Manejo de endometrio refractario en las pacientes que recibieron técnicas de reproducción asistida: presentación de 2 casos clínicos

Background and objective

The endometrium is a dynamic tissue that undergoes changes throughout the menstrual cycle, including morphological, biochemical and molecular changes, necessary for a successful embryo implantation process. When insufficient endometrial thickness occurs embryo implantation takes place near the spiral arteries in the endometrial basal layer with high blood flow and high oxygen tension which leads to excess production of oxygen free radicals, a fact that can interfere with embryo implantation and development (Catt and Henman, 2000). Thus, an adequate assessment of this situation is essential to achieve an ongoing pregnancy.

Patients

In this article, we present the clinical cases of 2 patients with insufficient endometrium and how we have managed their situation through hysteroscopic and pharmacological treatment.

Results

Pregnancies have been achieved in both clinical cases. One of the patients had an eutocic delivery at 32nd week of pregnancy and a healthy child of 2,100 grams was born. The other patient is still pregnant.

Conclusions

The prevalence of thin endometrium according to published studies is between 2.4% and 8.5% of women (Ribeiro et al., 2018; Kasius et al., 2014). Multiple studies have shown a correlation between thin endometrium, low implantation rates and lower percentages of ongoing pregnancy. A minimum endometrial thickness of 7 mm is suggested to increase these percentages.