IVF thin lining specialist recommendations

[Rubyroo1984]

Does such thing exist?

I am looking for a new IVF clinic and am at a loss which one to turn to. Please does anyone have any recommendations for thin lining issues?

We turned to IVF due to my PCOS (irregular / light periods all adult life, minus the 10 spent on contraceptive pill 😬). I had mild stimulation with create and have frozen embryos on ice, however thin lining is now my issue. Even with 25 follicles collected, lining was only 6mm. Had a hysteroscopy, endometrial biopsy, no issues. Thyroid all okay. 10mg of estrogen and patches, max 5.7mm.

Taking high doses of larginine, vitamin e, etc.

Anyone here had success with PRP, Neupogen wash, sildenafil…if so, please can you say where?

Thank you all, really appreciate any help / advice

Thank you @Enfys23 ❤️ xx

@Rubyroo1984 that’s amazing! What changes did you make?
My consultant told me I need to put on weight as my BMI was around 16. I put on a lot of weight in the last 1.5 years and am around BMI 20.5. He said it takes time for estrogen production to catch up but it feels like forever since I’ve put on that weight. I eat relatively healthy, mainly a veg diet. I don’t drink or smoke. I’ve been taking a pre pregnancy multivitamin, Co enzyme, omega 3, vitamin d, E and folate. I don’t drink tea or coffee, just water. I honestly don’t know what else I can do. My lining was 2.9mm when I was first referred to the clinic and it’s only got to 4mm after Prognova and patches, so at a loss.

Were any of you ladies told that having sex the night before transfer could increase chances of implantation or is that just a myth I’ve read online?

@Spin101 Made sure each meal was balanced with enough protein, carbs etc and I was eating enough. I used to skimp on carbs because I thought I was being healthy. I also used to eat a mostly veg diet, but don’t think I was getting enough protein either. Not sure if it contributed but I changed to gluten free and minimal dairy.
Do you exercise? I used to run and do HIT. Turns out that stressed my body contributing to out of whack hormones. Started doing slow weighted workouts and within 2 weeks I got a period.
My bmi was 20 last year December, it’s probably 22 now, so that has helped.
I personally don’t think the supplements made a difference for me it was definitely the above changes.
Also I did not respond well in a HRT cycle, I’ve done much better in a mild stims

Sorry I do not know about sex the night before transfer. On my most recent cycle I was told no sex the whole month before!

@Spin101 pcos wise- I learned a lot from Jessica ash wellness on Instagram

That’s fascinating. I’ve also had to gain some weight. I’m just normally at the lower end. Got up to BMI 20-21 over past few months and I think you’re right @Rubyroo1984 that’s probably helped most. I’m still in same clothes but definitely filling them out more. Really hard to gain weight eating healthy isn’t it. I’ve also cut out HIIT. Go on a brisk walk/gentle strolls now and do yoga.

suspect we all have this issue with HRT cycle. When my estradiol dose was increased between scans in October my lining looked worse on the second scan and got all friable and grainy, so that led to one cancellation. I started in the higher dose from the off the next month and still no go.

@Spin101 there’s proper studies with reasonable evidence that it’s helpful (seems to make biological sense that semen would have some stuff in that helps) so we have done this. It’s not great in fresh cycle as you don’t really feel like it post egg collection and can be painful, but pre FET it was nice to feel we were doing something to help the process. As long as you’re not someone who tends to get thrush/BV or cystitis immediately after it is a nice bonding thing as a couple I think given so much of the process involves not being able to! As we keep saying to each other who knew trying to make a baby would involve so much time not being able to have sex!

This is one of the studies I read @Spin101 if you’re interested. academic.oup.com/humrep/article/15/12/2653/2915864

@Rubyroo1984 That’s amazing! I wonder if I should try gluten free. I’ve thought about it but then always thought it’ll be too hard for some reason.
I used to do weights one or twice a week but stopped a year ago and only really do yoga and walks now. Not sure if that’s enough.
Can I ask what mild stims are? Is it FSH at low doses?
thank you for the recommendation, I’ve just followed that page on insta.

