The Impact of Transcutaneous Electrical Nerve Stimulation (TENS) on Endometrial Thickness in the Healthy Women, A Step to Improve the Female Fertility


  • Ihsan M Ajeena Middle Euphrate Neuroscience Center, Kufa Medical College, University of Kufa, Najaf, Iraq.
  • Nada Al-Haris Radiological Dept., Kufa Medical College, University of Kufa, Najaf, Iraq.
  • Huda N Al-Kefae Middle Euphrate Neuroscience Center, Kufa Medical College, University of Kufa, Najaf, Iraq.
  • Shehab A Goloom Middle Euphrate Neuroscience Center, Kufa Medical College, University of Kufa, Najaf, Iraq.
  • Khalid Al-Abudi Al-Sader Medical City, Ministry of Health, Najaf, Iraq.


Transcutaneous electrical nerve stimulation, female fertility, endometrial thickness, pulsatility index, resistance index


Objective: To determine the physiotherapeutic effect of TENS on endometrial lining thickness in healthy women at their childbearing age.

Methods: This is a prospective randomized controlled clinical trial including 46 healthy women within their childbearing age during the first year of their marriage. Uterine blood flow and endometrial thickness (ET) are measured at day 13 of MC before TENS application and at the same day of the next cycle after 6 sessions of TENS were applied.

Results: TENS significantly increases endometrial thickness from 5.80±0.24mm to 7.60±1.57mm. This has a beneficial effect to increase the rate of pregnancy as it properly prepares of the uterine lining for implantation of fertilizing ova mediated by the reduction of both resistance and pulsatility indices of uterine arteries. These findings were there regardless age and BMI of the participants.

Conclusion: There are beneficial effects of TENS to increase endometrial thickness in healthy women at their childbearing age.


