Endometrial Thickness and Reproductive Outcomes in Female Infertility: A Systematic Review of Clinical Evidence

Abstract

Background

Thin endometrium is associated with impaired implantation and reduced reproductive outcomes, particularly in assisted reproductive treatment. Endometrial thickness (EMT), assessed primarily by transvaginal ultrasonography, is a commonly used marker of endometrial development. Ayurveda conceptualizes female infertility through conditions such as Vandhyatva and Artava Kshaya, with emphasis on Apana Vata, Kshetra, and tissue nourishment.

Objective

To systematically review the clinical evidence regarding Ayurvedic interventions in female infertility where EMT or related reproductive outcomes were evaluated, and to assess the methodological limitations of the available evidence through 2026.

Methods

The review was structured according to PRISMA 2020 principles. Electronic and registry sources were considered from database inception through 2026. Human clinical studies, case reports/case studies, and ongoing registered trials were considered separately. Because of substantial heterogeneity quantitative meta-analysis was not performed.

Results

The direct evidence comprised of a single-arm pilot study of 15 patients on Saubhagyanandana Ghrita Yonipichu and a randomized study with comparative evaluation of Phalaghrita Uttarabasti with and without oral Phalaghrita (20 patients). The latter reported mean increases in EMT of 5.3 to 9.0 mm and 5.4 to 9.5 mm in the two treatment groups, respectively. A randomized, double-blinded, placebo-controlled study in 2026 using standardized Shatavari root extract in women with PCOS found a significant difference between the groups in this study for change in EMT. Limited evidence was found from case reports and registered ongoing trials.

Conclusion

Selected Ayurvedic interventions show preliminary potential for improving EMT and reproductive parameters, but larger, well-designed randomized trials with clinically relevant fertility outcomes are needed to confirm their efficacy.