Natural FET - starting …now!

[Fairsy2021]

Hi,

So, I’ve FINALLY been given the green light for natural FET.

Baseline yesterday (20/10/2022) lining 4.9mm

Meds started last night : Letrazole and Clexane.

Anyone along for the ride atm?

[Mudra85]

Hi Fairsy, I'm doing an ERA, EMMA and ALICE modified natural mock FET as part of my current cycle, and intending to do a modified natural FET immediately after that.

Are you also doing a modified natural FET? What days and for how many days will you be taking letrozole for? Also, what dose of letrozole are you on?

Roughly when are you expecting to transfer?

[Fairsy2021 in reply to Mudra85]

Hi Mudra. I’ve never come across those acronyms before - what is ERA, EMMA and ALICE? How are you feeling about things?

I’m feeling like I’m not sure what is going on, if I’m honest. This is a natural cycle as I’d had an embolism caused by my last stim cycle. I just have to avoid extra oestrogen and be on the blood thinners. I assume, they will get the letrazole going and then test me for ovulation after that. Not sure if I will be getting an hcg trigger or not 🤔. I’ve been on letrazole for 3 days and I’m on it for 5 in total. I have another scan and find out the next stage of plan, on Tuesday. I guess transfer could be in next fortnight- depending on any dominant follicles….

What happens next for you?

[Mudra85 in reply to Fairsy2021]

ERA stands for the Endometrial Receptivity Array. It checks to see if your endometrial lining is receptive at the usual time it would be expected to be, which is usually on the 6th day of progesterone exposure. Some women are found to have a displaced window of receptivity and if they are the ERA test is supposed to be able to work out how the duration of progesterone exposure should be adjusted for the transfer in order to hopefully increase the chances that an embryo will implant. EMMA test the endometrial microbiome. ALICE tests for infectious chronic endometritis. All three tests can be done from the same biopsy of endometrial lining. I'm happy to have these tests to at least rule these things out as potential issues as we've now had two failed transfers with good quality chromosomally normal embryos.

From what I understand Letrozole is used to speed up ovulation. The way it works is to suppress oestrogen, which prompts your body to start producing more FSH, which stimulates the ovaries to produce one or two dominant follicles that naturally produce oestrogen and help your lining to grow. Your clinic will monitor the growth of the dominant follicle and your lining and once both are a certain measurement they can either trigger ovulation with HCG or wait until you ovulate naturally. It sounds like all will be revealed at your next scan. May I ask what dose of letrozole are you on per day?

I will be starting my monitoring scans this week.

[Fairsy2021 in reply to Mudra85]

wow - those tests sound really great, especially with regards to knowing more this time around. Sorry to hear the last couple of transfers didn’t work out for you. It’s tough to pick yourself up and go again after things look/seem good and then the outcome wasn’t. So will you have the endo biopsy during this cycle as well as a transfer, or will they transfer next cycle after you get results? I just had 2 cancelled cycles as my lining was looking extremely thick on baseline days; a hysteroscopy was suggested, but not done as lining had thinned enough this cycle. I’m am left wondering what’s going on in there though. I’m taking 2.5mg of the letrazole (finished last tablet yesterday CD8) which seems a low dose after reading about it, but I did hyper-stimulate on both my stim cycles, plus the embolism risk due to high oestrogen… so I think they are being super cautious? I had a scan today and nothing really going on 😔 so back on Friday for another. I have to start ovulation tests tomorrow morning- something I’ve never done, as although regular periods, I don’t ovulate, so will see if i see anything there! Got some big headaches and lining was thickening - so maybe things are happening, but slowly! Not sure at what rate things ‘should’ really happen though - so more not knowing!

[Mudra85 in reply to Fairsy2021]

I'll have the ERA, EMMA & ALICE biopsy in the cycle I'm in right now (provided it all progresses as planned🤞). Then in the next cycle after that I'll have my transfer once I have the results back.

I'd ask your clinic about your lining being thicker at two of your baseline scans. I find it's always best to ask if you're concerned about anything. At the very least it may give you some piece of mind.

They've probably started you on the lower dose of Letrozole as they think it will be enough and to see how your body responds to that dosage first.

I'm not sure how fast the Letrozole should get things going, but it's a good sign that your lining is thickening. Hopefully you will have a lead follicle soon which will definitely be a sign that things are moving in the right direction. Good luck!

[Fairsy2021 in reply to Mudra85]

Hey 👋- hope you’re on track then for the biopsy’s. When will you know if all is good to go ahead?

I had to go and have investigations after the 2 thickened cycles at local nhs as it can be cancer marker, but all came back clear. I think it’s the oestrogen that does it. I have sky high, unopposed oestrogen so it’s not great in there at times.

I went yesterday for scan and lining was increasing well (7mm) but my ‘lead’ follicle wasn’t really a lead (6.9mm) and not much ahead of others. Clinic giving me till Tuesday but if no movement, we will have to abandon this month. I’m praying things move. What has made this cycle even harder, my sister announces she’s pregnant to me the other day, in a what’s app 🤦🏼‍♀️ couldn’t write it!

