What is the normal endometrial thickness during pregnancy

How will my egg cell
to my dream child?

The egg cells mature (approx. Day 1 to day 10)

With the onset of the menstrual period, a new cycle of egg maturation begins. Several egg cells mature at the same time, each in a shell, the so-called follicle. Only one follicle wins the race and reaches ovulation maturity, the other eggs die.



The uterus prepares

The uterine lining (endometrium) built up in the previous cycle is shed with the menstrual bleeding. The lining of the uterus can now re-prepare itself for a possible implantation of the fertilized egg cell. The structure of the uterine lining is controlled by estrogens that are released from the growing follicles. With a cycle of 28 days, the follicle reaches a size of 8-10 mm on the 12th day of the cycle. The maturation phase of the follicle and the egg cell it contains varies in length. In women with a cycle of 25 days, the so-called follicular phase takes about 10-11 days until ovulation. Maturation begins later in women with a longer cycle. With a cycle of 35 days, the follicular phase ends after about 21-22 days.



Ovulation (day 14)

Ovulation usually takes place around the 14th day of the cycle (in the "classic" 28-day cycle). The wall of the follicle tears and the egg is literally thrown out of the follicle. At this point, the open, funnel-shaped end of the fallopian tube turns over the ovary and picks up the egg cell.



The fertilization

If sexual intercourse occurs shortly before or after ovulation, the egg cell is fertilized in the fallopian tube. The egg cell is slowly transported in the fallopian tube towards the uterine cavity. This process takes about 5-6 days.



Nesting (day 6)

On the 6th day after fertilization, the embryo builds up pressure in the egg cell shell and bursts its shell (so-called "hatching"). Now it can implant itself in the lining of the uterus. During implantation, small blood vessels in the lining of the uterus are opened to supply the embryo with nutrients and oxygen. In a few cases there may be a slight implantation bleeding from the vagina. The growing embryonic tissue produces the pregnancy hormone HCG, which stimulates the corpus luteum. The corpus luteum develops from the remains of the follicle remaining in the ovary. It releases the hormone progesterone, which stabilizes pregnancy. If pregnancy has not occurred, the corpus luteum function breaks down. The resulting drop in hormones induces the shedding of the uterine lining and the associated menstrual bleeding - a new cycle begins.



The cycle calculation

The duration of the follicle maturation phase before ovulation varies from person to person. Therefore, the calculation of the time of ovulation is only possible for women with very regular cycles. The calculation of the cycle is based on the second, very stable corpus luteum phase, which is almost always. Lasts 13-14 days (period from ovulation to the onset of the following menstrual period). This stability of the 2nd section of the cycle makes it possible to calculate your own ovulation date in the event of regular bleeding; it is also the basis of the cycle "apps".



Causes of Fertility Disorder

In addition to the causes described under "Diagnostics", there are other possible causes of a fertility disorder.



Small mucous membrane thickness

In most women, ultrasound shows a mucous membrane thickness of approx. 8-10mm before ovulation, and the mucous membrane (endometrium) shows a typical structure (three layers), which changes after ovulation under the corpus luteum hormones. Previous studies showed that women with an endometrial thickness of less than 6 mm had lower pregnancy rates in artificial insemination. Therefore, attempts have been made often and in vain to use drugs to improve the growth of the mucous membrane in these patients (ASA, high-dose vitamin E, blood circulation-promoting agents such as pentoxiphylline or Viagra). Recent studies have shown that some women with thin mucous membranes can get and stay pregnant normally. With these, it would be completely nonsensical to try to make the mucous membrane thicker - it usually doesn't work anyway. Another situation is that in women, after surgery such as scraping, thin mucous membranes can be seen in the ultrasound. In these cases, the procedure can lead to a reaction of the mucous membrane with reduced growth and scarring in the uterine cavity (so-called Asherman syndrome). In these cases, therapy makes sense to restore the mucosal conditions and thus improve fertility.



Disorders of the function of the pituitary gland

The pituitary gland produces hormones that control the glands in our body (thyroid gland, ovaries or testicles, adrenal gland, mammary gland). The various systems are influenced or controlled by higher-level brain areas. In the case of disorders of the systems (e.g. thyroid, adrenal gland, etc.) or influencing the control systems in the brain, e.g. through extreme stress (e.g. extreme sports, starvation), the function of the pituitary gland can be impaired, which can lead to cycle disorders, among other things. There are also congenital disorders of the pituitary function.