@Enfys23 like you’re both saying perhaps HRT isn’t for us. I’ll see how this transfer goes and then ask my consultant for alternatives.
thank you for sharing the study! I love reading these. Definitely sounds like it helps! I’ll read the detail this evening.
Exactly, so much time not having sex! With all these medications, we havent made time for sex, which I know is bad. I don’t want to risk it today after having abstained for a few weeks. I’m glad I know this for if there has to be a next time!

What form of progesterone did you both take? I’m on two pessaries a day and had a blood test this morning to check if I need injections as well.

@Spin101 just wanted to say thinking of you today and hope all went well. Rest up and look after yourself xx

@Enfys23 thank you xx
What a journey I’ve had today…
Picked up the lubion from my clinic, went to another clinic to have my transfer (as my clinic doesn’t have an embryology lab). As soon as we entered the theatre, I knew something was up. Our 5AA embryo hadn’t thawed properly and they thought it was no good so thawed a 4AB which apparently also didn’t seem to thaw as well as they wanted. Then they realised both were expanding slowly. They told us that on the spot and asked us do we want to transfer two embryos (which my clinic advised against so I was surprised) or just one. We mentioned my thin lining and the doctor said his recommendation would be to transfer one. They looked at both of them again and decided the 4AB looked better so transferred that one. My bladder was so full during these conversations, I had to go and empty my bladder a bit 😆 before transfer.

Got to the car to drive home and opened up the lubion box and saw they were solutions for injections rather than pre filled syringes (which is what the nurse said I would be getting when she called me yesterday). I knew I had some syringes and injections at home from menopur but still started panicking about it. Turns out the nurse gave me incorrect information. Managed to do my injection an hour ago but it does feel quite sore around the injection site now. Might be because I’ve had a weird tummy since lunch. I felt so bloated, the doctor commented on my bowel movement on the ultrasound 🙈🙈🙈🙈

Wish the day wasn’t as stressful as it was! However I’m glad we got through it and have our embryo on board x

Oh bless you @Spin101 that is quite the rollercoaster of a day! So glad you could go ahead though. Well done for part emptying your bladder - that’s a challenge!!

I find Lubion sites are quite sore but sort of got used to it after a while and also found some days it was really ouch for the rest of the day when I accidentally pressed the site or twisted a certain way and other days it was barely noticeable. I couldn’t sleep on my belly at all! Just make sure you rotate sites you’re injecting. The things we go through eh?!

I always find progesterone makes me bloated and bunged up. I did use some laxido sachets when all else failed!

Hope you can take a deep breath this evening and enjoy knowing you’re PUPO xx

@Enfys23 it’s helpful to hear your experience with progesterone. My stomach has been odd since lunch, then I had the transfer and it feels even more crazy now. Hopefully it’ll pass in the morning.

That’s what I was just thinking.. the things we go through!

Thank you ❤️ xx

@Enfys23 how are you doing?

My OTD is on Friday but I caved and tested yesterday (6dp5dt). I got a BFN which didn’t surprise me. I will test again on OTD but am not expecting a change. I think too much happened on transfer day for me to have much hope, along with the thin lining.

Have you done back to back cycles or did you give yourself a break?

Have you tried menopur stimulation to see what it does to your lining? (I think that’s a thing) x

I’m sorry it’s BFN yesterday @Spin101 but it is very early days. I think 8dp5dt is really earliest it could tell you anything and that’s usually blood rather than urine test. I know it’s hard and I know when you just know it’s not worked in yourself but definitely retest later this week. Sending lots of 🤗

I’m doing okay thanks. I’ve had my review with the consultant. I decided to take a pause and so will be doing next transfer in March. Day 1 should be next week. He’s suggested adding in pred and clexane. Feels like big step to take but if it’s going to help then I’m willing to try. He was happy with my lining as it got over 7mm this time in the natural cycle so doesn’t want to alter anything from that point of view. I will have progesterone officially tested this time too on day 3 of starting progesterone. I have a feeling we will be heading to third stim so then it’ll be a case of whether we freeze all as my lining was crap in fresh cycle 🤦🏻‍♀️ but then I had to have whopping high doses of FSH which probably didn’t help.

