said it was OK to increase the dose of folic acid even if you haven't been tested.  I am already taking DHEA, multivits, wheatgrass and aspirin.  Also, drinking whole milk.  Not sure what else I should do.  I am also having a hysteroscopy and scraping of the womb lining next week, before my next cycle.  I seem to be in a position you were in not so long ago.  I hope I can achieve what you have.  That is all I ask for and any help you can give me would be greatly appreciated.

With love
Lara


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## daisyg (Jan 7, 2004)

Hi Lara,

(This is just my opinion, and I have no medical knowledge).

I so sympathise with you as I feel I have been in a very similar position. I don't know what the Bridge's results are like, but I understand your issue with changing clinics. It isn't really only a question of what the consultant would do differently, it is how good the clinic's lab and embryologists are as well and how many women of your age they have had live births with? Sadly, success for over 40s is often about eliminating potential problems, a first class clinic with a world class embryology lab. and putting back as many embryos as possible, preferably 5 or more just to beat the odds of most eggs being chromosomally abnormal at this age! This is why I went to the US. Sadly my clotting problems meant I miscarried all my pregnancies including my first donor egg pregnancy. This is one reason why I am so keen for eliminating all possible aspects. I personally would recommend the Lister and it may be that a change of clinic may give a different perspective. Sadly, there are very, very few women who have live births at age 44-45 with ivf in the UK - talk to a clinic who has had successful live births with over 42s. The highest success rates for women over 42 are in the top 2 clinics in the US - CCRM and Cornell - is this an option for you?

Has your clinic discussed PGD/PGS with you? It may be a way of finding out how many of your embryos are chromosomally normal just to get more information?

It is good that they have screeed you for potential problems like clotting. MTHFR is a genetic defect which can cause clotting issues and neural tube defects - the treatment is clexane plus 5mg folic acid, 50mg b6 and 1mg b12. It is detected via a blood test, but you could just take the vits anyway - you could double check with your consultant but I don't believe they could harm you. Karotyping is another blood test to see if you have any genetic issues which may affect fertility - it is a fundamental test to have and I would ask for it if poss.

I really would not take DHEA personally, especially if you are doing ivf. There is no reliable evidence that it works but it has been shown to seriously mess with your hormone balance, and as you are already taking a lot of hormones, I personally would not recommend this at all - the same with wheatgrass. These are appropriate for ttc naturally, but again may interfere with a medicated cycle and I would not take them and you are advised not to take them as they are contraindicated while doing ivf as they can interfere with the meds. you are already taking (ie. FSH, Antagons etc).

Aspirin should be prescribed by a consultant and not just taken just in case as there is some evidence that it may interfer with implantation in some patients. Has your doctor prescribed this for a specific clotting problem? My successful cycle was the only one where I did not take aspirin! - I miscarried all the others.

I was lucky to get pregnant on every single ivf cycle I did with own eggs aged 44 - 44.5 (at 3 different clinics). I took no supplements except a prenatal and the bvits and folic as mentioned. I gave up alcohol and coffee and just drank a couple of decaf teas a day. I drank at least 2 litres of water a day. Did nothing else. What is your BMI like? - this is something to watch. What are your FSH and E2 levels? How many embryos do you produce and what do they look like? Again, this is why you need a top class embryology lab. I was incredibly lucky as getting pregnant was not an issue, it was maintaining a pg. Have the doctors given any opinions as to why you are not achieving a pregnancy apart from age? It is unfortunately true that we may have many more physical problems in our 40s which will contribute to infertility.

Other tests are listed on the investigations and immunology board and I would recommend doing them - including glucose intolerence, thyroid and antithyroid antibodies etc. etc. Have you had your ANAs tested, auto immune issues like arthritis? NK Cells etc. etc.?

http://www.fertilityfriends.co.uk/forum/index.php?topic=80433.0

The other thing I would add would be progesterone injections rather than pessaries as they guarantee delivery of lots of progesterone. Sometimes as we age, we do not absorb meds. so well and I believe the injections are better than the pessaries just in case absorbtion is an issue.

One of the other reasons I am so keen on investigations etc. is that I was told that my miscarriages were all about age and to move to donor eggs. Sadly, I miscarried my donor egg cycle and it was only then that I was able to have further tests which revealed clotting disorders and auto immune issues which could then be medicated with clexane, prednisolone and extra folic/b vits.

I really hope you have success.

Wishing you the best of luck.

