Treating patients with thin'' endometrium - an ongoing challenge

Objective: To review the literature regarding inadequate growth (thin'') of the endometrium and to present the hitherto published methods aimed to improve endometrial thickness and the consequent endometrial receptivity. Materials and methods: A literature review was conducted for all relevant articles assessing the effect of various treatment modalities on thin'' endometrium and the consequent reproductive outcome. Results: Several treatment modalities have been offered to patients with thin'' endometrium, including hysteroscopic adhesiolysis, hormonal manipulation by estrogen and GnRH-agonist, vasoactive measures such as aspirin, vitamin E, pentoxifylline, l-arginine or sildenafil, intrauterine infusion of growth factor such as G-CSF and the recent application of regenerative medicine. In spite of the vast diversity of treatment, most of the options accomplish only minor change in the endometrium thickness and subsequent pregnancy rate, and when they fail, patients are usually referred to surrogacy. Conclusions: Thin'' endometrium is known to adversely affect reproductive performance. Treatment of thin endometrium'' remains a challenge and future large researches are required to further elucidate and optimal management of patients with thin'' endometrium.