Failed fresh transfer & looking for some advice on a frozen transfer

[EllVic]

Hi everyone,

I recently went through a fresh embryo transfer that, unfortunately, ended in a chemical pregnancy. I’m now preparing for a frozen embryo transfer (FET) in the coming months. I have one embryo left and I’m hoping to gather some opinions or experiences from others who’ve been through a FET.

There was no clear reason given for why the fresh transfer failed. My lining was apparently thick enough at the time of egg retrieval (9), but I started bleeding just 5 days after the transfer.

I’m trying to understand the pros and cons of medicated v unmedicated FET cycles and I’d love to hear how your experiences were?

I don't have normal cycles or ovulate and haven't since coming off the pill 1.5 years ago (thyroid issues amongst imbalanced hormones) so assume medicated would be better for me... but can see the medication comes in forms of tablets, pessaries, patches or injections and I have no idea which one is better?!

I want to go into my follow-up appointment feeling informed and better able to advocate for myself. Any advice, experiences, or insights would be so appreciated. Thanks so much in advance x

Hi @EllVic sorry your transfer didn't work, its really really tough. I have only done medicated transfers (1 cancelled, 2 went ahead, 1 failed and 1 successful)

The type of medication and protocol will vary depending on your clinical picture, but at my clinic the standard approach that I tried first was when my period started, I had a baseline scan to check all looking quiet then started on oestrogen - initially progynova tablets, to thicken the lining. They upped these and added in patches and pessaries too as my lining wasn't responding well. A combination of these seems to be what most people do, i guess the exact meds depends on your clinic and your medical history.

In my successful round, I did IVF stims to grow my follicles and natural oestrogen which worked a lot better for me, but from my (extensive!) reading up on mumsnet/reddit this doesn't seem to be super common

I do know someone who has had success with a natural, completely unmedicated cycle but I think that relies on you having a normal cycle and decent lining without any intervention.

I felt much better on my ivf stims cycle as it was all a lot quicker, versus the oestrogen transfer that went ahead as I was on it for like 3 weeks, had so many scans and was just stressed and exhausted but this wasn't an optimal situation!

Between my failed round and my successful round, I also had a hysteroscopy to remove scar tissue and a saline scan to check everything was fine before putting another embryo back, it might be unnecessary for you but just to mention. I also did a microbiome test and addressed some minor issues there before the next transfer to try and check for as many possible issues as I could. If my 2nd transfer hadnt worked (pgta tested embryos) I would have considered emma/alice/era but that's probably overkill for where you are at.

Best of luck!

Hi @Orangewillow thank you so much for responding.

That’s helpful to know about the type of medication you were on. Just curious, were you ever prescribed progesterone injections instead of (or alongside) pessaries? I’m a bit concerned that my body may not have been absorbing the pessaries effectively, which might’ve contributed to the chemical pregnancy.

It definitely sounds like an unmedicated cycle probably wouldn’t suit me either, since my periods are very irregular.

Also, sorry if I misunderstood, did you mean your successful round was a fresh transfer after your IVF stims? And regarding your cancelled cycle — was that supposed to be a frozen transfer that got cancelled because your lining didn’t thicken enough?

Just to make sure I understand the general medicated frozen process correctly, you start the cycle with your period, then begin oestrogen tablets to build up the lining, followed by patches and progesterone pessaries and depending on how your lining responds, the embryo transfer happens about 3 weeks later?

Thank you again for helping me get a better grasp on all of this. It’s really overwhelming x

No problem at all!

Yes I've been on progesterone injections following both transfers, mainly prontogest which is higher dosage, I also used Lubion for a short time. And then also cyclogest pessaries. I always seem to be on max dose of meds! My doctor is quite keen on testing progesterone, I had it before and after embryo transfer and then another one once I'd had my positive test as I had spotting

Sorry no, both my transfers have been frozen, ad we did pgta testing. So the 2nd one where I did ivf stims is a bit less usual, this was just the best way foe me to build my lining versus the more standard oestrogen in a frozen embryo transfer. Amd exactly that for the cancelled cycle, my lining was too thin and the progynova didn't stop me ovulating and they think I had, so cancelled the cycle.

So the process I followed was 1st day or early in cycle start oestrogen, have scans to monitor progress, once lining is at a decent stage they give you a trigger shot and transfer is a week later. The amount of time on oestrogen to build the lining varies, the 3 weeks I did before trigger is longer than it should have been, I've read people at other clinics have first scan at day 10 and if lining good then, trigger soon after. I think the process will vary quite a bit depending on the clinic, and some people will also downregulate which I didn't do. But I think overall start of cycle to transfer is roughly 3 weeks

There's lots of info, and lots of variables, I'm sure your clinic will be able to explain in much better detail that corresponds to your situation, hopefully they will be helpful at breaking it all.down!

I am due for a FET in September. How many weeks after starting your period did you have the embryo transferred? I have shortish cycles (between 24-28 days) so trying to figure out a timeline to help with planning work!

I have never done a fresh transfer, (my clinic doesn’t advise them) but I’ve done two FETs one medicated and one minimally medicated.
The first one was between day 1-3 of period go and get a scan done to check everything is looking good. Start estrogen pills. Go back after I think it was 10 days for another scan to see if the lining was good. If so, I had a trigger injection to take before transfer, also I was injecting something else but I can’t remember now what it was but it had to be every night at 9pm, and to start the progesterone pessaries twice a day. I was a mess. The hormones sent me loopy. It gave me heart palpitations, I felt on edge the whole time, awful. The day of transfer came and it didn’t work. They said that it is a bit of a numbers game and there was no reason why it didn’t work, but to try again.
The next time I asked if there was a way to do less meds. So I only did the one trigger shot and the pessaries. I felt sooo much better and it worked! I have my baby in my arms as I write this 💕
Good luck 🍀

I gave similar length cycles to you. Just checked my calendar and on my successful FET I had my embryo transfer exactly 2 weeks after the 1st day of my period - but I don't think this is the standard, as I followed a bit of a different medication approach with menopur injections to stimulate follicles and grow my lining, which got my lining to the right place quite quickly. I was expecting around 3 weeks from period to transfer. I think the meda can vary timing a lot

Thank you- good luck in your journey ❤️

@Kaybee1989 Thank you for responding - do you know why your clinic doesn't advise them? I find this interesting because I've spoken with some people who have treatment abroad (outside of UK) and they also seem to suggest frozen is better but when I asked me clinic they said there is no evidence that frozen is better and fresh is just as successful?! I don't know who to believe! either way, I won't be having a fresh one again.

So glad it all worked out for you ❤

I am actually in Spain and used a Spanish clinic. The reason they gave me wasn’t to do with success rates but to make sure that my ovaries had reduced in size after all the stims for the egg collection. Give my body a break to have a full cycle before starting preparing for the transfer. I guess incase you don’t react well, or OHSS etc. I was glad for the break to be honest!
What did surprise me was that they told me the success rates are higher in a non medicated transfer… but I guess it all depends on each individual case. We had male factor and in theory I was ‘fine’ so luckily it worked for us 🤗