Anyway, hope you’re doing okay x

[Mudra85 in reply to Fairsy2021]

Hey, I'm not sure how on track I am for the biopsy. I went in for a scan on Wednesday (cycle day 7) and my lining was 3mm and largest follicle was 9.1mm, so I'm a long way from being ready by the looks of things. I'm having another scan on Monday but I'm anxious about my lining thickening enough.

Once I have a follicle of at least 16mm and a lining thickness of at least 7mm they'll get me to trigger ovulation with Ovitrelle and then I'll have the biopsy 7 days after that.

I'm glad you're tests came back clear. I'm sure a cancer scare is the last thing you need!

I hope your follicle grows a lot by Tuesday! 🤞 It's so stressful thinking they could abandon the cycle, but hopefully it won't come to that.

I'm sorry that you had a pregnancy announcement from your sister while you're going through this. I've found pregnancy announcements to be one of the hardest parts of this process.

I'm doing OK thanks, I hope you are too. Hoping you get some good news on Tuesday!

[Fairsy2021 in reply to Mudra85]

Hi Mudra, sorry for the radio silence it’s been an extremely long week! Since we last spoke, I’ve had 2 more appointments and both scans were rubbish - follicle had stayed the same and was just simmering along with all the many, many others! Lining was thickening up though - so very frustrating. I’ve had another scan today (cd19) no follicles doing anything at all and lining is 10mm - nurses said they weren’t sure what to do and would call me, they called earlier and said I can go ahead with transfer next Thursday…. I’m so confused- I thought I couldn’t have fet without ovulating so now I’m worried it won’t work out as it will be cd25 by the time we transfer!! So strange!

How are you getting on? How did Monday go? Any news? Hopefully you’ve triggered or are close to and you can get this next step under your belt.

I agree with you on the difficulty of coping with others becoming pregnant- I’ve just been avoiding my sister since really, which is really sad but I just need to protect myself at the moment.

I hope you’ve been doing alright x

[Mudra85 in reply to Fairsy2021]

Hi Fairsy, no worries at all. I know how crazy a week in fertility treatment can be, so no need to apologise.I'm sorry to hear about the stressful scans you had this week! Are you using a trigger shot to ovulate? If you are then you should ovulate and they can accurately time when you should do the transfer.

I'm OK thanks, but my scan on Monday was really stressful as my lining was only 4.8mm. However, I had another scan on Wednesday and my lining had jumped to 7.8mm. I've now triggered ovulation and am due to have my endometrial biopsy next week. I'm glad to be getting this next step out of the way, but very anxious for the next transfer which will hopefully be the month after that.

I think it's important not to put yourself under any additional pressure right now, but it's still very difficult trying to avoid people and situations that you'd find upsetting, especially when it's your sister. It's such a difficult situation to be in.

I hope you're also doing OK! X

[Fairsy2021 in reply to Mudra85]

hey Mudra- I’m so happy for you! As you say, to move forward armed with more knowledge, will be brilliant- but I’m sure you just want to get moving with the other part, albeit filled with fear! I hope the biopsy goes well and results are returned quickly , you deserve to get that one under the belt.

I had the same stomach drop moment yesterday regarding the actual fet - as although we are approaching it and I’m delighted, I am now remembering how many more hurdles there are. I fell pregnant on my last medicated fet and we lost it at 9 weeks on Mother’s Day weekend in 2021- so now I feel I’m going to be pretty worried the whole time. But first we have to be so lucky to get another miracle in the first place, then daily miracles to get them to stay!

As for me triggering… this is all so weird; but in all the scans nothing going on follicle wise, ovaries so very quiet- lining building well, but that was all. Then they said yesterday to start progesterone today and the transfer will be next week. This is without triggering!! So I’m now worried, as I thought you had to ‘ovulate’ before progesterone in a natural fet. I’m also worried about how late in cycle the transfer will be- cd25!

It’s bizarre, and I can’t find anything about others in a similar situation so I have nothing to go off!

Anyway, I’ve started some audio hypnosis - so will go and listen to todays xx

[Mudra85 in reply to Fairsy2021]

Thanks Fairsy! I hope the biopsy will either provide reassurance or reveal something we can hopefully do something about. I think the results should be available about 2 weeks after doing the biopsy and I hope that's enough time so I can do another transfer before Xmas, but we'll see. Sorry to hear about your previous loss. It just feels extra cruel that it happened on Mother's Day weekend! I think it's very natural to be anxious about your FET and what happens after that, even if it does work. It can sometimes feel like only a miracle will get you through this.

I wonder what your clinic's rational is when you've not ovulated yet. I can understand your concerns. Have you asked your clinic about this? There may be a very good reason why they're proceeding despite you having ovulated, but it'd be good to know what that is for some peace of mind.

I hope the audio hypnosis is going well Xx