Fallopian tube dysfunction

The fallopian tubes primarily have a transport function: they promote the ascent of the sperm cells to the ovary and, once it has formed, pump the embryo towards the uterus so that it can finally implant there. In addition to this pure transport function, it also has "nourishing" tasks so that the function of the sperm cells is maintained and the embryo receives sufficient nutrients for its development on its way. This is achieved through the muscle layer in the fallopian tube wall and the mucous membrane inside When looking at the fallopian tube, its delicate structure is noticeable, which allows great mobility. Inflammation in the abdominal cavity or infections can lead to thickening of the wall and destruction of the mucous membrane. In the worst case, it comes to a complete fallopian tube obstruction. The changes in the mucous membrane are Hard to diagnose, but incomplete and complete occlusions can (see diagnostics).



Immunological causes

The subject of immunological causes is complex and for the most part not yet explored. It is clear that the implantation of the embryo as a kind of "foreign body" in the woman's uterus is an immunological phenomenon. Which mechanisms lead to the fact that the “foreign body” embryo is still not fended off by the maternal side is at best known in the beginning. The diagnosis and even therapy of possible disorders are therefore still in their infancy. Many implantation problems and frequent miscarriages are based on probable immunological causes. Although test methods for examining immune cells in the blood and in the mucous membrane are already being offered, these are still to be regarded as experimental, as are the possible treatments in the event of a “wrong adjustment” of the maternal defense system.



Disturbed semen production

The sperm cells are produced in the testes in small canals from the stem cells there (so-called spermatogonia). This happens around the age of 12 under the influence of pituitary gland hormones (predominantly FSH), the maturation of the sperm cell until it is functional takes about 3 months, during which the progenitor cells divide and receive the scourge for active locomotion. The finished sperm are stored and continue to mature in the epididymis, from where they are catapulted out through the seminal duct during ejaculation. Approx. 100 million sperm are formed every day, but only a small part of it comes to light during ejaculation (approx. 40-200 million per ejaculate). The rest are broken down in the testicle. Frequent causes of reduced sperm production are inflammation of the testicular tissue (e.g. in mumps), the toxic effects of smoking, alcohol and environmental toxins (in food, air). But permanently elevated temperatures (such as undescended testicles) can also lead to damage. Only short-term increases in temperature, such as when cycling, are of no importance. But there are also congenital disorders with missing stem cells in the testes, which can lead to a complete lack of sperm. The latter can be determined by examining the testicular tissue (testicular biopsy / TESE).



Disturbed semen transport

An interruption in the evacuating vas deferens can also lead to few or no sperm being found in the ejaculate, although their production may be completely normal. This can be found after infections of the epididymis, but also in congenital disorders of the structure of the spermatic duct (e.g. in cystic fibrosis patients). In these cases, the sperm cells can be obtained through a testicular biopsy.



Impaired function of the sperm cells

The sperm cells often show changes in the shape of the head or the flagella under the microscope). Some changes are associated with definite loss of sperm function. Other, minor changes (e.g. the shape of the head) obviously have no meaning. Under today's microscopes it is even the case that the vast majority of sperm cells are classified as morphologically (appearance) not entirely normal. This also applies to men who are completely fertile. There is a further functional limitation when the enzymes that are necessary for the movement of the sperm and for the thickening of the egg surface are reduced. However, the test procedures introduced for this are not yet fully established. In addition, there may be increased degradation processes on the chromosomes, which is generally a completely normal process in cell degeneration. In some men, however, an oversized proportion of sperm is already in such a degeneration process, which limits fertility (the risks for this are smoking, being very overweight, therapies such as chemotherapy or radiation treatments).



Erectile dysfunction and ejaculation disorders

Malfunctions of erection and ejaculation are reported by men, especially when they have been having children for many years. In the case of erectile dysfunction, increased stress is often the cause, the burden of having children alone is often the cause. It is important that such problems are identified in the course of the discussions in order to be able to treat them, since the functional disorders are very stressful for the men and their partners. Ejaculation disorders occur more often in men after previous operations in the genital area (e.g. prostate surgery).



And how is it with us?

Step by step, we approach the probable causes of your unfulfilled desire to have children during your fertility treatment - and thus the decision on the most promising treatment method. You can take the very first step for this now when you make an appointment for an initial consultation.

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