Natural v's medicated FET - advice / opinions / stories welcome

[allchatnicknamesgone]

Hi,

Got 2 embryos frozen. Can do a natural cycle as I'm pretty regular and ovulate fine and everything points towards having a good lining at the right time in the cycle. Obviously money is a draw to doing a natural cycle and also hoping body will appreciate less intervention.

But, ACU at Guys said only about 10% of their patients chose natural and that really threw me. The statistics were lumped together, so consultant wasn't able to advice either way. She said decision lay with me.

Also, she said that with natural is is better to wait for 2 cycles then try. I was planning to go next month meaning only one cycle would have passed since ivf fresh cycle. i.e. ivf oct, normal cycle nov, natural fet dec. Any thoughts on this? Bad move? I just wanted to get a frozen one in before Christmas as I remember the shitty feeling last Christmas and saying to myself I'd be preg by next xmas. Grasping at straws? Probably.

What does everyone think? x

I've just done a medicated FET using one of three embryos from our successful frozen cycle two years ago. I have PCOS and prior to the fresh IVF I did ovulate most months on my own, just couldn't conceive so we're unexplained.

We did medicated because I didn't want to take any risks and potentially 'waste' an embryo, iyswim? Yes, it costs more, but not enough to make me gamble a blastocyst on an unmedicated cycle.

Medicated FET is usually much ' easier' than a fresh IVF cycle too. Less drugs. My clinic's FET protocol for 95% of the women it treats is just tablets and pessaries. I got unlucky as I needed burserelin injections in addition to fully down regulate and that did make it harder, and about £150 more expensive.

My FET 'worked' as I got a positive test, but I had an early miscarriage last week, at 5w 5d.

Good luck whatever you decide. x

Gosh, I'm so so sorry inconceivable. I can only imagine how sad you must be. I hope you are coping ok.

Can I just ask though, why would you have considered it a waste? the clinic wouldn't thaw the embryo if they didn't think you were ready to naturally receive it I thought? They scan you to check your lining? I'd have to have injections instead of nasal spray btw, so even though less drugs, still the ball ache (although I was fine in the fresh cycle. Didn't have any probs)

Thx for replying and sorry again for your loss.

Inconceivable I'm really sorry about your loss. X
Allchat I had 3 x FETs, first two medicated although with slightly different protocols (downregged with one, not with the other) and neither worked. When I changed clinics for the third they suggested a natural cycle with progesterone support after the transfer. I personally found the natural cycle easier although there is obviously more personal responsibility involved in peeing on sticks! The third (natural) cycle worked and DD turns one early next month. I'm not saying it was the natural cycle that necessarily influenced our success (as we also used Clexane and I had 2 x IVIG drips which I didn't with the first two) but it certainly didn't hinder it. Good luck x

I've had 2 FETs. The first medicated, 2x3 day embryos transferred but neither implanted. The second was natural, with one blasto embryo and I'm now 35weeks pregnant! I found the natural one far less stressful, although sometimes a faff going to the clinic 3 or 4 times a week for scans. Fortunately I live in the same city as the clinic so not majorly inconvenienced. And obviously got a great result . If we try for another, I'd definitely prefer to go down the natural FET route.

Hi,

Thanks so much for all your replies. I'm definitely leaning towards a natural FET.

Can I just ask how long you left it between finishing the fresh cycle and trying FET?

x

I only did FETs as I had OHSS. I guess it was about 6/7 months between both cycles, but I was waiting for other tests as well as getting over the first cycle failing. It's only now I can really see how much it affected me at the time.

Interested in the responses about natural FETs. Has anyone had success with one despite having (mild, ovulatory) PCOS?

nobeer. Thx. Can I ask what other tests you had inbetween. Can't help thinking I should be doing more to find an answer.

Inconceivable yes I have pcos- mild and ovulatory (albeit late ovulation - anywhere from day 18 to day 25!).

I had immune tests done, and we had tests on the embryos too. I decided to press for that after reading Is your body baby friendly by Alan E Beer. If you have unexplained fertility I highly recommend it.

mmmm. I've been thinking about that. I'm at guys and they don't seem to do immune testing so maybe I have to go to another clinic? same goes with embryos. i really think there is something going on because with 100% fertilisation, my eggs really must like his sperm.

We went private too so they don't mind letting us pay for extra tests and they recommended the chromosonal tests on the embryos because "of my age". We had 12 embryos frozen, all were tested and 4 were normal. So well worth it. I can't even begin to explain the results of the immune tests because I was a bit blinded by science (and I live abroad so dealing with this in a foreign language), but they also found a I have gluten intolerance. In the end they recommended only transferring one embryo to give it a greater chance, and I totally gave up gluten while doing the fet until about 20 weeks.

Allchat I too had immune testing and was found to have very high NK cells. The jury's still out on whether it makes any difference to implantation or not but our consultant at the Lister explained that fully to us before we had the (very expensive) tests and IVIG treatment. By this stage though I was ready to give it a shot, having had 4 top quality blasts transferred with no whiff of a BFP.

Nobeer I also got OHSS on my fresh cycle so nothing was transferred then either. Miserable isn't it. Do you know if you're having a girl or a boy? Not long now!

