Lining is always too thick at baseline scan- I need to induce a strong bleed, but how?

[VillageFete]

Hi,

I’m cycling abroad. It’s incredibly stressful and i’m honestly at my wits end. When I cycled there and had my embryos frozen in 2019 it was fantastic, excellent communication and no issues at all. I have 2 PGS tested embryos in the freezer now.

I was about to transfer and the Pandemic hit. My Dr left, and I was put in the care of the only remaining Dr who only speaks Turkish and German.

I’ve been trying to get out there since September last year, but I have PCOS and although I’m regular (36 days) my bleeds are very scanty/barely there. Everytime I have a baseline scan over here on day 3, my lining is still 7-8mm and my bleed then stops.

My Dr in Cyprus will not help me, he tells the co-ordinator to tell me to try again next month. I’ve spent hundreds on scans and bloods since last year and I can’t afford to keep doing this.

My Estrogen, Progesterone and TSH bloods are all fine on day 2-3 of my cycle but the lining is always too thick.

I’ve had one good bleed two months ago and decided to do an ERA on that bleed (Came back pre receptive) But before and after this I haven’t had a decent bleed.

Last month my lining was 8mm on day 3 of my cycle (didn’t bleed any more after that) I asked my Dr in Cyprus could I try Norethisterone. He agreed and said to start it on day 12 of my cycle. I didn’t understand his reasoning as my lining was already 8mm on day 3, but I did what I was told. I had my withdrawal bleed a couple of days ago and was scanned yesterday. Lining is 8.4mm and i’ve stopped bleeding, so it obviously didn’t work.

My Sonographer who is a fertility nurses says structurally the endometrium looks great. No polyps, fibroids, active cysts, endometrial hyperplasia etc... all looks perfect and an Aquascan/Saline scan backed that up, so there’s no need for a hysteroscopy. I think it’s all hormonal and related to my PCOS.

Can anyone suggest anything that I can put forward to my Dr in Cyprus to strip this lining asap?

I was wondering if starting high dose Norethisterone tomorrow may help, as my lining is already so thick?

Any suggestions at all would be appreciated.

I don't know if it would help but before one FET cycle I had a Prostap injection, I think it was to make lining thin but the cycle was delayed due to other factors. Maybe some others will have knowledge of this, or know what would be an expected thickness at that point in your cycle.
Do you have the option to move your embryos to a different clinic?

Hi @LongerthanMrTicklesarms

Thanks for replying.

I saw a private Dr this morning and I actually mentioned this to him, but he said no, let’s try Norethisterone from today (day 4 of cycle) for 26 days.

Apparently the Norethisterone will stop the lining from growing, and then hopefully when I stop it in 26 days, i’ll bleed enough to shed quite a bit.

It should be 5mm maximum to proceed with a FET. Mine is always about 8mm after a very poor bleed, so I just need something to strip it asap.

Regarding moving the embryos, the Dr this morning also suggested this, but there’s so much red tape, it’s just not worth it.

Following this with interest - I think I have a similar issue, I only bleed for 2 days during my period and my lining has always been thick during early scans (about 7- 8mm for me too and can get as thick as 14mm by the last scan before transfer). My clinic seem it think it is fine (I guess because many women have the opposite problem), but 6 IUI's and 2 IVF transfers so far and nothing has implanted yet.

I can't explain it as it wasn't the reason why I used it, but I had a much heavier flow after the cycle when I took Vitex supplement. Might be worth trying.

@KatBeCool Thank you, will look in to this!

@IamnotwhouthinkIam Sorry to hear you have the same annoying issue. Has your clinic been happy to proceed with Estrogen even though your lining is so thick after your bleed, or do you bleed more after the scan? Have they never offered a solution to get it a bit thinner at the start?

@VillageFete - For both my fresh and frozen transfers they were happy to start the meds as planned after the initial scan (from what I remember I think I did continue bleeding after the scans, but probably not a huge amount with my periods being so short). But I wish they would scan you when your period has actually finished rather than the day it's due!

They have never discussed any way of making my lining thinner - but my clinic give norethisterone anyway at the start of the standard short IVF protocol/medicated FET (to make sure your bleed starts on time for scheduling purposes I think). It hasn't seemed to make any difference in my period length or the thickness of my lining, so I'm not sure if there's anything else they can do?

I can't believe I'm saying this but I wish I could find a way to make my periods heavier (to really make sure I'm getting rid of all the old lining)!. They used to be the more standard 5-6 days in my 20's, but in the last couple of years since I started IUI/IVF have shortened to the 2 days (I'm 39 now). I wonder if taking aspirin just before/during my period would help the blood flow more, might be worth a go?

