Does anyone know the detailed FET process at Create?

[Jo99999]

Just want to prepare myself with enough info beforehand. The nurse consultation availability is quite bad. I already missed a cycle to wait for a doctor's consultation and now may miss another cycle to wait for a nurse consultation. Not sure if they can accept the cycle start and nurse consultation happen at the same time.

Which days do you have scans?
Are there any blood tests?
What meds do you take before and after transfer?

Thanks!

I did 5 rounds of IVF with Create

It really depends on the protocol you are on. With mild IVF you normally start stims cycle day 2 and then have the first scan day 5 or 6 depending on if it falls on a weekend. Then scans and blood tests every other day until trigger day. You might have the odd day where you end up with a blood test and scan two days running if it's getting close to trigger

With natural modified IVF you don't start stims until cycle day 4 or 5 or even 6. Again scans and blood tests every other day

Before and after transfer again depends on your specific case but I was on cyclogest (progesterone), clexane and in non covid times prednisolone (steroid)

Bear in mind if you haven't paid for the support package you have to pay for blood tests etc on top as you have them

@ivfbeenbusy, thanks for the reply. I have done freeze-all 3-cycle package with Create except the last one . I am just waiting for frozen embryo transfer from the next cycle or the earliest they are available if not next cycle. Do you have details on just the frozen transfer specifically? no stimulation in frozen transfer cycle. Thanks.

I recently did a FET with Create after a freeze all egg collection. They gave me the option of medicated or natural.

First attempt I did medicated: start oestrogen tabs on CD2 (Progynova 2mg three times a day), scan on day 8-11, if lining >7mm then they will book your transfer for the following week, and you start progesterone pessaries (utrogestan 200mg three times daily) 5 days before. If lining is less than 7mm they will increase your oestrogen and bring you back for another scan after 2-3 days. I wasn't offered any blood tests. Mine first transfer ended in ectopic unfortunately.

Next I tried another medicated but I didn't respond well to the oestrogen so we abandoned on CD18. They increased my progynova and added patches but lining not thick enough.

In January I'm going to try a natural FET. No oestrogen, just scan on CD8-11, if lining >7mm and follicle big enough they will either continue to track to natural ovulation (with scans, bloods and OPK sticks) or give an ovritrelle trigger to allow them to precisely time ovulation and 'take over' my cycle. Then start progesterone pessaries, then transfer 5 days later.

They consider 7mm ET adequate but I've requested not to transfer unless ET reaches 8-9mm as I've read this thickness is better. Hope that all makes sense! Annoying about having to wait for your doctor and nurse appointments, I've been able to get one within 3 weeks or so each time. Are you with St Pauls?

I should also say that these are the meds I was prescribed, not sure if they give any other brands of oestrogen/progesterone. As the PP said some people have other drugs added in depending on your personal situation e.g. prednisolone, aspirin, clexane. I think what I've described is their basic FET protocol with no 'add ons'

@bicyclesandbeyond, thanks for the details. I am at St Paul's. My doctor advised estrogen tablets and aspirin. How do they decide between medicated or natural? What is your view on medicated vs natural? My doctor recommended medicated. I did not know FET could be medicated as my FET at CRGH was natural and CRGH did not even discuss different options. CRGH did scans every 2-3 days and they did not time ovulation with trigger either. They just checked at the scan that the follicle was gone. I was scanning daily in the last few days. It is confusing that the process is different per clinic.

I just read my scans and bloods from the CRGH cycles which I have records. It looks that in the natural FET my lining was 7mm on day 3 and grew to 13mm on day 14. It took a couple of days extra than usual in that cycle I believe. In the stimulated cycle lining was 8mm on day 7. I think natural may be better for me with less drugs? Thinking of talking to my doctor again. I know she did no check my numbers when she made the recommendation. When I asked, she did not know my numbers.

Sorry, one more question, she already mentioned thyroid test. I did the test 15 months ago and it was good. Do I need to do thyroid test again before FET?

The decision on my FETs was based on how regular my cycles were and whether I naturally had a good lining thickness - yes to both

@ivfbeenbusy, thanks for the answer. I would say yes to both as well. Will discuss with my doctor again.

@Jo99999 I'm doing a 3 cycle freeze all with Create too. I have completed 2 rounds so far. Do you mean that you have your 3rd cycle left too and will FET after this one?

I'm trying to get an idea of timeline too. If my 3rd cycle is in January, i presume i will have the usual post EC bleed around a week later, then be able to start my FET on the following period?

I have found it quite easy to get appointments, but i know it can depend on your coordinator. If they're not helpful, email the support address or just call up and speak to whoever is on reception.

@Jo99999 I think most FET cycles are medicated as they are easier for the clinic - they have more control, and are less likely to be cancelled due to 'missing' ovulation. I chose medicated initially for this reason, and also I assumed that extra oestrogen would be better. This turns out to not be the case for me and I think my own natural oestrogen will hopefully do a better job.
Do you know their rationale for the aspirin? I keep asking about adding things like this and they always say no, just stick with folic and and Vit D.

