Thin lining

[bicyclesandbeyond]

Wondering if anyone on here wants to swap stories on their experience with thin endometrial lining?

I did a freeze all cycle in May and was lucky to get 4 blasts frozen.

FET 1 - medicated, lining got to 7.3mm on CD11, ended in ectopic
FET 2 - medicated, lining only got to 6.7mm by CD18 so cycle abandoned
FET 3 - natural, lining only got to 5.4mm by ovulation so cycle abandoned

I've got a consultant appointment tomorrow to discuss next steps.

So far I've tried Vit E, l-arginine, pomegranate, beetroot, extra exercise, less exercise etc etc.

As far as I can tell options are going to be:
a) Another medicated FET with a shed load more oestrogen from the start
b) FET with low dose stims
c) Tamoxifen at the start of the cycle

Would love to hear from anyone going through similar, has had success, or experience of the above options! It's a frustrating issue to have with 3 blasts waiting in the freezer... thanks to anyone who has some thoughts on this! X

@bicyclesandbeyond basically I insisted on all of this, I’m a doctor and I just read a book aimed at specialists on preparing the endometrium and I read all the research papers. My specialist was a bit like yours, saying it will be fine etc. that was until I got my embryos PGT-A tested, in my fresh cycle I got 9 blastocytes, half were 1,1 and 83% came back as euploid (I’m 35), when that came back my specialist said she can’t pin it on the embryos, she thinks the 2 I had transferred were normal and that we should do recurrent implantation failure tests.

I have had autoantibodies and a thrombophilia screen as well as a test for C4M2, that cost £1500. We are doing the ERA EMMA ALICE at the moment, my clinic has never done the EMMA and ALICE before but from my reading the microbe flora is really important, it would be £1000 just for the ERA and £1500 for the ERA EMMA ALICE together. I am quite sure they do it under ultrasound guidance with a speculum, similar to the transfer.

I also saw my GP and had some routine blood checks done, checking for iron and vitamin d.

@bicyclesandbeyond I missed the timing question, it’s a mock cycle essentially so should be identical to future cycles, so I will be scanned on day 10 to check the lining and they will check my progesterone level to check my body isn’t naturally making it before starting any. I will need 5 full days of progesterone and on the 6th day it’s the biopsy. They look at the genes that are activated and say if you need to be on progesterone for more/ less time. 1 in 3 women with recurrent implantation failure have a shifted window of implantation. I have had massive issues with progesterone, I have progesterone hypersensitivity, so in my case it seems sensible to do the ERA.

That's really interesting @Gardenlady543 thanks for your reply. I'm a doctor too (GP) and I've been reading lots of research papers as well! I've really learnt the importance of advocating for myself during this journey and it's given me a whole new perspective whilst I've been on the other side. It seems that we are in a very similar situation. Good luck with your tests - please let me know how you get on!

@bicyclesandbeyond Oh wow another doctor! When I first started the journey my specialist told me not to read stuff, I think because it adds to the stress if you’re medical, but I mean I can’t help myself.

I just read this book, I’d recommend it for anyone medical going through IVF, you need a knowledge of anatomy, physiology and research to get the most out of it, so it should be good for you. Annoyingly it doesn’t have much on endometrial thickness but the chapters were really helpful and cover things like the microbe, ERA, hysteroscopy, scratch, steroids, immunosuppressants, heparin/aspirin, I downloaded it for £31 and feel I understand the endometrium so much better now
www.amazon.co.uk/Prepare-Endometrium-Maximize-Implantation-Success/dp/110840281X?tag=mumsnetforu03-21

I’ve found going through all these tests so stressful, my Gp tests flagged up a transferrin saturation of 60% I’m hoping it isn’t right, I wasn’t fasting when I had it done, but now I have the stress of trying to organize a repeat and worrying that I have haemochromatosis!

Well I just tested... and so far so good... two lines...

That’s great news @paitentlywaiting is this your first BFP? I’ve never had one before so can’t imagine how great you must be feeling!

@Gardenlady543 it is my first time ever. I once thought I got a positive but it was the trigger shot. I didn't have a trigger shot this time but my hubby still thinks it's the same situation as then hehe.

That’s amazing @paitentlywaiting do you think it was a fluid build up causing issues before? If the environment has too much fluid in then it prevents the embryo from adhering so it can’t implant. As you’ve managed to get rid of it, it looks like it’s worked for you

@Gardenlady543 this was the first time I had fluid and it was due to the increased estrogen trying to get my lining thicker. I'm not sure why I couldn't fall pregnant but I have one ovary and possibly scar tissue from when the other ovary was removed. I also had two laparoscopes to remove endometriosis and I have pcos. The surgeries were all +10 years ago - my doctors always told me that I had very limited chance of falling pregnant on my own and my fertility doctor moved me pretty quickly to IVF after two negative results with Clomid

Ah you must be thrilled then!! @paitentlywaiting I hope these lines get darker and darker for you

@Gardenlady543 thank you :)

Congratulations @paitentlywaiting - lovely news for you!

Thanks @Gardenlady543 for the book recommendation - might need to add that one to my Amazon basket with all the CoQ10, vitamins, pregnancy tests, OPKs etc etc

@bicyclesandbeyond oh this whole thing takes over your life (bank balance) doesn’t it!

I got some more news today I’m heterozygous for the MTHFR gene (affects the metabolism of folate), so I’ve ordered methylfolate which is the activated form. And I am heterozygous for the PAI mutation (so they’re putting me on heparin after a transfer as well as the aspirin I’ve been told to take).

You know I always thought I was healthy before all this, I wonder how many women that just got lucky and got pregnant without any issue, are wandering around with these things.