@IamnotwhouthinkIam I take aspirin. Unfortunately it hasn’t helped me but I don’t take a large dose, I may up it when i’m due to stop my Norethisterone.

How many days were you put on Norethisterone and also can you remember what day in your cycle? The specialist I saw has just started me on it on day 4 of my cycle for 26 days, hoping this may be the answer!

@VillageFete - I usually take it for 10 days (5mg 3 times a day), starting day 13 of my cycle (so with the expectation my period will start on my usual time of about about day 27 after I've stopped the tablets).Though as I said, I think my clinic use it to be certain my period will arrive on schedule, rather than for lining reasons - so it might be different if you are taking it for that purpose.

Interesting that Aspirin hasn't helped you - how much do you typically take? I'm not sure it would help me either - I've already tried/am taking Fish body oil, NAC and ALA (plus regular exercise), all of which is supposed to help with blood flow but hasn't lengthened my periods (the NAC/ALA has helped with the cramps/made it a bit less clotty though!)

@IamnotwhouthinkIam Yes, last month I tried Norethisterone from day 12 for 10 days, but this Dr I saw last week seems to think it wasn’t long enough and that by starting it on day 4 of my cycle will ensure that my lining doesn’t grow any more and then hopefully the dip in Progesterone when I stop the Norethisterone will be nice and steep because i’ve been on it for 26 days, and so that may induce a decent bleed. I bloody hope so!!

Regarding aspirin, only 75mg, but I may take double that dose once I stop Norethisterone.

@VillageFete Thanks for letting me know about the aspirin and the Norethisterone length. I'm too late for my potential fresh transfer (I've just started the 10 days of pills) but if this doesn't work again and I manage to get any frozen, I'm going to ask about starting the Norethisterone earlier for a FET - I can't see how it would hurt.

I might also mention the aspirin to my clinic, although I don't really see how trying a small dose just before and during my period could do any harm to potential eggs or implantation chances. Good luck - I hope the longer dose of Norethisterone makes the difference for you!

I am currently going through the same thing. 2 failed scans bc of the lining and that's over a thousand dollars right there. I don't know what the Dr. Is going to suggest. May i ask is you ever got your lining dilemma fixed? Last cycle it was 19 and this one 13. This is a new problem I've never had before.

@Nichole7

Hi. I know this thread is just over a year old, but I’m preparing for frozen transfer and I used to do oestrogen priming to do stims to thicken lining but now lining is too thick at cd3. I had my baseline scan and it was 6.2mm today. I have to repeat on cd 5 and they want it below 4 to start. I did have a heavy bleed for 2 days but by third day it lessens and I am 43. Any advice on thinning lining would be good?

I'm sorry you are going through that. I didn't do anything special. By the 3rd baseline i was ok and it resolved on its own. The second time I think was bc I was gearing up to ovulate early (I was 43). My transfer was successful and I have a 5m old. I'm wishing you the best!

@VillageFete I’ve had so many cancelled cycles due to lining thickness. I’m 43 now with high fsh. I used to do oestrogen priming but lining has recently becoming too thick on cycle day 3. When I did oestrogen priming last month with norethisterone, I had a very heavy period. This month my consultant told me to stop hrt completely and just take norethisterone for 3 weeks starting on cd5 which I did. This has been one of my lightest periods. There’s no spotting but flow is light. My lining feels thick so dreading scan tomorrow. I read somewhere that norethisterone does not work well if oestrogen is too low. How did you get on? I’m feeling very fed up as I just want to transfer for my second child.

@2021ivfagain Hi, i’m so sorry to hear this and can truly say I know how you feel.

I have my baby now! What worked for me was Letrozole. I ended up consulting via Zoom with a Canadian Dr (Dr Victory on Instagram) And he strongly suggested a modified natural transfer cycle as the meds clearly play havoc with my lining.

You take Letrozole at the start of your cycle and it naturally lowers estrogen levels, balances things out, and ensures you ovulate around day 21 of your cycle. You may possibly need a couple of months of this to even things out.

I was then scanned regularly until my lead follicle was 19mm and then triggered ovulation with medication (You need to know exactly when you ovulate) And you transfer the embryo exactly 7 days post trigger.

Do look in to Letrozole, it worked for me.

Another couple of things to note - Have you been tested for endometrial hyperplasia? I did have a hysteroscopy with a very, very light d&c to check for this and remove a little bit of lining (I didn’t have hyperplasia)

Also, it transpires that my scans were never wholly accurate. On my transfer cycle the Sonographer told me my lining was 8mm on day 3, I then sought a second opinion with Dr Lower on Harley Street as he specialises in endometrial issues and he said it was absolutely not 8mm, his equipment is far more sensitive and it was closer to 4mm.

It could be worth getting another opinion.