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]

Honestly glummy quality means nothing. I know women who've had PGS whose supposedly poor quality embryos were genetically perfect (and became people) and supposedly top quality embryos that were duds. Regarding transferring both I guess it depends on how confident you are in the uterine environment. What does your Dr advise?

Clearblue digi is coming up positive

Will have to see what the hCG is doing tomorrow. Not sure how much it will tell us - if it's doubling but still low I think we're just going to have to watch them and wait...

[LHReturns]

Hello Glummy...

I have resisted testing so far....Tuesday will be 7dp5dt but I am keen to wait until Wednesday. I think I can survive tomorrow but getting further will be difficult!

And as Banana has beautifully proven, testing early can provide a very challenging few days!

Let us know when you decide to get going...

[GlummyMummy]

LH - your patience is admirable!

Banana - that's better news then! I have a feeling it's all going to turn out well for you, but understand how frustrating the waiting must be!

think will probably be starting in October, clinic were a bit vague. Nurse said they like you to have one normal period after failure bleed, doctor said best to leave yourself three months between cycles and I had read that with frozen you can just get going straight away! I'll probably need to have another scratch and want to start on some new supplements, though I suspect if it's an estrogen issue rather than blood flow issue, these supplements will probably be just like sweeties! Don't want to leave it too long though, as I am aware with every month that passes, my lining is just getting poorer!! Was expecting period this month to be a stonker, but it's been one day of bleeding and not much else!

[bananafish81]

glummy I was told we could go straight away for a FET - the plan was going to be to start progynova immediately after my period from the fresh. That didn't happen because I didn't have a proper bleed, but ideally that's what we would have done. Dr said 3 months as a general rule between fresh, but FET you could do without a break

Getting older shouldn't make any difference to your lining, it's only the eggs which are affected by age? It's why success rates for women in their 50s with donor eggs are better than for women in their 30s with own eggs.

AFM, good news. hCG has doubled! Still low obvs. Only 33. Wasn't going to be much higher given where it was on Sat. But out of 'equivocal' and into 'pregnant'. At least something has tried to implant - and hopefully just a late implanter and a lazy bastard who was wandering around aimlessly before it found somewhere to get comfy. Apparently FET can be late implanters. Maybe they take a while to wake up after being in the deep freeze?! Anyway. Go back on Friday for a repeat 🙏

[GlummyMummy]

Oh Banana, that's great news! Really pleased for you. The only way is up now! Suppose that's where testing early is more stressful....but like you, I couldn't have waited!

I just assumed that as Dr says estero fen levels decline with age, then lining would decline too. Certainly, my periods are WAY lighter than they were say three years ago.

Think we'll just get going next month. I was hoping to think about acupuncture before we begun, but maybe if it's not a blood flow issue (?!?) then acupuncture wouldn't really help?

Operation thicken lining needs to begin in earnest if this is going to work....need to make a plan!!

[bananafish81]

As far as I'm aware the estrogen decline is more related to increasing FSH, I don't believe it has any impact on lining thickness. And in any case the point is that in a FET the oestrogen is provided exogenously, hence why women who have full POF or who are post menopausal can successfully carry donor egg pregnancies.

Have you had your uterine cavity checked out to ensure the lighter periods aren't related to any damage from childbirth (am I remembering you say you had a PPH?)

Exciting for you to get cracking!

AFM, sadly the only way isn't necessarily up, if this is a chemical the only way could be down. Or indeed if it's a miscarriage. Trying hard not to compare with last time, when the test line was darker than the control by this point, and my hCG was terrific! DH keeps reminding me that the Dr said every pregnancy is different - including different pregnancies in the same woman - and that we have been told it's the rate of doubling that matters, not the absolute level itself. And that the doubling rate is better than last time! Still absolutely pooping my pants. And hoping that if this isn't going to go anywhere that it ends sooner rather than later.

[GlummyMummy]

This being in limbo must be driving you insane Banana!! That's the worst thing about IVF....you know too much!! In a non-IVF pregnancy, you probably wouldn't even know you were pregnant at this point and even then it would just be pregnant or not! Hope you are hanging on in there and managing to distract yourself somehow!!

As I've said before, my clinic aren't exactly helpful!!! Asked if I could have a hysteroscopy and Dr said " I can tell you now it wouldn't show anything."!!!! Apparently if Ashermans, there is a visible white area which they checked for at EC and I didn't have it. Now, I'm not saying I have ashermans but my bleeding is definitely a lot less than it was.

This is what frustrates me...if it weren't for the frozen embryos in their freezer, I'd be going elsewhere as they really haven't suggested anything or even tried to get to the bottom of our unexplained infertility.

I'm left kind of not knowing what to try, as I say, wondered about acupuncture but will that help if blood flow is supposedly ok?