Yes @Gardenlady543 it feels like a bloody miracle that anyone gets pregnant sometimes!! Although my patients regularly remind me this isn't the case - urgh! I'm taking methyl folate rather than folic acid, I've never been tested but thought it was one more thing to tick off. It really sounds like you've made some progress - good news!

@bicyclesandbeyond I mean I don’t know, it seems like I went from everything’s fine, to a list of problems: thin lining, arcuate uterus, small fibroid, progesterone hypersensitivy, thrombosis issue, folate metabolism issue. Hopefully the ERA EMMA ALICE doesn’t add to it!!!

That’s a good plan taking methylfolate! My specialist told me to take 5mg folic acid today and I happened to be at the Gp having my blood rechecked and she gave me a prescription. Then I looked a bit online and saw it’s dangerous! I’ve changed my prenatal vitamin as well, may as well stick with methylfolate rather than folic acid in that too.

Hi everyone! Sorry for delay posting a reply. @bicyclesandbeyond - hysteroscopy was grand, nothing identified, it all looked normal. They weren't going to do a biopsy due to my young age, but I asked them to do it given that they were in there anyway! Waiting to hear back on that, but given they weren't going to do one, I'm not expecting anything out of the ordinary with the result! Whilst they were there with the hysteroscopy, they did an endometrial scratch which I'll be honest was very painful. But glad I've had it done in hope it changes something for this cycle. I've started preparation for another FET and have my day 10 scan tomorrow. I'm the same protocol as last time so not expecting any change, but secretly hoping the scratch has altered things for the better. X

Forgot to say, have people had their oestrogen levels measured during FET prep? Last time my levels were 5000 showing my body was absorbing the oestrogen, just lining not responding. They said this is very high. Just wondered if others have had theirs done the same. Clinic tell me I'm on the highest dose of oestrogen, which I don't believe as I hear other people have two patches on rather than one. I'm with abc/create so think their approach to mild / low levels of medication means they restrict it.

So I’m really disappointed today is day 9 of my ERA cycle, my specialist wants me to get my lining up to 9mm as it shrinks on progesterone. Last time I was 7.4mm on day 10 and 8.1mm of day 12, I was on oral estradiol 2mg three times a day but took it vaginally between day 5 and 7 (As I was vomiting) and it was then increased up to 5 times a day. This time I’m on estradiol 2mg three times a day and 100mcg patch every 72 hours.

My lining today on day 9 was 6.4mm, I don’t understand how this is possible, since this time I’m on more estradiol, I’m taking vitamin E, l arginine, aspirin, I’m eating all the right things, I’m using castor oil packs. The only thing I’ve not done is used the estradiol vaginally which I presumed was giving me a lower dose than orally. They’ve taken my blood today to see if I’m absorbing it. This isn’t a transfer cycle but I just really wanted to get it right for the next cycle.

@BewilderedBee I’ve had my estradiol taken today on day 9 of the mock ERA cycle, it was 837 and LH 8. They’ve asked me to take an extra 2 estradiol tablets a day vaginally alongside my regime. The person that rang me didn’t know what a good level is at this point. If it’s measured in the same unit as a research paper I’ve seen, then my level would be at the high end. That would make sense if they’re saying to take some vaginally.

@BewilderedBee thanks for the update on your hysteroscopy. How was your scan? Do you think the scratch has made any difference? I'm also with Create (Wimbledon for scans and St Pauls for transfers).

@Gardenlady543 I wouldn't be too disappointed with that - CD9 is still early. I think it can thicken by up to 1mm per day? Also, my understanding is that ET is meant to compact after ovulation as it is exposed to progesterone. Therefore I think it's the ET on the day of ovulation that is key (my clinic is happy with >7mm, but like you I want 8-10mm ideally). I don't think there is a huge value in continuing to measure ET once the lining is under the influence of progesterone. Has your clinic said otherwise?

Also @Gardenlady543 my clinic also reckons that we have 'good' and 'bad' months with ET so if we have a thin month then we might just be unlucky. It may not always correlate to our diet/drug dose/any other weird stuff we try. Maybe they were just trying to calm me down by saying this?!

@bicyclesandbeyond The whole thing is so complicated I know that it’s difficult for the technicians to measures the endometrium once progesterone has been started. There’s a couple of research papers out there about measurements before progesterone and on the day of ET one says more compaction is good and the other seems to say the opposite. They didn’t try to measure the lining in my last transfer but the specialist noted it looked very thin, although failed to tell me this when I specifically asked. It was only in my review appointment that my specialist told me he had written it in the notes. This is a mock ERA cycle and my specialist has said they’ll try and measure it on the day to give some indication of how much it has compacted down.

Because of the compaction my specialist wants me to get to 9mm. I have literally done everything I can to increase it and somehow ended up with a thinner endometrium than when I did nothing to help. So it seems the diet, vitamins and castor oil has very little impact compared to the meds. They’re going to scan me again on Tuesday so I’ll have to see if the vaginal route has any impact.

Got everything crossed for you @Gardenlady543 - having had 2 FET cycles cancelled I completely get it. Waiting for the scans is horrible, and so frustrating when your body doesn't do what you want it to. I have felt that my body has completely let me down but trying to work away from that mindset now, it's so hard though. Keep me posted. I've got an appointment with a new clinic on Wednesday so I'll let you know their take on this issue xxx

@bicyclesandbeyond Having your FETs cancelled must have been devastating
It’s not the end of the world for me at the moment, this is only a mock cycle after all, I just really wanted to get it spot on so I’d be reassured that I’m in with a good shot next time. Now I’m going to be constantly worried in my next FET. There are a few different meds that can be added in to help with lining which my specialist might try. You know someone in a thread on here didn’t ever respond to the meds and ended up having a frosties transferred in a fresh cycle, so I guess that’s always an option. Your new clinic should be good, hopefully they can look at things with a fresh pair of eyes!