- Thin Endometrium and Asherman Syndrome
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If the endometrium is thin, repeated implantation failure may occur. Endometrium is considered when it is less than 7 to 8mm. It is generally known that for successful pregnancy, endometrium should be at least 6mm. It has been reported that low-dose aspirin, estrogen, and G-CSF and Viagra vaginal suppository may be helpful for thin endometrium, but further studies are still needed to determine its effectiveness.
Asherman syndrome is the formation of scar tissue in the uterine cavity and commonly occurs with D&C procedures, abortion, or intrauterine contraceptive devices.
As a new treatment attempt for infertile women with severe endometrial adhesions, CHA Medical Center conducted the first study in Korea to treat endometrial regeneration by the transplantation of autologous adipose-derived stromal vascular fraction containing adipose stem cells. Currently, autologous platelet-rich plasma, which is known to have blood clotting and hemostasis, angiogenesis, anti-inflammatory and antibacterial effects, are under clinical studies for treatment of endometrial regeneration in patients with intractable thin endometrium while showing success rate in pregnancy.
- Adenomyosis
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Adenomyosis is a disease that is characterized by severe menstrual pain, heavy menstruation, and pain during intercourse due to the presence of endometrial tissue in the myometrium. The prevalence of adenomyosis in patients with infertility has been reported to be 8-27%, and a number of studies have reported that adenomyosis and endometriosis are associated with infertility. A recent report showed that patients with adenomyosis had 28% lower pregnancy rates through IVF and embryo transfer procedures than those who did not.
Hysterectomy is the usual treatment method for adenomyosis. The therapeutic effects with medications such as GnRH agonist, contraceptives, progestin therapy, danazol, and NSAIDs are still unclear.
For those who had an unsuccessful conventional treatment and has continuous pain, ‘dopamine agonist' is used for patients with severe uterine adenomyosis and wants to become pregnant. 'Dopamine agonist' is also commonly used to suppress lactation, treat premenstrual syndrome, terminal hypertrophy, and Parkinson's disease. Recently, a thesis paper using dopamine agonist for the treatment of endometriosis has been published, and it has been reported that the nerve fibers associated with pain have been reduced.