[bananafish81]

Lots of clinics don't even do betas so in many places I'd just be 'ok, I've got positive tests, I'm pregnant, get booked in for a viability scan'. We definitely know way too much!

You don't necessarily need a hysteroscopy unless there's any indication - if you're concerned could you not go somewhere else to get a saline ultrasound? Couple of hundred quid to have a proper look on a scan in case there's anything worth checking out? Checking the blood flow when they do a scan should also help diagnose any adhesions - if they just use the doppler to have a look at the blood flow, it will show up any blockages. So that's a very easy way to have a look

With a FET there's nothing to say you'll have any lining issues yet is there? If you haven't yet seen your response to oestrogen presumably it might be that you do terrifically in a FET? Everything crossed!!

[GlummyMummy]

I'm not getting the estrogen cycle, just the highest of the normal frozen cycles, if that makes sense?!? Can tell I'm a novice, I know!

Ultrasound might not be a bad idea, my clinic seem to think that cause I got the triple stripe and no obvious white stripe, that all is well in there! Said if blood flow was an issue I wouldn't get the triple line appearance.

If adhesions are present, can these be treated?

[bananafish81]

Oh are you doing natural FET instead of a standard medicated FET? Normally for a frozen cycle you'd do estrogen pills / patches to grow your lining ready for transfer - unless you're doing a natural FET where they just follow your natural cycle and you pop an embryo back 3/5 days after you ov?

Not sure I follow what you mean about doing a frozen cycle but not an estrogen cycle?

If you're getting triple stripe seems unlikely you'd have any adhesions, sounds like the appearance is great!

[GlummyMummy]

Sorry!! Confusing myself too!! :-)

It is medicated with HRT, but I think there's also another option with extra estrogen?!? Would that be right?

[bananafish81]

Medicated is oestrogen is HRT!!

HRT is oestrogen pills or patches

There's two medicated protocols:

• long protocol, where you down reg first and then start oestrogen (HRT)
• short protocol, where you start oestrogen (HRT) on day 2

Oestrogen blocks ovulation so my Dr doesn't generally down reg - some clinics prefer to as they have more control

More or less oestrogen just depends on how your lining responds I think?

[GlummyMummy]

Hmmm, from what I remember, dr said that id be on nasal sprays too.

She said that there were two options for frozen-normal HRT cycle (with low, normal, high drug level) or HRT cycle with extra estrogen.

[bananafish81]

Ah okay so you'll be doing a long protocol FET

Sounds like your clinic has quite specific ideas about doses etc. Interesting! I was just started on a medium dose of progynova and then we tweaked based on my response. My Dr said that until we started stimulating the endometrium with HRT, we didn't know how I would respond. So start lower and build up / switch mode of administration.

How do they decide whether you need a higher or lower dose at the outset?

[GlummyMummy]

I can only think because I was on high level drugs previously, they've just done same again. I have serious doubts about my lining thickening up though so any ideas for what might actually help?!? I'll try anything!! ;-)

[bananafish81]

But you haven't done a frozen cycle before have you?

The dose of stims needed in a fresh cycle is about ovarian response - that doesn't have any bearing on the ability of the endometrium to respond to oestrogen?

[GlummyMummy]

Nope, first frozen cycle. Perhaps as they think my lining being thin end of normal is due to decreased estrogen, they are going for the highest dose? Who knows....

[bananafish81]

Well hopefully you'll have a lush cushiony lining for a fabulous frostie!!

If this one doesn't stick them we are back to the hysteroscopy + oestrogen + copper IUD + pentoxifylline plan. Think we would probably have another crack at a normal medicated FET to see if I respond better to pills / patches after having had the treatment. And / or possibly a tamoxifen cycle

Obvs desperately hoping this one hangs around though and these plans become academic!!

[GlummyMummy]

Aw Banana, just seen your update on another thread - totally gutted for you, after you pulled out all the stops too for this one. Hope you are managing to stay positive, thinking of you.

My clinic have a waiting list for FET so looks like starting November on long protocol so be around Christmas time before anything really happens (Happy Christmas to me.....mince pies and HRT!!!!)

[bananafish81]

Thanks lovely. Wasn't expecting this one to be viable but you can't help but hope?

I'm just really sad. It's the second chromosomally normal embryo that hasn't made it and so it's my body that can't look after them. And I don't know how we fix it. We know the uterine environment looked good on a scan but obv something isn't right. Yes I had a bleed before this cycle (which is why we cancelled the hysto and started a treatment cycle), but we don't know why I didn't properly shed the 11mm of lining I grew in my May cycle - why I just got a day of black clots, and although lining thinned, I never got a bleed. 

