What the endometrium does
The endometrium is the inner lining of the uterus. Each month it thickens under the effect of hormones to prepare for a pregnancy. If no pregnancy happens, it sheds as a period.
In IVF, the embryo must attach to this lining. A healthy, well-prepared lining gives the embryo a better place to implant.
When is the lining called thin?
Doctors measure the lining by ultrasound. A lining that stays thin despite normal hormone support is a concern in IVF. Many doctors consider a lining under about 7 mm on the day of planning as thin.
The appearance of the lining on scan also matters, not just the thickness. Some women with a thinner lining still conceive. Your doctor looks at the whole picture.
Common causes
- Scarring inside the uterus, sometimes after a D&C, infection or surgery. This is called Asherman syndrome.
- Genital tuberculosis, which can damage the lining.
- Low oestrogen levels or poor response to hormones.
- Reduced blood flow to the uterus.
- Long-term use of certain medicines that affect the lining.
Sometimes no cause is found. That can be frustrating, but treatment can still be planned.
Tests your doctor may suggest
Repeat ultrasound
Serial scans across the cycle show how the lining grows. A transvaginal scan gives the clearest view. These scans can often be done in your own city and shared on WhatsApp.
Hysteroscopy
A thin camera is passed through the cervix to look inside the uterus. It can find scarring, adhesions or other problems. Some of these can be treated during the same procedure.
Tests for infection
If tuberculosis or another infection is suspected, the doctor may order specific tests. Treating an infection comes before any embryo transfer.
Treatment approaches
There is no single fix for a thin lining. Treatment depends on the cause. Your doctor will explain which options suit you.
| Cause or finding | Common approach |
|---|---|
| Adhesions or scarring | Hysteroscopic removal, followed by hormone support |
| Infection such as TB | Full course of treatment before IVF |
| Low hormone response | Adjusting oestrogen dose, route or duration |
| Lining not ready on time | Freezing embryos and transferring in a later cycle |
Oestrogen support
Oestrogen helps the lining grow. The doctor may change the dose, the form, such as tablets, patches or vaginal use, or the number of days before transfer.
Frozen embryo transfer
With a frozen embryo transfer, the embryos are stored while the lining is prepared separately. This gives more time and flexibility. Transfer happens only when the lining looks ready. Read more on our frozen embryo transfer page.
Other treatments
Various other treatments are sometimes discussed for a thin lining. The evidence for many of them is limited or still being studied. Ask your doctor about the benefits, risks and costs before agreeing to any add-on.
What a lining preparation cycle looks like
- Baseline scanA scan early in the period checks that the lining has shed and the ovaries are quiet.
- Oestrogen phaseYou take oestrogen for around two weeks, sometimes longer if the lining grows slowly.
- Follow-up scansScans measure thickness and pattern. Doses may change between scans.
- Decision pointIf the lining looks ready, progesterone is started and a transfer date is set. If not, the cycle may be extended or stopped and tried again.
Stopping a cycle can feel disappointing. But transferring an embryo into an unready lining may waste a good embryo. Waiting is often the wiser choice.
When the lining does not respond
Some women have a lining that stays thin despite every effort. This can be emotionally hard. The doctor will discuss realistic options with you openly.
In certain medical situations, a surrogacy consultation may be part of that discussion. Surrogacy in India is only altruistic and needs a medical indication certified by a District Medical Board. Our surrogacy eligibility guide explains who qualifies.
Questions to ask your doctor
- What was my lining thickness in past cycles, and how did it look?
- Do I need a hysteroscopy to check for scarring?
- Should I be tested for tuberculosis or other infection?
- Would a frozen transfer with a longer preparation help me?
- Which add-on treatments, if any, do you suggest, and what is the evidence?
Honest answers to these questions help you make informed choices and avoid paying for treatments that may not help.
Lifestyle and general health
- Do not smoke, as it reduces blood flow
- Stay active with regular walking
- Manage thyroid and other health conditions
- Avoid unprescribed supplements or herbal remedies
These steps support overall health. They are not a cure on their own but help create good conditions for treatment.
Keep a record of your past cycles, including lining measurements and medicines used. This history helps the doctor see what has and has not worked before.
Cost to plan for
A frozen embryo transfer cycle typically costs ₹40,000 – ₹80,000, and embryo freezing costs ₹15,000 – ₹40,000. A hysteroscopy, if needed, adds to the cost. You receive a written itemised estimate before treatment. See our IVF cost guide for details.