Fluid in the Endometrium

As usual I find myself apologizing for the long delay between blog posts and as usual I have no real excuse except that I am just a bit tapped out....sigh. The summer has flown past and soon we will be back in the grind of school and work with the playtime of summer a distant memory. This Fall will be memorable as my oldest child will be off to college. Hard to imagine. You know, when I started practice I used to get the "you look too young to be my doctor...." but now not so much! I was thinking about looking into microscopic hair transplantation but my wife assures me that she loves me even as my bald spot and waistline seem to growing inexorably larger. But enough about me....

Everyday I answer posts on the INCIID.org website. I have done this for over 10 years and hope that some of you have found the feedback helpful. Dr. DiMattina and I have launched an online community for our practice (Fertile Grounds) that also provides opportunities for both patients (and non-patients) to post questions to us. We try to answer to the best of our ability and rest assured that posting a question on Fertile Grounds will not result in you being hounded to switch clinics and become a patient of Dominion Fertility....although we would welcome you with open arms and provide all qualifying individuals with a 2 week vacation to the French Riviera.

Recently I had another post on the INCIID.org website concerning fluid in the endometrium. This problem crops up a couple of times a year and is often a great source of distress to the patient who is informed that the lining does not look normal.

So where does this fluid come from? Initially just after a period ends there may be some residual fluid in the endometrial cavity. This fluid is usually old blood and as the follicle(s) begin to develop the lining thickens in response to the rise in estrogen and the fluid vanishes. This type of fluid is not an issue.

More concerning is fluid that appears during stimulation for IVF or for an FET. In general, the etiology of this fluid can be divided into anatomic and hormonal causes. Anatomic problems that lead to fluid accumulation are usually the result of previous damage to the endometrium during surgery. The most common surgical procedures that could damage the lining are removal of fibroids (by laparotomy or hysteroscopy) or a D&C performed for a retained placenta following delivery. Scarring that is present within the cavity is usually called Asherman's Syndrome (especially if it results in the absence of menstrual flow). The risk of adhesions after fibroid removal can be reduced by taking care during the surgery to ensure the lining is not damaged or by treating with estrogen after surgery to induce the rapid regrowth of the endometrium to cover any raw areas within the cavity.

Hormonal causes of fluid accumulation may relate to the high estrogen levels that can be seen in some patients undergoing IVF or FET. If the problem occurs during an FET then the cycle could be aborted. If seen during stimulation then a cryo all could be contemplated. However, in my experience the fluid will often reabsorb once HCG is given or progesterone is started. If, by the day of ET, the fluid persists then the embryos could be frozen or the fluid aspirated and the transfer performed if the lining otherwise looks normal.

Evaluation of the uterine cavity in such cases usually includes hysteroscopy or water sonogram (hysterosconogram). I have also found in helpful to monitor the lining during a spontaneous cycle and see if the endometrium looks normal. If it does, then a Natural Cycle FET may be the best treatment option. In cases of severely abnormal lining the use of a gestational carrier may be the best choice but this option may not to acceptable to all couples.