I had a (successful) medicated FET after my fresh cycle failed. It was a surprise to me that my clinic recommended a medicated cycle as I ovulate regularly, and for fresh cycles their "thing" is mild IVF, so I had assumed the frozen cycle would be a natural one. However, they strongly advised a medicated FET as they were getting better results that way. Like you I was upset about the consequent delay in getting to transfer - I had banked on the same one cycle gap as you. But with hindsight, waiting a little longer was a good thing for me, because I needed more time to grieve about the failed cycle and build up my emotional resilience for the next round (I get that Christmas isn't the best time for doing that though).

As to whether medicated cycles are actually "better" than natural, all that I've heard and read makes me sceptical - for example www.ncbi.nlm.nih.gov/pmc/articles/PMC3114968/ .

MrsH yes it wasn't much fun! You build youself up, and then they tell you they'll be freezing the embryos. But in a funny way everything's worked out ok. We're having a girl, but I didn't mind either way. MIL is pleased as she's already got 2 very boisterous grandsons . I haven't told her that my niece is quite a livewire too...

Congrats Nobeer. I've got a live wire girl too! She's into everything. Hope it all goes well x

I'm about to undertake a FET, and my clinic go for unmedicated. I was quite happy with that approach as figured maybe all the drugs from the IVF rounds (2, both failed) were hindering implantation, and maybe a natural FET would be more likely to work. Interestingly my clinic doesn't feel any need to have a period inbetween the IVF and the FET. I have just had my period following a failed IVF and am told I can do FET this cycle. For me this means going in for daily blood tests from day 10 to check ovulation, (not sure why OPKs won't do... Not keen on all the bloods to be honest!) and then take progesterone pessaries from 2 days after ovulation, then have the FET 3 days later. There was no mention of a scan but perhaps they do that too and just didn't mention it. I do appear to ovulate normally each month, and was keen to start straight away - partly because of Christmas, and partly because I had an endo scratch in October and would like any positive benefit from that to still play out.

Hi smidge!
That is interesting that your clinic doesn't think you need a break. My clinic said only 10% chose a natural FET and that completely threw me. I also wondered is that because they like everyone to do medicated.
My clinic just does scans and not bloods, but yes you have to poas for ovulation. I'm like you appear to ovulate normally.

Can I ask how was your AF after your ivf cycle. I started mine about 2 dats after I stopped the pessary. The first day was almost unbearable. I spent a lot of time sitting on the loo and lying down, but then it eased and lasted about normal length. Do you have very regular periods? Mine are pretty good give the odd day of 2. I should be having my period in about a weeks time, so need to make a decision by then. Interestingly, been told that I don't need pessaries either because they are only required in fresh cycles/or medicated cycles…

Hi Allchat!
I would have been very surprised to hear only 10% choose natural FET too. I've always heard the positive with a FET transfer is the lack of playing about with hormones, so am surprised so many would opt for medicated. However, I've not asked what the stats are for my clinic (though clearly natural is quite common from the brief discussions I've had with nurses).

I've just looked at my period tracker app - my period after IVF failed was pretty normal last time. A bit shorter than normal actually, but still had a definite heavy day and light either side. Same as you it arrived a couple of days after stopping the pessaries.

This time it arrived 3 days after stopping the pessaries (but I stopped them a day early anyway as I knew I wasn't pregnant) but has been way shorter - I don't think I'll be getting any bleeding today at all, which would be only 3days (normal for me is 8, after round 1 was 5). To be fair I usually count light flow before the heavy day, and maybe the progesterone staves that off.

However, in terms of pain, I wouldn't say it was much different to normal. Perhaps a bit more (I think generally I notice period pain way more since being on any drugs ttc, but perhaps it's all in my mind as I constantly symptom spot)

While looking at this, I decided to look at the cycle after my first IVF round. I'd forgotten, but that cycle I spotted from the day after ovulation until my period (which happened as normal on day 31). Like 15 days or something!!! Now I am worrying about heading straight into FET because surely spotting from ovulation wouldn't indicate the best cycle to try a non-medicated FET? Not that I'd necessarily have the same thing happen after this round of course, but as ever it's given me something to be anxious about. If I don't go ahead with it now though, I will have to wait until the end of feb, by which time any benefit from endo scratch is likely to be over. (And mentally/emotionally I can't stand the limbo). Am supposed to be getting to speak to my doctor tomorrow, so I guess I'd better raise it, but am going to be thing myself up in knots whatever I do. Aaargghh!

Oh, as for pessaries I understand my clinic get you to take just one a day on the natural FET. (Normally for IVF it's twice a day).

Hi smidge. Let me know what your doc says….I just posted to you on other thread also, so don't mind if you want to write it all there as the others are checking there also.

The limbo is awful. I always thought that after an ivf bfn I'd need a few months, but I can't stop thinking about it. i've since learned that the 2 frozen embies are actually better quality than the fresh one they put back. i find it all very confusing.

I'm due roughly 24th Nov, so need to decide in less than a week! I'm also worried that test date if I go ahead will fall on Xmas so I'll also have either an incredibly shit xmas with family not knowing why I'm grumpy or the best xmas ever!

