Endometrial growth and uterine blood flow: a pilot study for improving endometrial thickness in the patients with a thin endometrium

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. Patient(s): Sixty-one patients with a thin endometrium (endometrial thickness [EM] <8 mm) and high radial artery-resistance index of uRA (RA-RI >= 0.81). Intervention(s): Vitamin E (600 mg/day, n = 25), 1-arginine (6 g/day, n = 9), or sildenafil citrate (IOU mg/day, intravaginally, n = 12) was given. Main Outcome Measure(s): EM and RA-RI were assessed by transvaginal color-pulsed Doppler ultrasound. Result(s): 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 I I (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. Conclusion(s): Vitamin E,1-arginine, or sildenatil citrate treatment improves RA-RI and EM and may be useful for the patients with a thin endometrium. (Fertil Steril(R) 2010;93:1851-8. (C) 2010 by American Society for Reproductive Medicine.)