There's other questions which we'll discuss in the follow up. Given I did successfully propagate a pregnancy into crappy lining with no immunes, but didn't into supposedly decent lining with pred / intralipids, question is whether they left me over suppressed. Prof Quenby and Brosens at the Coventry implantation / RM clinic say if uNK cells are on the low end (even if peripheral blood levels are high) that you need some inflammation for successful implantation, and that in some cases pred and intralipids can do more harm than good. I'm not sure that going to their clinic for the endometrial biopsy for uNK cells would add any clarity - from stalking the Quenby threads on FF it seems it could raise more questions than answers. Quite a few women get wildly different levels of uNK cells from one month to the next - which of course doesn't get you any closer to identifying whether pred would or wouldn't be beneficial in a treatment cycle. I'm minded to use my own history as a diagnostic - we know the embryos were both normal, so given I had decent implantation without immunes but didn't with immunes, I think if / when we eventually get to another treatment cycle 

Hoping if I’ve stopped the progesterone on Fri I will get some kind of period next week. The hCG was low so there can’t be much to pass, I’d have thought?

Follow up consult is arranged for a week on Friday - hopefully I’ll have had a bleed by then, but if not then we can see what’s going on when he scans me and take it from there. He’s put us in for the last appt of the day so we can take as much time as we need, he said he wanted to meet up so we could review everything step by step, and discuss where we go from here.


If I get a bleed then I will restart progynova (plus pentoxifylline and vitamin E) on day 2, to start to prepare the lining for a hysto & potentially a coil.

If I don’t get a proper bleed that’ll be a pretty important diagnostic tbh (as well as the quality of whatever bleed I do get)

I don’t think I will be able to cycle again for a while, as we really need to work on the endometrium - we can’t keep doing rounds of stims with EC just to put back a frostie, and we need to get me menstruating properly. Ideally if we do the IUD plan I imagine we’d want to have another crack at a dummy medicated FET, to see if I respond better to HRT. We’d also mooted the idea of a Tamoxifen cycle, so that’s on my ever-growing list of questions.

Back onto the bench of boredom I go!!

[coconut779]

Hi All

Great to find this thread....my clinic cant seem to get the right measurement of my endometrium and we have had 3 failed transfers. I suspect it is due to a thin lining.

What can i take to improve the thickness of the lining? already taking 800 units of Vit E per day...How much of L'arginine?

Does anyone know how their consultants measure a thin lining? Is it with the normal transvaginal scan?

Thank you

[bananafish81]

Hi coconut

Sorry you find yourself here - sadly I have persistent lining issues and have ended up as a bit of an amateur endometrium specialist!!

My consultant measures thin lining exactly the same way as a thick lining - standard TVS (aka dildocam!)

Mine also always checks the uterine blood flow using the colour doppler ultrasound - he just flips a switch on the ultrasound machine and turns it into doppler mode! Checks the uterine artery and helps establish if your issues may be due to compromised blood flow

Are your failed transfers fresh or FET?

I had issues in both fresh and FET: in fresh cycles it was a case of adding in extra oestrogen on top (Progynova tablets) to give my lining a boost

In FET, unfortunately we found that I just didn’t respond well to pills or patches: my Dr said some women don’t respond to artificial oestrogen, but do to their body’s own natural oestrogen. So we had a crack at an ovulation induction FET - using low dose stims to just encourage a couple of follicles to develop, to get my body producing natural oestrogen to thicken my lining (as in a natural cycle), and added some Cetrotide and progynova in on top. Unfortunately my lining is REALLY stubborn, and I didn’t respond well to this, so we had to take very extreme measures - but I am literally the only patient my Dr has ever had where he’s had to do full IVF strength stims just to put back a frozen embryo, so I would ignore this option

The other things we tried were more experimental treatments like a G-CSF wash and vaginal viagra pessaries

These were very much at the more extreme end!

I am now having a copper IUD put in and going on a couple of months on cyclo-progynova to try and work on my lining. Sigh.

I will be taking the 1000u (600mg) and 6g of l-arginine as well. The l-arginine comes in 1g tablets which are like horse pills so with 6 of them that’s a lot of pills!!!

xx

[bananafish81]

BTW what lining are they transferring at?

My Dr's absolute minimum (which the literature seems to back up) for ET is 7mm at trigger / initiation of progesterone. That's an absolute lowest, and really the goal is at least 8mm

[coconut779]

thank you Bananafish81 - my Dr has never tried the dopler ultrasound...we are changing clinics so i will bring it up with the new clinic

I have started Vit E and L'arginine...only taking 3g will increase to 6g.

they always say y lining is 8-10mm but we recently did a biopsy and the lining was quite thin despite the measurements and our consultant cant explain why the significance difference....another reason to change clinics

Good luck with your cycle :-)

I am doing FET

[LHReturns]

Coconut, I can promise you that you will NEVER find advice better than Banana's (on most IVF subjects but especially about lining).

So sorry you are struggling but a new clinic plus a print out of Banana's advice with you at your consultation will be a good start!!