Your Endometrium & how it relates to your fertility

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The endometrium is the lining of the uterus where an embryo will implant and grow… eventually turning into the placenta to support life. It’s mostly made of mucosal tissue. The endometrium is thickened by signaling of progesterone from the ovaries, along with the rise of estrogen that happens just before ovulation — in preparation for potential implantation!. If implantation doesn’t happen, the progesterone drops, and menstruation (shedding of the uterine lining) will happen. If implantation occurs, the endometrium will not shed but rather continue to sustain itself in order to be able to sustain life.


When the growth of the endometrial tissue goes beyond the confines of the uterus, we have the development of endometriosis. This can be a huge detriment to fertility! If you have endometriosis, treatment is essential. And, if you’re not sure you do, you need to work with a doctor who can help figure it out. My favorite test for this is Bcl-6 which some OBGYNs or REs can administer. It’s less invasive than laparoscopic surgery which is the only other alternative for diagnosis. A good suspicion of endometriosis is extremely painful periods. Other indicators are pain with sex, urination, or bowel movements. Unfortunately, 30-40% of women with endometriosis can have trouble conceiving. The good news is, once diagnosed, you have a good chance of having a successful pregnancy with an integrative approach- i.e. combining hormone therapy (not birth control!) and supportive naturopathic or holistic methods.


The implantation itself is a complex process of communication between the endometrium and the blastocyst (embryo). There are many signaling molecules involved in this communication: adhesion ligands, cytokines, growth factors, lipids, and more. The optimal time for implantation is between 6-11 days post-ovulation. Optimal endometrial thickness is over 8 mm. If your endometrium is not thick enough or the communication molecules are not releasing at the right times creating a proper communication between endometrium and embryo, implantation can be difficult. More so, implantation might happen briefly but continue forward to a chemical pregnancy (an early stage miscarriage).


Note: There is such a thing as too thick endometrial lining (technically called endometrial hyperplasia). If the lining is too thick, you may want to consider high estrogen levels. Also women with polycystic ovarian syndrome, can have endometrial hyperplasia. In general, it’s not a good thing for fertility!


What creates a healthy endometrium?

First, healthy levels of progesterone and estrogen. Progesterone is tricky since it is released by the corpus luteum of the egg that was ovulated. So, you can guarantee that if you don’t have a great quality egg, there won’t be healthy  levels of progesterone. Additionally, estrogen levels have to be optimal, meaning not too high and not too low.


Last but not least, the endometrium must not be inflamed. Implantation, in and of itself, is inflammatory. There is a release of prostaglandins and cytokine chemicals that facilitate the implantation of an embryo. However, this inflammation is very specific and only happens at the time of implantation — when there is more generalized inflammation of the endometrium, implantation will be challenging.


Understanding your endometrial lining:

First and foremost, the easiest way to assess you endometrial lining is to observe your menstruation closely. Do you have clots? Do you have a healthy bleed? Do you have cramps?


If your menses is lighter than it used to be, and/or you don’t have at least 2 days of a healthy bleed (equivalent to at least 1 pad every 3-4 hours), your endometrial lining is too thin.


If you have clots or cramps, these are signs of likely generalized inflammation, not conducive to a healthy implantation and pregnancy.  


Beyond this, you can have an Endometrial Receptivity Assay through your reproductive endocrinologist to figure out the optimal timing for implantation.


What to do for a healthy endometrium?

  • Optimal blood flow and circulation is needed for the uterus, and development of healthy lining. A type of gyno-visceral manipulation therapy that I utilize in my practice is great for this purpose. You can read more about that here


  • Low level laser therapy is a technique that can help to reduce local inflammation of the uterus and increase blood flow to the uterus, which will in turn support healthy implantation. You can read more about that here


  • Oxytocin during the implantation period: evidence suggests that increased levels of oxytocin during the time of implantation can help increase implantation success. My favorite ways to do that is via lots of hugging and cuddling


  • Sex around time of implantation: There are prostaglandins in semen that can support implantation, as well as the release of oxytocin that is caused by  skin-to-skin stimulation


  • Localized Progesterone can increase endometrial receptivity in certain women. Talk to your holistic fertility doctor to see if this might support you.


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