Estrogen doses and lining

[elsaesmeralda]

Anyone have any experience of 16mg of estrogen ? I have lining issues so it seems so my clinic want to put me on a high dose straight away rather than building it up gradually. I'll be using patches then the 16mg will be tablets both orally and vaginally.

Is there anyone who's previously had trouble getting there lining up but a high dosage then worked for them ? 🤞🏻🤞🏻

Hi @elsaesmeralda I hope you're doing ok? So I think some people can struggle to absorb estradiol and they benefit from higher doses. Have they taken any estradiol blood levels in your previous cycles? It can help to vary the routes like they're doing with you.

In my first FET I took 2mg orally three times a day and then at the first scan they said the lining could be better so they checked my estradiol and it was about 800, that meant they had some scope to increase the dose and told me to increase the dose by 4mg.

I then did a mock cycle starting on 2mg three times a day orally and a patch every 72 hours and again it could have been better so they upped the dose again. In my most recent FET they started me on 2mg three times a day orally and 2mg three times a day vaginally. The lining was looking good and they took a blood test and my estradiol was 8000! None of the specialists had ever seen a level this high in a FET before, they couldn't find any source in me producing estradiol so clearly this was far too high of a dose.

So I think it's important that the dosage is at the right level for the person. I've read in papers that a prolonged course of estradiol is an option for thin lining. I also took aspirin. I have Raynauds so I've told my specialist I want to add in pentoxifylline and viagra next time. There are also g-cfs washes that some people have for lining.

Have you looked into other investigations? I was found to have thin lining in a natural cycle and I was having light periods. I had an ERA EMMA ALICE and my microflora was awful, I had no good bacteria in my uterus. It was treated and had a much more normal period and the lining looked better in this recent cycle, even though it didn't work.

I'm good thanks @Gardenlady543 I've been away for a while after the last failed fet just too basically get ivf and babies off my mind and I feel ready to go again now, although dreading the buserelin ( my skin was awful and I bloated like crazy and still am bloated from the last fet )

How're you getting on? Wow you've really gone through a lot haven't you but it's given you a lot of experience by the sounds of it. You really seem to know your stuff. I'm sorry your latest fet didn't work. Are you ready to go again anytime soon? I remember you have quite a few embryos in the freezer like me.

No they haven't taken any levels and no mention of it. But they have said this time they want to check my progesterone levels the day before transfer and if they're low I will get an injection or something. My lining only just made it to 8mm when they made the decision to just go for it. Obviously it was just too thin but I'm glad they tried anyway.
It's so frustrating because as far as I'm aware I've never had an issue with my lining, but it does make me think maybe this is why I've been having issues ttc all along.
I've been pregnant once in my life, 6 years ago and have my ds from it. Total surprise and nothing since. My periods have always been on the lighter side and I have pcos. My only symptom seemed to be irregular periods and acne, metformin has helped regulate them but still no pregnancy.

What are the other investigations ? All this is still very new to me

@elsaesmeralda 8mm isn't bad at all, in my most recent FET the readings I was getting varied (there is measurement error involved in this stuff), but my specialist concluded I was somewhere between 7-8mm and it looked lovely.

Gosh I have had so many tests over the last few months.

• I PGT-A tested my embryos, my recent FET was with a euploid. I have 4 more euploid left.
• thrombophilia screen and autoantibodies
• ERA EMMA ALICE
• HSG

I went into this recent FET with everything thrown at me. The microflora had been treated, I was on aspirin and heparin, I had the correct transfer window as it was shifted in the ERA and it was with a euploid embryo. But as usual the embryo made no effort to implant.

My specialist insists on a cycle off inbetween so I'm going to hopefully repeat the EMMA in August to see if I need anymore microflora treatment and also recheck the ERA in case the microflora change has caused it to differ. I have also joined a waiting list for NK cell tests. My specialist mentioned a hysteroscopy but they said my anatomy looked perfect on the HSG so I'll probably hold off. There really isn't much more I can do.

I will probably then have another transfer around October or November (a year since my fresh cycle). I never knew when I started IVF that this would be taking so long. I think once it's clear everything has been set up correctly it really is a numbers game.

I remember you having a lot of embryos too, at least that's in our favour.

@Gardenlady543 I'm really hoping it gets thicker than 8mm this time. My clinic left me too long on my first fet and then cancelled the cycle. Then on the second one they were better but still took me to day 28 to get my transfer. I want to transfer ASAP this time without them holding back waiting to see if it thickens, I think it gets to a certain point when it's only grown like 1-2mm in a week that they should realise it's not going to get any thicker.

It sounds like you're doing all you can and I really hope all the extra investigations and procedures works out in your favour.

I agree it's a numbers game if everything looks okay. I keep thinking I don't think I can go through this potentially another 8 times. It's so hard on us mentally aswell as physically. This will be my second fet. I keep thinking if I've carried a child before why wouldn't it work again, what's changed so much in my body since then

So as far as I'm aware there is no evidence that those that require longer on estradiol to get a good thickness do worse than those that get there in a shorter amount of time. So I wouldn’t worry about the time length.

Anything above 7mm should be fine. I’m not sure why your clinic insisted on cancelling cycles. My clinic have told me they would cancel twice at the last minute and I’ve refused. It’s horrendous to go through a course of these meds for nothing.

With a good amount of embryos have you considered PGT-A testing if this cycle doesn’t work out? That will help select out the euploids since you have a good number, this would hopefully get you there quicker. I was watching a journal club where they were optimistic that with euploid embryos, even if there have been 3 unsuccessful transfers, the chance of success for the 4th transfer is pretty consistent with a live birth rate of 56%. Part of the issue is keeping women from dropping out and they were saying as clinicians they need to keep women motivated, I saw it as a bit of a pep talk. This is the video, they do briefly took about estradiol course lengths in it:
[[https://youtu.be/LYt-JgTKsA8

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That's good to know then. I was convinced leaving it so late had something to do with it.

It's their policy, 8mm and above and they will transfer. My lining appeared healthy, triple layer etc so who knows !! I did actually get a postive test on 7dp5dt, albeit very light. Later that day i started spotting and the next day I was passing clots.

I would love to get them tested but money is tight now. It's cost so much for this package with access and we just can't afford anything else especially with all the meds to pay for. Thanks for the link to the video I will have a look 😊