Infertility and Endometrium / Lining Issues

[funkymonk]

Please join here if you are experiencing infertility as a likely result of lining issues... Support and chat needed...

[bananafish81]

BTW I am told viagra pessaries have absolutely zero recreational side effects

Oral viagra didn't do anything for me, for this amount of money I want fireworks, rainbows and unicorns dammit

And obvs you feel WELL sexy with melty white waxy pessaries permanently leaking out your fanjo. Have to use four times a day!!

Will report back from the front lines. Updates as they happen....

[bananafish81]

Latest in the running commentary on my endometrium...

Had my scan and Neupogen wash yesterday morning. Remembered in the nick of time not to pop a viagra pessary in, as thought he could probably do without wading through a sea of white melty goop to get the catheter in 

He said it was hard to get a true measurement of the endometrium after the wash because it's distended with fluid, but he said the appearance was lovely and at 8.5mm with fluid he reckoned hopefully somewhere around 7.5mm.

Wants to scan me on Tues: ideally wants to leave trigger as late as possible to give the lining more time, but doesn't want the follicles to get overripe and risk progesterone levels starting to rise. So will do bloods and assess accordingly. I think we're looking at EC on Fri

I asked if it was worth adding in Progynova 'for shits and giggles', he said OK let's add in twice a day (not 3 times a day as before) for a bit of extra oomph. Hoping they + wash + viagra + follicles keeping growing does the trick.

Hope everyone is having a lovely bank holiday weekend xx

[LHReturns]

Banana have you had another scan today? Any news? Friday still looking likely?

I am good to start tonight - so relieved! Scan and bloods on Friday (I was a very fast responder last time, only 7 days of stims) so they want to scan more quickly this time. Appears they had a fright last time which I wasn't aware of at the time - I thought everyone got dragged in on a Sunday morning at 9am to take bloods!!

I have a question: my baseline scan showed a lining at 3.7mm this morning. You have all lectured me already to stop whining on about my light periods, and to stop trying to be in your Poor Lining Club.

BUT - my period is nearly over (always about 3 days). Why is there 3.7mm of ANYTHING in there if my period is almost over? Surely it should be all cleared out? Unless some is getting stuck in there - not good.

Lister's most senior sonographer said anything under 5mm is fine at baseline. Do I accept this?

[bananafish81]

LH great news! 3.7mm at baseline is perfect - the functional later of the endometrium can’t shed in its entirety, so as your nurse says, they’re looking for anything below 5mm. That sounds ideal for day 3 - you’re right on track!

7 days stimming is VERY quick - my Dr says he normally looks for 10 days before trigger, so will usually start high and stair step the dose down to avoid stimming too quickly. The first cycle is so often as much of a diagnostic exercise as anything - so now Lister have the learnings from your first cycle, they can use those to optimise this cycle. Excited for you to get going!

Scan was this afternoon - had my intralipids @ CARE and then hotfooted it to the Dr’s office. Lining is 8.4mm and he said it's the best it's ever looked!!! He wants to push it an extra day, because my largest follies are 18-20mm so we have headroom before anything tries to pop - so we're aiming for trigger Thu for EC on Sat if poss (awaiting confirmation from CARE). He said he would def be happy to transfer into that endometrium, so thinks we should proceed to ET - which will hopefully be a week on Thu (8th Sept)

If we were doing IVF then he'd scan me again before trigger to check on the follicles. But for a FET - as he's happy with the lining as it is - don't need to be scanned before EC. The only way is up between now and Thu evening, so hope my lining manages to squeeze that extra half a mm to get over the magical 9mm mark. He's dropped my Gonal-F down to 75iu for the next 2 days, and upped my Progynova to 3 x daily. Colour doppler showed my uterine blood flow was terrific, so hopefully the Viagra is doing something. Hopefully that plus the extra oestrogen will hopefully give it bit more oomph for the final furlong!!

