Conflicting FET prep advice. What would you do?

[ThreadWalker]

Hi everyone,

My partner (39M) and I (38F) would love some community advice as we plan our first FET.

After several tough IVF cycles, we’re so grateful to finally have euploid embryos banked. We’re now at the prep stage and want to do everything we can to maximize our chances.

Here's our dilemma: We've gotten conflicting advice, and we're not sure which path to take.

• Clinic 1: Recommends keeping it simple. Suggested only a hysteroscopy and a thyroid function test. They specifically advised against EMMA/ALICE (said it’s not very useful and there's no guaranteed solution if the results aren't perfect) and also said no mock transfer is needed.
• Clinic 2: Recommended the opposite. Suggested we should do the EMMA/ALICE testing and a mock transfer to gather more data before the real thing.

We're feeling pretty stuck. After all the work to get these euploids, we want to give our first transfer the absolute best shot. We don't mind doing more tests if they genuinely improve the odds, but we also don't want to do unnecessary procedures if our first clinic is right.

We’re also curious if there are other tests people found useful before transferring a euploid (like immune panels, blood clotting tests, etc.)?

Has anyone faced this "simple protocol" vs. "test everything" debate? How did you decide which way to go? Any other advice in order to optimize our chances ?

Thanks so much for sharing your experiences!

I had already done thyroid and immune testing before starting IVF, plus blood clotting tests pre FET, but my clinic didn't think it was necessary to do alice/Emma etc until at least one failed transfer. They weren't very strongly in favour of the tests anyway, and I wasn't sure it would be worth it either, but I would have considered it more if a 2nd euploid Fet had failed

After my 1st FET of a euploid didn't work I had a saline scan revealing scar tissue, which had been an issue and treated before, had slightly returned, so I had another hysteroscopy to resolve. I'd had thin lining issues and believe this helped get ir better for attempt 2, plus different meds ro grow my lining

Personally, I'd do the thyroid and clotting tests, and check the uterine environment with a saline scan or hysteroscopy, but not do alice/emma until you've attempted a transfer, but it depends how many euploids you have- my Dr dud say if we had 1 or 2, then going the whole hog at the start made more sense

I would not do the endometrial receptivity tests right away.

Yes to thyroid function, I thought that was a pretty basic test.

Is the hysteroscopy just to have a look or is there a suspected issue?

Other things I would recommend (that you may already be doing) are taking Vitamin D, extra on top of your prenatal vitamins. And probiotics - it’s not clear exactly how the vaginal microbiome impacts FET success but I think it’s good to tick the easier stuff off your prep list. Fingers crossed for you!

I agree with this - I’ve just had a hysteroscopy after a failed FET and my consultant was also not hugely in favour of ALICE / EMMA. I’d go with clinic 1’s ideas. It’s so hard when you get so much conflicting information

I haven't been through IVF (yet - currently awaiting our initial tests appointment) but from a perspective of wanting success, I'd be looking at the basics. Thyroid and clotting blood tests would be my first port of call as those can cause implantation issues and miscarriage and are simple blood tests with a quick turnaround time.

hi op, have they advised yet if they would want you to do a natural FET or a medicated FET?

Thanks everybody for the advice !!

I think it confirms what I read online which is that these tests are a bit controversial and probably not really necessary at this stage.

@daisypizza I think the hysteroscopy is more a precaution and mostly to check that everything is fine. I don't think they have seen anything suspicious outside of my fibroid but we already talked about it and they said that we wouldn't do anything about it at this point.

Thank you for the recommendation regarding vitamin D and the probiotics. Clinic 1 recommended probiotics as well so we already bought it.

hi @lemons44 , this is another difference between the 2 clinics. Clinic 1 recommends a natural FET and clinic 2 recommends a "modified natural" FET (so somewhere between natural and medicated). I don't really know how much it changes things and if one is better than the other but we have decided to go with clinic 1 so we will see how it goes.

How many euploids do you have ? I had unexplained infertility and my first euploid worked. I still have a frozen euploid, I got 2 of them out of the 5 embryos we made . I didn’t do any additional tests I just did a medicated fet and it worked first time. I know I’m lucky . I followed my consultants advice and just went ahead. She didn’t suggest any extra tests. If it didn’t work I would have asked about additional tests for the next fet. I still have no clue why I couldn’t get pregnant naturally we were trying for years. It’s so frustrating when you don’t know and it’s easy to go down a rabbit hole of researching every available test. I would just go ahead and get additional tests if the fet doesn’t work if you have a few euploids. My clinic makes everyone get basic tests like karyotype and thyroid function before starting ivf. Wishing you lots of luck.