IMPROVING THE UTERINE LINING

RESOURCE: For Recurrent Pregnancy Loss

Blood flow to the endometrial lining measured as uterine artery resistance (pulsatility index or PI) and subendometrial flow is under hormonal control and has been shown to correlate with pregnancy outcome. If resistance of flow through the uterine artery is elevated or if flow of blood though the spiral arteries leading to the endometrium is low, successful pregnancy outcome is not expected. Decreased blood flow to the uterus has been shown to be increased and to result in increased successful pregnancy rate with treatment with both aspirin and sildenafil (Viagra).

Aspirin Therapy
Among women with increased resistance of blood flow through their uterine arteries who were treated with aspirin for a minimum of two weeks, the miscarriage rate decreased from 60% to 15%. An increase in subendometrial flow has also been noted with aspirin therapy. The usual dose of aspirin is 80mg a day (one baby aspirin). However, in an occasional woman as much as 360mg (one adult aspirin) has been required to see a beneficial effect on uterine blood flow. Do NOT go on this therapy without the advice of your physician.

Sildenafil (Viagra) Therapy
When aspirin is unsuccessful in improving uterine blood flow or if the miscarriages are associated with a thin (less than 9 mm) uterine lining, sildenfil (Viagra) has been used successfully to increase uterine blood flow. Viagra in the form of vaginal suppositories given in the dosage of 25 mg four times a day has been shown to increase uterine blood flow as well as thickness of the uterine lining. To date, we have seen significant improvement of the thickness of the uterine lining in about 70% of women treated. Successful pregnancy resulted in 42% of women who responded to the Viagra. It should be remembered that most of these women had previously experienced repeated IVF failures.