He'll scan me at EC, but it's the trigger day that matters, because it'll already have started to compact by the day of collection. I'd like to know what it is on Thu (nosy), but I'll just have to think thick

To think I was originally booked in for a hysteroscopy and having an IUD put in tomorrow! Shit's getting real...!!

[LHReturns]

Banana so sorry for such a slow response. Hideous few days at work.

This is so exciting - your uterus is playing ball!!! I am literally holding my breath to hear your news over the next few days, and cannot wait to know you are carrying one of those gorgeous perfect embryos around with you. How are you feeling today?

I realised I actually stimmed for 8 days last time - a Monday to a Monday, including both Mondays. Then the EC was on the Wednesday. I had a very clear result with those exact 6 follicles racing ahead from the start, and then a huge gap to just tiny ones that had no chance of responding in time regardless of what they did to my dose. So we had to get on with it. Maybe it will be a little less frantic this time! First scan on Friday morning...

[bananafish81]

Good luck with your scan tomorrow LH - will be thinking follicular thoughts and visualising ovaries like juicy bunches of grapes

Trigger is done! EC at 0830 Sat morning. Have to say I'm now ready to get these eggs out of me - definitely nothing like last time, but my ovaries feel rather like beach balls and I do somewhat resemble a spacehopper

Curious as to how many follicles / eggs there actually are, as we didn't count them exactly. Dr did say it was a bit tricky to visualise the endometrium as the ovaries were pressing against the uterus

It's definitely not anything like last time, which is a good thing: that was fine for a freeze all cycle, but he wouldn't have wanted to do a fresh transfer last time with 28 eggs, due to OHSS risk

It's bonkers to me that 12 months ago I had an AFC of 5 and AMH of 1.5. Couldn't have predicted my AMH would be 62 a year on - and that the eggs would turn out not to be the problem at all

Keep us posted tomorrow!!

[LHReturns]

Hello!

I am beyond excited for you Banana and well done on having triggered!

I am fascinated by your AMH change - as someone with a low AMH I was under the impression there I was nothing I could do to improve it. Is there something very unique about your situation? I am much older than you of course, so that puts me behind anyway.

Can you remind me of your original infertility diagnosis or is it unexplained?

I have now done three of my big fat 450iu Gonal F injections and tonight started to feel some effects. Lower abdominal ache, and quite sharp pain in left ovary when I lift my left leg. Very sluggish and think today was my last exercise class for a while. Do you exercise throughout IVF?

I will be keen to see what we see on the scan tomorrow.

Banana I am truly crossing everything for your coming week, and cannot wait to hear that you have a gorgeous embryo chilling out inside that truly made over uterus!! Remind me - will you put one or two in?

Hugs.

[bananafish81]

Lh had started to reply to you last night with the epic saga of my changing AMH, but was zonked - response to follow

Home and snoozed off some of the anaesthetic, all went well this morning 👍

Not too many eggs which is vg, as for a transfer cycle he didn't want oestrogen levels through the roof. About 7 good ones and 10 small / medium, I think. Can't quite remember through sedation! We didn't stim me to try and optimise the eggs - obv if we'd have been doing IVF rather than a FET would have stimmed me differently

He'll do a final lining check on Weds before we thaw anything - but things are looking loads better than in my last transfer cycle. The lining has started compacting (which it's supposed to, as the trigger causes progesterone levels to start to rise) but not compacted too much (unlike before)

In my Jan cycle it was 7.2mm the day before trigger - but had compacted to 5.5mm by EC (which was more than my Dr would have expected) . We reached 8.5mm by transfer - but it's thickness on the day of trigger that counts. Dr Sher says anything below 8mm at trigger is insufficient, 8-9mm is intermediate and 9mm+ is really what's needed. So mine was really only just above the minimum.