I have definitely heard of others having mild stim to build lining for FET. Worth exploring all options.

Thank you @Enfys23 🥰 I will wait until OTD on Friday to retest.

I hope you’ve been keeping yourself occupied during the pause. Another injection to add to your protocol - the things we do! Were you on low dose aspirin at all at any point?I hadn’t heard of pred until you mentioned it. Have you done much research on it?

Glad they will test your progesterone too! Were you on two pessaries and Lubion for your last FET?

Aww you poor thing! What dosage of FSH were you on?

I’ve got DH to keep all pregnancy tests hidden from me in the last transfers @Spin101 I just feel no good can come from early testing,I did in my very first transfer and it was just painful!! and I’ve seen people on boards where they do test early and get positive but then it’s light etc and they stress about that. It’s so hard though so I now just don’t have any I can access!

Thanks. It’s such a minefield isn’t it. Prednisolone seems to be the first step in immune treatment. I don’t want to do anything that causes baby harm but it sounds quite safe. I have autoimmune thyroid etc and endo so it seems quite commonly used in that kind of history. My consultant is quite anti aspirin (apparently it’s more likely to cause bleeding if there’s trauma during embryo transfer, or egg collection in fresh) and prefers the clexane as first step so not been on aspirin before.

Yes Cyclogest and Lubion. This last transfer is the first time I’ve had Lubion. I was on 450iu of the FSH. Seems perhaps wasn’t the best idea (wasn’t my usual consultant who did the protocol in the end).

@Enfys23 that’s really disciplined of you! You’re right, regardless of when you test, there’s something to worry about. I tested today and it was still a BFN and I don’t think that’s going to change on Friday.

Ah you poor thing, 450IU of menopur! Do they think it’s the high dosage that reduced the quality of the lining for a fresh transfer?

I’m glad your consultant is really tailoring the protocol for you! Really glad you shared that about aspirin, as I asked my clinic if I can start aspirin and they said if I get a BFP and want to, I can.

I’m at a bit of a loss as to what to do. I don’t get periods anymore, but assume I will next week, similarly to after EC. I’m wondering if I request a Prognova prescription to start on my next cycle so that I can see if it has the same or a different impact. If it’s the same, I will get to see the consultant sooner and will ask him what we can do differently. This time, I will definitely ask to cancel the cycle if there’s no change.

Can you remind me, did you see/are you seeing a thin lining specialist? x

Sorry didn’t reply sooner. As you might have seen on the other thread been a bit bonkers in work.

Unfortunately I don’t think a specialist really exist for this. It’s really trying to gather as many ideas as possible and try to get consultant to consider and listen. I don’t want to stress you but I would definitely advocate for doing something different this time. I’m not saying it’s right for you but my plan involved getting the TRIOME biopsy done to make sure I didn’t have chronic endometritis etc, hysteroscopy, and then when they were still thinking medicated cycle going for 12mg Progynova with half by oral and half by vaginal, plus 200mcg patches every other day, and viagra. Then I think if that hasn’t worked we’d have been looking at some form of mild stim. But then I did a webinar with a consultant on mild stim and asked about this and lining issues and they were really helpful and said they’d do the above kind of plan first then they also suggested natural cycle if I was having regular ones, so that’s when I asked my consultant - he arranged a scan then in my next natural cycle and miraculously over 7 after all the 3-4mms in medicated FET attempts. Be as assertive m as you can with your medical team, and take some ideas to your review that challenges their thinking. While some bits may not be NHS most clinics will let you “top up” paying for some elements outside the usual NHS funded bits. Most research is saying not to transfer until you get to 7mm. That might just not be physically possible for you but it’s worth trying a few different things and trying to get it as close as possible.

