Takasaki, A., Tamura, H., Miwa, I., Taketani, T., Shimamura, K., & Sugino, N. (2010). Endometrial growth and uterine blood flow: a pilot study for improving endometrial thickness in the patients with a thin endometrium. Fertility and Sterility, 93(6), 1851-1858. https://doi.org/10.1016/j.fertnstert.2008.12.062
Takasaki A, Tamura H, Miwa I, Taketani T, Shimamura K, Sugino N. Endometrial growth and uterine blood flow: a pilot study for improving endometrial thickness in the patients with a thin endometrium. Fertil Steril. 2010;93(6):1851-1858. doi:10.1016/j.fertnstert.2008.12.062
Takasaki, Akihisa, et al. "Endometrial growth and uterine blood flow: a pilot study for improving endometrial thickness in the patients with a thin endometrium." Fertility and Sterility, vol. 93, no. 6, 2010, pp. 1851-1858.
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Vitamin E, l-arginine, sildenafil improved thin endometrium in a pilot
In a Japanese observational pilot of women with a thin endometrium and poor uterine blood flow, vitamin E, l-arginine and sildenafil citrate each thickened the lining in over half of treated women. Only 1 of 10 controls improved. Pregnancies occurred in all three treated groups and in none of the controls.
Key Findings
Among 25 women given vitamin E, 18 (72%) had lower resistance in the uterine radial arteries (RA-RI) and 13 (52%) reached a thicker endometrium. Five (20%) conceived that cycle.
Among nine women given l-arginine, eight (89%) had better RA-RI and six (67%) had a thicker endometrium. One (11%) conceived.
Among 12 women given sildenafil citrate, 11 (92%) gained on both RA-RI and thickness. Six (50%) conceived in the treatment cycle.
Of 10 controls who took nothing to raise uterine blood flow, one (10%) improved on both measures, and none (0%) conceived.
Biopsies from five women on vitamin E showed more gland growth, more blood vessels and higher VEGF protein in the endometrium.
Interpretation
The study is a prospective observational pilot. Each treated woman was compared with her own previous cycle, and 10 women who received no medication to raise uterine blood flow formed the control group. Biopsy results come from five women. Sildenafil was given in IVF-ET cycles. The vitamin E and l-arginine groups had natural cycles or cycles with ovulation-inducing drugs. The authors note the groups had different fertility treatments. Follicle counts and serum estradiol did not change significantly, and the authors suggest the gains came through endometrial blood flow.
RRM Context
Ultrasound can track endometrial thickness and uterine artery resistance across a cycle. The authors suggest a thin endometrium may be due to high resistance in the uterine radial arteries. Asking what drives poor endometrial growth fits the root-cause approach of restorative reproductive medicine. Two vitamin E pregnancies came in natural cycles.
Our editorial summary of this paper, not the article's abstract.
Abstract
Objective
To examine whether thin endometria can be improved by increasing uterine radial artery (uRA) blood flow.
Design
A prospective observational study.
Setting
University hospital and city general hospital.
Patients
Sixty-one patients with a thin endometrium (endometrial thickness [EM] <8 mm) and high radial artery-resistance index of uRA (RA-RI >or=0.81).
Interventions
Vitamin E (600 mg/day, n = 25), l-arginine (6 g/day, n = 9), or sildenafil citrate (100 mg/day, intravaginally, n = 12) was given.
Main Outcome Measures
EM and RA-RI were assessed by transvaginal color-pulsed Doppler ultrasound.
Results
Vitamin E improved RA-RI in 18 (72%) out of 25 patients and EM in 13 (52%) out of 25 patients. L-arginine improved RA-RI in eight (89%) out of nine patients and EM in six (67%) patients. Sildenafil citrate improved RA-RI and EM in 11 (92%) out of 12 patients. In the control group (n = 10), who received no medication to increase uRA-blood flow, only one (10%) patient improved in RA-RI and EM. The effect of vitamin E was histologically examined in the endometrium (n = 5). Vitamin E improved the glandular epithelial growth, development of blood vessels, and vascular endothelial growth factor protein expression in the endometrium.
Conclusions
Vitamin E, l-arginine, or sildenafil citrate treatment improves RA-RI and EM and may be useful for the patients with a thin endometrium.