This time it was 8.4mm two days before trigger - and compacted to 8.5mm today. So I'm hoping that means it was over the magical 9mm when I triggered 🙏

Tbh if anything the fact I had a proper bleed and the lining regenerated probably is as important as the thickness, if not more so. All the new research from the Coventry recurrent miscarriage clinic says it's this regeneration that actually determines in some cases whether a pregnancy will miscarry - ie it's menstruation that is the key

Pleased with how it's all looking - just have to hope it's enough!!

[GlummyMummy]

Reading with interest ladies....LH, your lining is 10mm?!? That's great, wow! And Banana, your lining is sounding like its playing ball too which is fab. Fingers crossed for you both, we need some good news on our thread! I have my review appointment next week and am trying to get an action plan for thickening this lining all ready for frozen embryos awaiting! Have heard about l'arginine but not sure what else I'll try, focus till now has been on egg quality so this is a bit different. Banana, that was interesting about the lining at trigger being most inportant, mine has been very thin at this point so may explain a lot!

[bananafish81]

glummy  good luck for your review appt next week! I switched my supplements up from egg quality to the uterine environment, which mainly meant adding in 6g l-arginine a day (I was already on 1000iu Vitamin E a day). I also upped my omega 3. 


LH so excited for you having read the latest on the other thread - 10mm lining, holy moly that's amazing!!

Exercise wise I did and will do yoga throughout my cycles, don't do anything too high impact that could risk ovarian torsion, but generally don't wrap yourself in cotton wool either 

Very long-winded answer to the 'what's your infertility diagnosis' question (I bet you wish you'd never asked)

I am the shittest example of basically anything in reproductive medicine as I am filed under the 'not a fucking clue' folder. I went from PCOS to (seemingly) severe DOR to PCOS again. We don't know why it (seemed as though) my eggs had all vanished, nor why they all 'came back'. My consultant said of me right from the start 'I'm stumped - and I'm not usually stumped!' 

I originally went to him for pre TTC advice regarding my various existing health conditions and medications (epilepsy and hardcore strong opioids for chronic pain from a spinal injury) and to discuss my PCOS 

I was diagnosed with PCOS when I was 28 - I came off the pill to get myself checked out, as I suspected there might be issues as when not on the pill I'd never had proper periods. 9 months without a period and I get my day 3 bloods done, an antral follicle count scan and my AMH tested. Diagnosed with PCOS, but ovarian reserve fantastic (antral follicle count of 42, AMH of 28). Didn't feel we needed to rush to start TTC as biological clock was looking ok, but knew I would likely need to get Clomid from the word go, given I didn't ovulate. Decided we'd go private because no point hanging around for a year until the NHS would do anything, if I didn't have periods. Went back on the pill, all OK. About 2 years ago I was diagnosed with epilepsy, and had to take a double dose of the pill because the epilepsy meds can interact with the metabolism of the pill 

Had to delay starting TTC for 6 months cos of getting epilepsy under control. Finally come off the pill - plan is to just give myself a month to get the hormones out of my system before going to see the consultant to get Clomid. Except I ovulate my first month off the pill. Which is my signal that something is up. Because I'm not supposed to ovulate. See Dr and we do a scan and my ovaries are no longer PCO and I have an antral follicle count of just 5. Freak out. Get day 3 bloods done and it's catastrophic. FSH of 17.6 and AMH of 1.5. FUCK. 

We repeated the AMH a month later to check it  wasn't a lab error (it wasn't)

Within 3 months of TTC we were doing IVF because my AMH had declined 93% in 5 years and we felt we didn't have time to hang around to see if a natural miracle happened. 

Turns out that although I had three months of actually ovulating each month, no way I could have possibly conceived as my lining didn't get above 5mm. 

And we know now that even with ovulation induction and oestrogen tablets - as we tried for my ovulation induction FET last month - my lining didn't respond properly, so it seems unlikely I would have been able to conceive without IVF, even without rushing to start treatment, because it looked like I was hurtling towards premature ovarian failure 

First cycle I responded like a low AMH person
Second cycle I responded like someone who wasn't low AMH - no one could understand how someone with AMH of 1.5 two months prior had got 17 mature eggs. 
After the miscarriage my ovaries seemed to have rebooted somehow, and I was PCOS again?! AFC was 25+, FSH was 5, LH through the roof (23!) and AMH was 62.2. 