The other thing that is at the back of my mind is that I really hate the term 'unexplained'. I'm shitting myself that maybe I need tests like these NK cell tests I've read about. i'm concerned about throwing money and wasting embies at a natural FET. I've never had that much exploratory stuff done as the thought it was initially a male factor. Transpired it wasn't male factor at all and he's ok, but we still can't get pregnant. Since the failed ivf I've spoken to GP and consultant about my worries and they say I present no other symptoms for them to think there is something wrong.Normal cycle, normal ovulation, no thyroid prob's etc. no problems with birth of 1st child 6.5 yrs ago.

Can I ask why you had the endo scratch and how that helps implantation?

Sorry for long post!

Hi Allchat. Funnily enough my frozen blasto ended up being graded better than the one they put back in me as well. The one transferred was a 2:2 (1-3 grading based on inner cell mass and outer cells for placenta etc), but the one that ended up being frozen was a 2:1 (inner cell still the 2). As I understand it, the choice of which to put back was a timing thing - the one that was used was further ahead in development. They froze the other 5hours later by which time it had advanced and they could judge it better. Fingers crossed it survives the thawing process and actually implants.

I'm more and more convinced that my unexplained issue is really about immune response. My NK cells were high and to be honest that's no surprise when I think about it as my family on my mother's side all have immune issues (some quite significant, some just hay fever and gluten intolerance). However, my doctor only prescribed me clexane. It seems from reading other posts that a lot of fertility centres prescribe this as well as a steroid called predislone (sp?) even without doing the tests - just in case. I'm going to ask my doctor about the steroid this time. She wasn't so keen as it does have more side effects and you have to be weaned off it but tbh I want to try anyway. Feels daft to have had the test and then not actually do much about the results which clearly show my NK cells are in the way too high range.

Apparently the scratch can help simply by the fact that your body sends in heaps of repair cells to fix you up - and the repair cells then outnumber the attacking immune response cells. (In basic terminology!). Didn't work for me clearly though, so maybe it is just my eggs after all. But I can't understand why it wouldn't even manage to implant - the other blasto survived another 5 hours and started to hatch even before they froze it so it feels as if my uterus must be hostile for the embryo to give up before implantation.

I should be speaking to my doctor this afternoon (Aus time) so will update you on what we decide. It's hard to know if my spotting is a problem or not for FET. They will be doing blood tests daily to check I ovulate, so if the spotting means I didn't ovulate and my hormones are to pot then presumably they just wouldn't go ahead with the transfer. I guess they can also check thickness of the uterus wall if they do an ultrasound. So perhaps the spotting isn't a problem. It's very hard to know as clearly I want to give myself the best chance, but oh I can't stand the limboland. I'm not working (haven't been for the best part of a year now) as we thought I should concentrate 100% on ttc without work stresses! especially with the investigations/IVF procedures. And I'm ok with that while we're doing IVF, but I feel so lost and like my life is just passing me by when I'm not - and having to wait til February will be a nightmare!

Must get a grip and just see what the doc says!

Well I have spoken to my doctor now. She doesn't want me to start this cycle now she knows I'm going to be flying to England for Christmas. Not so much about the flying, just that she wants me here for monitoring, blood tests etc and not being the other side of the world if I start bleeding or anything. I kind of tried to make it clear I was only expecting a negative anyway so hadn't thought about pregnancy monitoring! But she wasn't having it.

So we now have to delay until my February cycle. Given the wait, we can do either the FET or go for another fresh cycle and save the frozen for another time (sibling?). Not sure which to go for. I think my husband will prefer frozen as it is less invasive. But I think I'd rather get some more eggs while I'm still 38.

Anyway, whichever we go for, the doc and I have agreed the following.

Day 4 - have another endometrial scratch, in her offices, 'like a smear'
Day 7 - start prednisone
Day 10 - go into day surgery for an 'infusion of intralipids' which apparently can soak up peripheral NK cells (never heard of this, will do some googling in a moment)
Clexane again (not sure from when)
Week 7 (if pregnant!) - another intralipid infusion
Week 10 (if pregnant) come off the clexane, and prednisone

Oh, all while taking 'megafole' (a massive dose of folic acid to help counter the risks of cleft palate) and extra caltrate and vitamin D to help counter impact to my bones

If I do fresh again she recommends long down reg as this seemed to produce better embryo results for me than the short protocol.

Gosh. And to think my main worry (truly) is that this will mean an OTD of not until 19th Feb. That's MILES away!!!

Hi smidge, hope you are feeling a bit better about the delay. I'm sure your trip to the UK and the fact it is Xmas will make it go really quickly.

I must say your consultant seems very thorough. You must feel like you are in good hands and that they are doing their best to help you conceive. I don't really have that sort of deal where I am and I'm starting to question whether I should move clinic, but I have pretty much decided I want to do the natural FET next month. Big question now, is whether I put 2 back in or just 1 frozen embie. I only have 2.

I've heard of intralipid infusion on other threads relating to immune issues.

Sorry, if you've said before but how many cycles have you had?