My thin endometrium lining

“Five per cent of women under 40 have thin linings…it’s difficult to treat and we rarely know the cause”.

I still remember the day our IVF specialist uttered those words. The problem was: we were onto our third fertility specialist and knee deep in IVF.

So how did we get here?

Up to that point, all I knew about the endometrium lining was it had to measure at least 6mm to transfer in Australia (8mm in most countries). But it was after three consecutive cancelled transfers and a few worrying remarks from our sonographers, “Oh dear, your lining’s looking a bit thin”, I started to research it. And wow did I find out a lot!

What was the first thing I learned?

The lining is crucial to falling pregnant and sustaining a pregnancy. It’s considered one of the stars of the female reproductive system and plays a key role during pregnancy. As the wallpaper of the uterus, it becomes thicker with pregnancy so it’s ready to receive an embryo and support the placenta.

An optimum lining is 10-12mm at transfer. On our cancelled cycles, my lining measured late 4mm’s. On the transfers that went ahead, it was 5.5-6mm. But with a lining around 6mm, it’s extremely difficult to conceive.

As one of our specialists put it, “You need healthy and rich soil for a plant to grow”

One research study I read found with a lining of 6-7mm, the pregnancy rate (not birth rate) was only 7.4 per cent. For women with a lining over 7mm, it was more than triple, 30.8 per cent. Another study showed that with a lining of 6mm, of 35 embryo transfers conducted, only two babies were delivered.

For most women, it’s hard to treat but one of the few known causes is lack of estrogen. On one cycle, I took about 10 estrogen pills a day (I wish I were exaggerating). I also tried acupuncture to help nourish my blood and thicken my lining. What felt like millions of tiny needles were placed into my body. I looked like a porcupine. But to my surprise, I found it quite relaxing.

My lining increased, but not enough

On day 22 of this cycle, our nurse told us we would have to cancel the transfer. There were so many tears that day. I was exhausted. For 22 days I had tried everything, and it still wasn’t enough. I had barely moved the dial. My lining had started at 3mm and 22 days later, it was only 4.7mm. Most linings start at 3mm at the end of your period and increase 1-2mm a day, with many women reaching 10-12mm by their transfer day (usually day 16-20).

It was on our last cancelled cycle I finally took matters into my own hands. On this cycle, my lining had remained stubbornly low and at my final scan, five days before our transfer, it was only measuring around 5.5mm.

I wasn’t confident, but our specialist encouraged us to push ahead as it was, “close enough”. Only, I had read that with people with lining issues, it’s not uncommon for the lining to fluctuate. I asked for an ultrasound the day before the transfer. Not being standard practice, she reluctantly agreed. It was at this scan we learned my lining had gone back down and was barely reaching 5mm. The cycle was abruptly cancelled.

As the failed and cancelled cycles started to build up, we changed to our third specialist

At our first appointment, he hit us with the hard truth: thin linings are rare, usually genetic, and often difficult to fix. And while he confirmed everything I had already read, when he said the words out loud, it felt confronting.

He went on to tell us that as we had already tried the popular treatment solution – Estrogen therapy, aspirin, acupuncture, and Clexane injections – it didn’t leave us with many options.

It was then he told us surrogacy was our, “best chance of success”.

We didn’t know too much about surrogacy then, but it seemed overwhelming and I knew in my heart I wasn’t ready to give up on being pregnant myself. Accepting our decision, he made another suggestion: a stem cell procedure. The procedure would help invigorate my blood flow and nourish my lining. It would either work or it wouldn’t. One day off work and minimal recovery time. It was worth a try.

It worked. For this treatment cycle, my lining reached 6.5mm

We transferred in a Grade A Pre-implantation Genetic Screening (PGS) embryo and I became pregnant. I still remember so clearly the day we got our positive result, the high was enormous. But the next day, dread set in. I was petrified of something going wrong. The lining measurement haunted me. Yes, it was enough to transfer, but it wasn’t the ‘ideal’ thickness.

At our first scan at 7.5 weeks, we had the devastating news our baby was measuring too small and the heartbeat was too slow. Two days later at our follow up scan, the baby had passed. We were heartbroken.

A couple of weeks after my D&C procedure, our specialist called with the biopsy results. The baby was genetically normal. The baby was perfect. The baby was a girl. I wish I hadn’t found out the gender as it was impossible not to imagine how life would have been like with a baby girl. But above all else, it was yet another confirmation that the issue was me. Each egg collection, the specialist would retrieve an above average number of eggs for my age. When they tested them for chromosome abnormalities using PGS, most tested normal.

So, it wasn’t the embryos that were the problem. It was the carrier. It was me

As we had fallen pregnant though, we decided to try one last time. It didn’t work of course. I’m was not sure what we’re thinking. I suppose we weren’t ready yet to close that door. You always hold out hope.

But the day we received the negative result, I knew I had had enough. Something snapped in me that day and I knew that I never wanted to try and get pregnant ever again. Ryan agreed 100 per cent.

