title: Strategies to manage refractory endometrium: state of the art in 2016.
abstract: The endometrium is one of a number of factors involved in achieving optimal outcomes after assisted reproductive treatment. Owing to its "passive" growth following adequate ovarian stimulation, it has received virtually no attention. Only when either endometrial thickness or ultrasonographic pattern seem inadequate have different strategies been assessed to try to improve it, especially in those cases where it seems difficult or impossible to make it grow. The objective of this review is to summarize the different strategies that have been investigated in patients with inadequate endometrium, to attempt to provide solid evidence of therapies that may be beneficial and to move away from empirism. A review of the existing literature was performed by searching MEDLINE, EMBASE, Cochrane library and Web of Science for publications in English related to refractory endometrium. Most current treatments are based on anecdotal cases and not on solid data, although worldwide many doctors and patients use them. In conclusion, this review found that it is not easy to provide a pragmatic, evidence-based approach to help physicians and patients confused by the available data on how to improve a poor endometrium. Honest balanced information provided to our patients is the best that we can do.
authors.affiliation: IVI-Madrid, Rey Juan Carlos University, Madrid, Spain. Electronic address: juan.garcia.velasco@ivi.es.
authors.forename: Juan A
authors.initials: JA
authors.lastname: Garcia-Velasco
authors.affiliation: Fundación Jiménez Díaz, Madrid, Spain.
authors.forename: Belen
authors.initials: B
authors.lastname: Acevedo
authors.affiliation: URE Centro Gutenberg, Málaga, Spain.
authors.forename: Claudio
authors.initials: C
authors.lastname: Alvarez
authors.affiliation: Hospital Materno Infantil, Las Palmas, Spain.
authors.forename: Monica
authors.initials: M
authors.lastname: Alvarez
authors.affiliation: IVI-Valencia, Valencia, Spain.
authors.forename: Jose
authors.initials: J
authors.lastname: Bellver
authors.affiliation: Hospital Virgen de las Nieves, Granada, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Fontes
authors.affiliation: IVI-Murcia, Murcia, Spain.
authors.forename: Jose
authors.initials: J
authors.lastname: Landeras
authors.affiliation: Hospital Clínico, Barcelona, Spain.
authors.forename: Dolors
authors.initials: D
authors.lastname: Manau
authors.affiliation: Hospital Universitario Quirón-Dexeus, Barcelona, Spain.
authors.forename: Francisca
authors.initials: F
authors.lastname: Martinez
authors.affiliation: IVI-Vigo, Vigo, Spain.
authors.forename: Elkin
authors.initials: E
authors.lastname: Muñoz
authors.affiliation: Hospital del Mar, Barcelona, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Robles
authors.affiliation: Hospital Clínico Universitario, Valladolid, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Rodriguez-Tabernero
mesh_terms: D004717:Endometrium / Q000473:pathology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D027724:Reproductive Techniques, Assisted; D014591:Uterine Diseases / Q000503:physiopathology / Q000628:therapy*
keywords: IVF; assisted reproductive treatment; endometrial lining; refractory endometrium