No one has a bloody clue what has gone on with me. Something caused by ovaries to go into mega suppression mode, but we don't know what. Clearly my eggs didn't vanish and then come back again, but quite what kind of disappearing act went on, we have no idea. 

If I hadn't gone private I don't think I'd have got diagnosed - as unless I had monthly follicle tracking scans (given many trusts won't do this for ovulation induction, no way that would have happened when I actually was ovulating) the thin lining wouldn't have been picked up 

Now I'm PCOS again we don't know whether I would naturally ovulate or not. We suspect not, but unless we leave my body to its own devices for months we won't find out. 

If this cycle fails then I guess we'd go back to the hysto and copper IUD plan, but I really don't know. If we can't get a PGS tested embryo to stick with a decent lining and full immunes, I don't know where we go from here...

Final lining check today, just to give it a final once over before anything gets thawed. Eek. 

If you made it to the end of that epic download you deserve a medal! 

[bananafish81]

I also asked Dr Sher, given he is Dr thin lining, and he echoed everything my consultant said, which was reassuring :

• it's the thickness that matters rather than the echogenic pattern. It's more important than it thickens up, triple line doesn't matter so much (Dr sher said he doesn't even look for it now)

• it's the thickness on the day of trigger that counts. Ie I shouldn't worry that it's started to compact after trigger and thinned on the day of EC, nor got thicker by ET as it's started to fluff up under the influence of rising levels of progesterone. It's only the thickness on the day of trigger, when it's the last day of it being proliferative, that matters

Makes sense that my lining last time was so iffy given it was only 7.2mm at trigger. This time we started oestrogen earlier (and did all the other stuff) and that def made a difference

[GlummyMummy]

How was your lining looking today bananafish?

Still taking coq10 (though a lower dose) and pregnancy multivitamin, will add in l'arginine and get back on the Vit E again. As you say, total change of focus now from egg quality to getting this lining to play ball!!!!!

[LHReturns]

Banana thank you so much for such a great overview (and a further education). Maybe Mumsnet should set you up with a pay-per-view thread? 80% to you, 20% to MN.

If you don't mind I will come back properly tomorrow after my EC. I am very distracted and twitchy ahead of tomorrow (trigger last night all fine, feeling very hormonal and irritable). So sitting watching Bake Off and wishing the hours away. Hate that I don't get a final scan before EC so it is like a 'surprise' when I wake up tomorrow!! If it is four or less I will be pissed off.

I need to get to Lister for 7am tomorrow.

Banana, wishing you the most wonderful ET tomorrow. It's funny, after all our exchanges since March, we both end up having exciting events on the same day!

Hello Glummy - have missed you lately!

[bananafish81]

Good luck tomorrow LH - everything crossable crossed for you! 🙏

Consultant is happy with lining and we are GO for FET tomorrow. Kick off 1300. Apparently will get an email in the morning to confirm one has thawed (aaarrrrgggghhh!!!)

See you on the other side girls....

[LHReturns]

Speak tomorrow Banana, and seriously all my warmest wishes for a straightforward, uneventful lovely transfer day for you tomorrow!

[bananafish81]

Congrats on your egg haul LH absolutely fabulous news! Hope you're resting up

Frosticle thawed beautifully and one euploid blast safely on board!

Consultant said transfer went perfectly, said he's feeling really positive about how the cycle has gone, that we've hit every milestone - but now it's the hard bit, and just have to hope the result in 9 days time is a good one

Not sure who looked more anxious - him or us!

Tested the trigger and it's gone - last time I made it till 8dp5dt, can't quite see that happening this time....!

[LHReturns]

Thank you so much Banana.