It took us a couple of years to fall pregnant with surrogacy but on 5 July 2019, our beautiful son Spencer John Wilson was born.

But if I had my time over, I wish I had been more proactive with my treatment. A thin endometrium lining is a key cause of preventing pregnancy and it’s easy to diagnose. And yet, it took us years of treatment before we knew this.

Reflecting back, I now know how crucial it is to do your research; be informed; arm yourself with knowledge; and talk to others who are also going through fertility treatment.

This Is Infertility - Book

I'm thrilled to announce that my book - 'This Is Infertility' - will be published by C&R Press later this year. I'm also proud and humbled to be awarded the C&R Press 2021 award for Nonfiction.

I'm passionate about raising awareness about infertility so that it's more commonly accepted and understood. This Is Infertility is about my 6 year IVF and surrogacy journey and everything I learned along the way.

Stay tuned for more info!

Kirsten x

Be your own advocate

Six years, 700+ injections, miscarriages, several failed and cancelled IVF cycles, and international surrogacy in two countries. But by the end of it? Our precious son Spencer.

I don’t regret too much during our infertility journey. I do regret staying silent too often when people offered us advice, “You just need to relax” and “It will happen when you stop trying”.

But one of my biggest regrets? Not speaking up enough with our medical specialists.

It wasn’t until we saw our third fertility specialist, that I was properly diagnosed with having a thin endometrium lining. The endometrium lining is crucial to falling pregnant and sustaining a pregnancy. As one specialist put it, “You need rich and healthy soil for a plant to grow”.

The other infuriating part about my diagnosis? It’s easy to diagnose a thin lining. You can you monitor your cycle with ultrasounds and measure it. If it’s thin, you can try treating it with options like estrogen therapy and see if it increases. If it doesn’t? Then your lining could be an issue.

I firmly believe we would have saved ourselves time, money, and heartache if we had advocated from the very start.

It wasn’t until the second half of our journey, after several failed and cancelled IVF cycles and a ‘Pregnancy of an Unknown location’, that I realised the importance of speaking up and challenging the specialists.

After a few failed and cancelled cycles, our nurse one day casually remarked at an ultrasound that my lining was looking, “a bit thin”. The requirement to transfer in Australia is 6mm (it’s 8mm in the United States and many other countries). On a transfer that went ahead, my lining measured late 5’s/early 6’s. On the cancelled cycles, it was 4-5mm.

After our nurse’s comment, I started to do my own research. And boy did I find out a lot!

I discovered that with a lining under 6mm, it was almost impossible to fall pregnant or sustain a pregnancy. A lining between 6-7mm was not great either but you stood a chance. Ideally you needed above 8mm.

One research study I read showed that with a lining of 6-7mm, the pregnancy rate on an IVF cycle was 7.4 per cent. For women with a lining over 7mm, it was more than triple, 30.8 per cent. Also, the study only reported pregnancy rates, not live birth rates. Another study showed that with a lining of 6mm, of 35 embryo transfers conducted, only two babies were born.

What was the final straw?

On one transfer cycle, my lining was increasing at a gradual pace. Once it finally reached late 5mm’s, my specialist recommended we transfer as it was, “almost 6mm”. But through my own research, I had discovered it’s not uncommon for thin linings to fluctuate. As my transfer was five days after my last ultrasound, I insisted on a scan the day before our transfer. Not standard practice, my specialist reluctantly agreed.

What did the scan show? My lining had gone back down to early 5’s. There was no chance of our embryo implanting. The cycle was abruptly cancelled.

If I hadn’t insisted on the scan, we would have wasted one of our precious embryos. Feeling confused, angry, and betrayed, we changed specialists. Our third specialist hit us the hard truth - thin linings are rare, they rarely know the cause and they’re difficult to treat. And that gestational surrogacy was our best chance of having a baby.

Thanks to his diagnosis and gestational surrogacy, we have our beautiful son Spencer.

What I learned?

- Arm yourself with knowledge. You can’t always rely on the medical specialists. Read about infertility and learn from others. Online communities and magazines like IVF babble are invaluable in helping to expand your knowledge.

- Join a community. Talk to others going through it. Learn from their experiences. The ‘Trying to Conceive’ online community is a fantastic resource. There are so many of us out there.

- Come prepared to your appointment. Bring a check list of questions. For example – What are the success rates (and for your age)? How many embryos make it to Blastocyst stage? What are the treatment options? Side effects? What is a thin endometrium lining? What’s Pre-Genetic Screening (PGS)? There are so many questions you can ask.

- Take your time at your appointment. Don’t feel pressured to be rushed out the door. Speak up. Don’t stay silent if you don’t feel satisfied with an answer.

- Get another opinion. Get a second or even third opinion if you think you need it.

So much of infertility is outside your control. I think that’s something I struggled with the most. Like any medical disease, infertility is indiscriminate. But one of the very few things in your control is speaking up and being your own advocate.