Daisy
xxx


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## Lara200 (Aug 26, 2006)

Hello Daisy

Thank you for all this valuable information.  I have thought of moving to the Lister (and their results are slightly better than those of the Bridge) but I may have left it a little late now.  I am having a hysteroscopy on Monday and that is with a view to starting my cycle on 23 March.  I agree with everything you say about the tests.  I had PGS done last time as 4 eggs fertilised.  Of the 4, 1 egg did not have anything in they could test, one was normal and the other 2 were abnormal.  The chromosomal deficiency in the two were different in both eggs which I am told indicates that I probably don't have a problem with all of my eggs.  It's just a cse of getting the good ones out and getting them to implant.
All the supplements I am taking, apart from Wheatgrass (which I will stop) are all as prescribed by my doctor.  Unlike you I haven't even been able to get pregnant and the doctor isn't really able to tell me why.  In my first cycle I didn't have PGS, as I only had 3 fertilised embryos and they could all have been aneuploid for all I know.  In the last cycle I did but even the 1 normal embryo didn't stick.  My FSA levels have always been fine.  In my last cycle it was 5.3. I don't recall the E2 level but it was fine too.  I have just had all the tests done again but haven't had the results yet.
I hadn't considered going to the US for treatment, simply because of the difficulties and I suppose the expense too of being treated there.  I will ask my doctor on Monday about some of these other tests and then decide what to do.  I know that if I want to change clinics I should do but I also don't want to lose any more time.  I am almost 45 and every month it seems like the chances of success become more remote.
Anyway, I can't thank you enough for all your help and I will continue doing more research and trying to decide what to do.
All the best

Lara


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## daisyg (Jan 7, 2004)

Hi Lara,

I totally hear you about changing clinics and that every month is precious. Sometimes the panic of time seems overwhelming and we are desperately trying to find answers to all of this under such pressure.

I also remembered another very important test that is often overlooked and that is infections like Ureaplasma and bacterial vaginosis which can lead to infertility and miscarriage. I would strongly recommend your doctor does a swab for these to be sure.

Statistically speaking (and all health, tubal, hormone and uterine issues being equal), one is more likely to get pregnant over 44 naturally or by a medicated iui cycle. Several monitored cycles using injectibles and iui might be a way forward if your ivf fails. There is a very good website for over 40 who are ttc. The board founder had a baby at 46 by using this method having failed on her ivf cycle (mind you she had grown up kids already). It is worth a look if you want to continue to try with own eggs (and cheaper than ivf!).l

http://www.fertilityover40.com/Forums/FertilityOver40Forum/tabid/60/Default.aspx

After this there are donor eggs which will be another step for you perhaps to consider. One has to come to terms with this step in one's own way and in one's own time (but don't leave it too long!). But it sounds like you hopefully will have 'closure' and know you tried all you could before moving on if that is what you do. Believe me, there is light at the end of the tunnel!

Sending best wishes and lots of luck.

Daisy
xxx


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## Lara200 (Aug 26, 2006)

Daisy

Thank you again for your post.  The further tests you mentioned.  Are these ones which my GP could do.  I can try and see my GP on Monday to see if they can help me.  My head is bursting right now with all of this.  It doesn't help not having anyone alse around to help make the "right" decision.  I will go ahead with the hysteroscopy on Monday and ask the doctor about these tests too.  Many thanks.

Lara


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## daisyg (Jan 7, 2004)

Hi Lara,

The ureaplasma and bacterial vag. tests are easy for either GP or your ivf clinic to do.  It is worth seeing the GP to see if they could get it done asap for you?  

I am so sorry if I have caused more confusion.  I was worried about this, but felt I wanted to pass on all this stuff rather than not.  I know it makes you feel like there is so much more to think about, but it sounds like you may have had a lot of these tests already?  It is definitely good that you are having a hysteroscopy and you get a chance to ask your consultant about further tests.

Again, apologies if I have caused more headaches.  I really wish you so much luck for your next cycle.

Daisy
x


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## Lara200 (Aug 26, 2006)

Dear Daisy

You have not caused confusion and there is absolutely no reason to apologise.  I am incredibly grateful for your help.  You have given me so much information, far more than the doctors I pay vast amounts of money to help me.  On this site we all learn from each others' experiences and it is such a wonderful support system.  You have given me lots to think about and it is always best to better informed.  I will get some of these other tests done and who knows, it may just be the one to help me get through this, in whatever way it ultimately works out.  Thank you again for your help.

Love Lara


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