1. Jarzem PF 2005 Transcutaneous electrical nerve stimulation [TENS] for chronic low back pain. Journal of Musculoskeletal Pain. 13(2): 3-9.
2. Desantana JM 2009 High and low frequency TENS reduce postoperative pain intensity after laparoscopic tubal ligation:a randomized controlled trial. Clin J Pain 25(1): 12- 9.
3. Zheng CH, Zhang J, Wu J and Zhang MM 2014 The effect of transcutaneous electrical acupoint stimulation on pregnancy rates in women undergoing in vitro fertilization: a study protocol for a randomized controlled trial. Trials: (15):162.
4. Khadilkar A 2006 Transcutaneous electrical nerve stimulation (TENS) for chronic low-back. The Cochrane Library (4).
5. Madaschi C, Braga DP, Figueira RC, Iaconelli A Jr 2010 Effect of acupunctureon assisted reproduction treatment outcomes. Fertil Steril (28): 180–4.
6. Salsabili N, Noureddin NA, Katayoon B, Asefeh S 2011 Effect of physiotherapeutic TENS in a woman with un explained infertility. Physiotherapy theory and practice 27(2): 155-9
7. Ng EH, Yeung WS, Ho PC 2009 Endometrial and subendometrial vascularity are significantly lower in patients with endometrial volume 2.5 ml or less. Reprod Biomed Online (18): 262-8.
8. Gomez O, Figueras F, Martinez JM 2006 Sequential changes in uterine artery blood flow pattern between the first and second trimesters of gestation in relation to pregnancy outcome. Ultrasound Obstet Gynecol 28 (6):802-8.
9. World Health Organization/Department of Reproductive Health and Research (WHO/RHR 2008 and Johns Hopkins Bloomberg School of Public Health/Center for Communications Programs (CCP), Knowledge for Health Project. Family Planning: A global handbook for providers. Baltimore and Geneva: CCP and WHO/RHR.
10. Dominguez F, Remohi J, Pellecer, Simon C 2003 Human endometrial receptivity: a genomic approach. Reprod Biomed Oneline (6): 332-8.
11. Raine-Fenning NJ, Campbell BK, Kendall NR, Clewes JS, Johnson IR 2004 Quantifying the changes in endometrial vascularity throughout the normal menstrual cycle with three-dimensional power Doppler angiography. Hum Reprod (19): 330–8.
12. Zheng CH, Zhang MM, Huang GY, Wang W 2012 The role of acupuncture in assisted reproductive technology. Evid Based Complement, Alternat Med: 543-924.
13. Stener-Victorin E, Fujisawa S, Kurosawa M 2006 Ovarian blood flow responses to electroacupuncture stimulation depend on estrous cycle and on site and frequency of stimulation in anesthetized rats. J Appl Physiol: 101(1): 84-91.
14. Ho M, Huang LC, Chang YY, Chen HY 2009 Electroacupuncture reduces uterine artery blood flow impedance in infertile women. Taiwan J Obstet Gynecol (48): 148–51.
15. Sharma KN 2012 Atlas of Acupuncture Points. USA, ISBN:13 9781480205420.
16. Stener-Victorin E, Wu X 2010 Effects and mechanisms of acupuncture in the reproductive system. Auton Neurosci (157): 46–51.
17. Fong K, Kung R, Lytwyn A 2001 Endometrial evaluation with transvaginal US and hysterosonography in asymptomatic postmenopausal women with breast cancer receiving tamoxifen. Radiology 220 (3): 765-73.
18. Jayaprakasan K, Campbell BK, Clewes JS, Johnson IR, RaineFenning NJ 2008 Three-dimensional ultrasound improves the interobserver reliability of antral follicle counts and facilitates increased clinical work flow. Ultrasound Obstet Gynecol (31): 439-44.
19. World Health Organization 2004 Expert consultation. Appropriate body mass index for Asian population and its implication for policy and intervention strategies. The Lancet 157- 63.
20. Sutter PD 2006 Rational diagnosis and treatment in infertility. Best Practice & Research Clinical Obstetrics and Gynaecology (20): 647–64.
21. Engmann L, DiLuigi A, Schmidt D, Nulsen J 2008 The use of gonadotropin-releasing hormone (GnRH) agonist to induce oocyte maturation after co treatment with GnRH antagonist in high-risk patients undergoing in vitro fertilization. Fertile Setril (89): 84–91.
22. Salsabili N, Salsabili H, Berjis K, Akbariasbagh F 2011 The Effect of Transcutaneous Electrical Nerve Stimulation (TENS) on the Pregnancy Rate in Women Undergoing Assisted Reproduction Techniques and Embryo Transfer. Gynecol Obstetric (S5): 001.
23. Zheng CH, Huang GY, Zhang MM 2012 Effects of acupuncture on pregnancy rates in women undergoing in vitro fertilization: Asystemstic review and meta-analysis. Fertil Steril (97): 599- 611.
24. Gong X, Li Q, Zhang Q and Zhu G. (2005): Predicting endometrium receptivity with parameters of spiral artery blood flow. J Huazhong Univ Sci Technolog Med Sci: (25):335–8.
25. Mercé LT, Barco MJ, Bau S, Troyano J 2008) Are endometrial parameters by three-dimensional ultrasound and power Doppler angiography related to in-vitro fertilization/embryo transfer outcome? Fertil Steril (89): 111-7.
26. Chesterton LS 2013 Effects of TENS frequency, intensity and stimulation site parameter manipulation on pressure pain thresholds in healthy human subjects. Pain (106): 73-80.
27. Randolph JF, Sowers JRM 2003 Reproductive hormones in the early menopausal transition: relationship to ethnicity, body size, and menopausal status. Journal of Clinical Endocrinology & Metabolism: 88 (4): 1516-22.
28. Merviel P 2008 Predictive factors for pregnancy after IUI: An analysis of 1038 cycles and a review of the literature. Fertil Steril. Nov 7.
29. Meduri G, Bausero P and Perrot-Applanat M 2000 Expression of vascular endothelial growth factor receptors in the human endometrium: modulation during the menstrual cycle. Biol Reprod (62): 439-47.
30. Isaksson R, Tiitinen A, Reinikainen LM and Cacciatore B. (2003): Comparison of uterine and spiral artery blood flow in women with unexplained and tubal infertility. Ultrasound in Obstetrics and Gynecology (21):174- 80.
31. Franconi G, Manni L, Aloe L, Mazzilli F 2011 Acupuncture in clinical and experimental reproductive medicine. A review. J Endocrinol Invest (34): 307–11.
32. Tsai HD, Change CC, Hsieh YY, Lee CC 2000 Artificial insemination: Role of ET and pattern, of vascular impedance of the spiral and uterine arteries, and of the dominant follicle. J Reprod Med (45): 195-200.
33. Kolibiianahis EM 2004 Endometrial thickness cannot predict ongoing pregnancy achievement in cycles stimulated with clomiphene citrate for IUI. Reprod Biomed online (8): 115-8.
34. Ng EH, Chan CC, Tang OS, Yeung WS, Ho PC 2006 The role of endometrial and subendometrial blood flows measured by three-dimensional power Doppler ultrasound in the prediction of pregnancy during IVF treatment. Human Reprod (21): 164-70.
35. Schild RL, Knobloch C, Dorn C, Fimmers R, van der Ven H et al., 2001 Endometrial receptivity in-vitro fertilization program assessed by spiral artery blood flow, endometrial thickness, endometrial volume and uterine artery blood flow. Fertil Steril (7):361-6.
36. Smith-bindman R, Weiss E, Feldstein V 2004 How thick is too thick? when endometrial thickness should prompt biopsy in postmenopausal women without vaginal bleeding. Ultrasound Obstet Gynecol 24 (5): 558-65.
37. Amir WMD, Micha BMD 2007 predicting factors for ET during treatment with ART. Fertil Steril (87):799-804.
38. Esmailzadeh S 2007 Endometrial thickness and pregnancy outcome after IUI. Fertility Sterility 88): 432–7.
39. Gesink Law DC, Maclehose RF, Longnecker MP 2006 Obesity and time to pregnancy. Hum Reprod (22): 414- 20.
40. Dechaud H, Bessueille E, Bousquet PJ, Reyftmann L, Hamamah S, et al., 2008 Optimal timing of ultrasonographic and Doppler evaluation of uterine receptivity to implantation. Reprod Biomed Online (16):368-75.
41. Chui S, Chow FC, Szeto YT, Chan K, Lam CW 2014 "A Case Series on Acupuncture Treatment for Female Infertility with some cases supplemented with Chinese Medicines." European Journal of Integrative Medicine 6(3): 337-41.
42. Wang W, Check JH, Liss JR, Choe JK 2007 A matched, controlled study to evaluate the efficacy of acupuncture for improving pregnancy rates following in vitro fertilization-embryo transfer. Clinics Experimental Obstetetrics & Gynecology (34): 137- 8.
43. Ng EH, Chan CC, Tang OS, Yeung WS, Ho PC 2007 The role of endometria lblood flow measured by three-dimensional power Doppler ultrasound in the prediction of pregnancy during in vitro fertilization treatment. European Journal of Obstetrics & Gynecology and Reproductive Biology (135): 8-16.




How to Cite

Ajeena, I. M., Al-Haris, N., Al-Kefae, H. N., Goloom, S. A., & Al-Abudi, K. (2018). The Impact of Transcutaneous Electrical Nerve Stimulation (TENS) on Endometrial Thickness in the Healthy Women, A Step to Improve the Female Fertility. Journal of Contemporary Medical Sciences, 4(2), 74–77. Retrieved from