@IslandStars I think you are right - when I had my freeze all collection I had my withdrawal bleed and then did my 1st FET starting with my next normal period. I guess technically you could do a fresh transfer after the 3rd collection but they might prefer to wait?

@Jo99999 in terms of thyroid test - I repeated mine after a year just to check it was still ok. I don't think the clinic mentioned it before FET. If there is no family history of thyroid disease and your TSH was well below 2.5 you probably don't need to be too worried. I was just determined to get all the bits in my control 'right' that I asked my GP to do it along with my Vit D level and a few others.

@bicyclesandbeyond thank you, that's what i was hoping for as time isn't on my side! In a real rush to get FET done, especially if i'm not successful on first attempt.

I'm doing PGT so have to hope the results are back in time to start on my next normal period. Looking at the timelines described, it seems it might be difficult.

Good luck @IslandStars - all the waiting is truly rubbish xx

@IslandStars, I have completed 3 cycles and did a fresh transfer in the 3rd cycle which did no stick. The 3 cycle package includes only 1 transfer so I suppose they have to do paperwork for subsequent FET. I wanted to do FET straight after the failed fresh transfer but the doctor's appointment was after 2 weeks and my period started before doctor's call. Now after doctor's call there is a nurse call to sign consent and go through everything which is another two week's wait and my next period will start at about the time of the nurse call. Considering getting extra test done and obtaining prescriptions before my period starts, I might have to wait for another cycle. The reception said that there was no availability earlier than this.

@bicyclesandbeyond, aspirin is for anti blooding clotting. I think it is good to take it especially if you are taking estrogen which can cause blood clotting and affect implantation. I had inhixa injections after my FET at CRGH which is also anti blooding clotting. Aspirin tablets are much easier than injection. Regarding natural vs medicated FET, I have regular cycles and ovulate on my own and my lining is always quite thick early in the cycle. I just feel there is still quite a lot of inconclusive researches for natural vs medicated FET and don't want tinker too much with different hormone levels and timings if I don't see problems in ovulating regularly and lining naturally.

@bicyclesandbeyond The waiting is the worst part for me, i'm prepared to put up with the physical toll, i just hate this part. Good luck with your next FET too.

@Jo99999 Thanks, i see what you mean now. It's frustrating that the 3 cycle package only includes 1 transfer, but the embryo banking has been good for me so far. Create and their consent forms are a nightmare, the online consent can be quite fiddly i find. Sounds as though their appointments have got more restricted over the Christmas & new year weeks. Best of luck with it all when it finally gets started.

@bicyclesandbeyond Hope you don’t mind me digging up this thread. My medicated FET failed and I believe caused 2 polyps to grow through estrogen, so I will be doing a natural FET once they are removed.

I’m with Create too and trying to find out about the Natural FET timeline. You mentioned scan on D8-11, then monitoring. How many scans did you have in total before transfer and did the clinic provide ovulation sticks for you? Hope you had some luck.

Hi @IslandStars sorry to hear about your FET and pesky polyps. My natural FET attempt was a bit of a disaster! I had scans on CD 8, 11 and 14. My lining only reached 5.4mm and then I ovulated on CD15. We cancelled because my lining wasn't thick enough. I used my own ovulation sticks - just the cheap ones from Amazon which I'd been using for bloody ages so was very familiar with them. Also on my scan on CD14 I had a 22mm dominant follicle which was ready to ovulate (this backed up my positive OPK that same day). I didn't have any blood tests. I have always found tracking ovulation quite easy so would have been a good candidate for natural FET, had it not been for my useless natural lining! Hope that helps? I hope it goes well for you xx

@bicyclesandbeyond Thanks for the reply, sorry it didn’t work out. I’ve never tracked my ovulation before so was a bit worried about it, maybe I should practice in one of my cycles beforehand. Sounds like natural is easy enough if lining plays ball...there’s always something to worry about isn’t there!

Hi @IslandStars yes that would be a good idea! Practicing on a few cycles would helpful I think. I think the doctor assumed I'd know what I was doing (in my case I did - so many sticks peed on!). The scans were pretty clear but the sticks will confirm exactly which day you ovulate. My tip would be to test 2-3 times per day when you are getting close as the 'peak' (darkest line) can be pretty short lived.

50 x One Step Ovulation Strips 20miu/ml Test Kit Sensitive Fertility Predictor Testing Sticks (Wide Width) https://www.amazon.co.uk/dp/B001G7STT0/ref=cmswwrcppapiglttfabcCMWE3FAYJ4WWESBCPB04??encoding=UTF8&psc=1

@bicyclesandbeyond Thanks so much for the link I will get some to try out as I’m not transferring until September after polyps are removed x

For simple step by step FET process go see this video