I am SO incredibly excited and happy for you. You and your consultant have planned this process with military scientific precision and I am thrilled that you have the satisfaction of knowing that is what has been delivered. No What Ifs, no regrets - what happens now could not possibly have been set up for any more success.

Enjoy that feeling and SO MUCH luck to you.

Xxxx

[GlummyMummy]

really pleased to read that everything went well for you both yesterday, you can breathe a sigh of relief! Look forward to hearing how things progress x

[GlummyMummy]

LH and Banana-how are you both getting on? Had my review appointment yesterday so Dr reckons as I had a chemical pregnancy that the embryo was abnormal. Still saying lining was ok, although it was thinner than I would have liked. Reckon blood flow is ok, so lining just got thinner over time due to age and reduced estrangement. Next plan is a frozen transfer. Feeling very unsure about going on HRT -the link with breast cancer does worry me! Especially if I take it and then embryos don't survive the thawing! Feeling a bit fed up of the whole thing to be honest, and my clinic is very uninspiring!

Thinking of you both during your two week waits, hope you're keeping busy!!

How is everyone else?!

[GlummyMummy]

Oops, "estrangement" meant to be oestrogen!!!! In too much of a rush!! ;-)

[LHReturns]

Hello Glummy - so good to hear from you.

If you take a look threads Failure Stories and The Mind-Numbing Boredom...you will see most recent updates from Banana and me. Please join one of these threads!

[GlummyMummy]

Hi LH- I'll take a look, though find it hard to keep up with all these threads, need to be better organised! Always feel I'm half reading while trying to do something else!

[bananafish81]

Hi glummy

Glad the follow up was productive! Re the HRT, it's only really a potential issue if you take long term. And no more so than taking the pill. Certainly for a matter of weeks or months it will make no difference at all. And if the Dr says it's an oestrogen issue then hopefully the cumulative exposure will help to wake up the oestrogen receptors in the endometrium

How many frosties do you have and how many would you put back? And what are your timings? Do they want to do a long or short protocol FET?

Regarding freezing, presumably your clinic uses vitrification, so any decent lab should have a v good thaw survival rate. What have they quoted? My lab said euploid embryos generally survive the thaw well, it's only poor quality ones that may not (or if there's a quality control issue / the lab aren't experienced with freezing)

AFM I'm in limbo. I think we're probably looking at a chemical pregnancy. Early urine test faint, hCG yesterday (7dp5dt) was inconclusive, so having it repeated tomorrow (9dp5dt). So low that I don't think it's likely to be viable, hoping that we'll know one way or the other soon enough, although I have a horrible feeling this could drag out for days and fizzle out slowly...

[LHReturns]

Glummy, Banana is totally correct about HRT.

I used estradial gel for about six months to try to get my mind and brain in order when my DS was about 6 months old (I was suffering with post natal anxiety, and ADs were all that sorted me out eventually). I saw Mr Hormone on Harley Street, and you only need worry about HRT after much longer periods of treatment.

What Clinic are you at, and when ideally when you love to do a FET?

[GlummyMummy]

Banana - sorry to hear your news, you're obviously not feeling hopeful :-( It is still early, with my daughter I only had a very faint positive 8 days after ET so it is still possible. Hopefully you'll find out one way or another soon though. Thinking of you, after everything you've been through I was willing you to have some good news xx

LH - you managing to resist early testing?!?

the info on HRT is reassuring, thanks both! I had to have breast surgery following an abscess caused by breastfeeding, and I was on the pill for many years, so I'm probably just being paranoid about it all!

We have two frozen embryos, one slightly poorer quality than the other. My clinic don't do testing of embryos unfortunately. Not too sure of timings yet, will be starting next month now I think.....and need to give a lot of though to whether we would put two back if it came to that..which I doubt it will. Not holding out much hope for these frozen ones to be honest. And I have made it clear to the Drs that I only want to to transfer if lining is above 9mm, which I really don't think it will get to! I think my body is in a slow decline towards an early menopause to be honest!