Yep there was some thinking it’s the high dose stims (I had Ovaleap) that affected lining in fresh. It got to 6mm on trigger day but kept dropping off to 5mm by EC day. I got some extra oestrogen between EC and ET for 2nd cycle but I don’t think it was really the right thing to do.

I think aspirin is used often for those at risk of pre-eclampsia in pregnancy etc so has good safety record but I think it’s started a bit later (around 12 weeks) than equivalent to pre transfer, so I think it’s more a timing of when you start it which is why my consultant isn’t keen.

Thinking of you this morning ❤️

Realised I didn’t tag you @Spin101

@Enfys23 Thank you ❤️

It was still a BFN this morning 💔😢 It hit me after I did the test and I just cried to myself.

I’m sorry work has been hectic for you. Will you take some time off around transfer so you can really relax?

Thank you so much for that detail, I really appreciate it. I will certainly do lots of research and take ideas to my consultant and I will explicitly state we are willing to pay for the tests the NHS doesn’t cover. I’ve already starting writing down what you and others have recommended and then will try make sense of it all and be more logical about it.

On top of the thin lining, I really am fearful of the remaining embryos not thawing. I think I need to reject the next transfer if the embryo hasn’t fully expanded and they can’t confirm it’s viable.

I am really sorry @Spin101 it hurts really bad even when you expect it. Take some time to heal from the loss and look after yourself.

Yes I will definitely get signed off around the transfer time. I want to make sure I have no regrets.

That’s a good idea. I always find it helpful to focus on research and plan after a BFN, though I know everyone’s different.

Oh I am sorry you have that worry too. I think it was very unusual to have issues with the thaw so hopefully that was just a one off. It sounds like they just needed to give them a little time. Make sure you write your questions about that aspect and ask at your review too.

Sending love ❤️

Thank you @Enfys23. You’ve been so helpful and lovely! ❤️

I’m glad you’ve planned to take time off!

I have so many questions for my consultant, I don’t know where to start! I’m going to take some time over the next couple of days to gather my thoughts and be concise x

That sounds a good idea @Spin101 I’m sure once you sit down you can put them in themes and topics and make it a bit more concise. But remember they are there to answer your questions so go through what you need to. When is your review appointment? (Sorry if you already said and I’ve forgot)

I’m really glad I could help a bit. It’s such a lonely struggle this one ❤️

@Enfys23 It really is ❤️

I don’t know when my follow up will be unfortunately. I’m still waiting for the clinic to come back to me. I’m trying to see if I can get a private appointment sooner.

Which supplements are you still taking at the moment?

Oh I hope it’s not too long a wait for you @Spin101 any luck with getting it sooner?

I’m still taking Vitamin E 400iu, 200mg ubiquinol, Vitamin D 2000iu for winter (1000 in summer), 2g L-Arginine, Omega 3 in Pregnacare Max conception, and taking Optibac (oral) probiotics “intimate flora” for women at the moment (I took it for 12 months before my EMMA/ALICE tests so feel they must have done some good as had great results). Also doing a lining yoga regime, fertility acupuncture (lady who does mine used to work in IVF clinic, she’s like my fertility coach/counsellor too! I know I’m really lucky though that my parents have offered to pay for these sessions, couldn’t keep it up this long otherwise), and trying to do some activity (even if it’s a little dance around the kitchen post work) but avoiding any hard cardio, eating Brazil nuts and drinking pomegranate juice daily. Who knows if any of it really does anything but I’m willing to keep at it 😂

@Spin101 This is a webinar I did where I asked a question to the consultant who seems a very experienced chap, if you wanted to watch he gave some advice on thin lining:

from 37:38 minutes

And I also found this helpful when doing research on thin lining: