medicated versus natural cycle for FET

[Corchi]

hello does anyone have any thoughts or advice or experience between medicated cycle or natural cycle? Pros and cons? Please 🙏🏼

[Skittles11]

I wish I could help as you've been so supportive to me...unfortunately I have such limited experience having only ever done a medicated FET, never a natural one so can't compare. So sorry to hear you could not proceed today with the transfer. Its horrible when you've gone through all the meds and the build up but so pleased to see the embryo is okay xx

[Corchi in reply to Skittles11]

thank you Skittles ❤️❤️❤️

[Titawine]

I did 3 medicated cycle no one of them worked for me, now I'm on natural modified cycle (with trigger shot support ) , and I hope it will work this time, I'm not sure.

[Corchi in reply to Titawine]

hi thanks. Can I ask why it didn’t work?

[Titawine in reply to Corchi]

To be honest I don't know, I have mild adenomyosis and endometrioma in my ovary, I feel like estrogen taking during medicated cycle tends to worsen the endometriose in my case, but I can't tell for sure, my embryos are not tested, this time I added steroids too so we will see

[Corchi in reply to Titawine]

so I was on cyclacur x3 a day for last 10-12 days. Could have been that. I think that’s the estrogen….I hope all goes well for you soon xx

[Fairsy2021]

hi Corchi,

I have had both a medicated and a natural FET. From my experience - the medicated cycle gives so much more control - ie getting to appointments and knowing when trigger will be, and knowing when embie transfer will be, whereas the natural is soooo very different. I did letrazole for first 5 days of my ‘NATURAL’ cycle (so there are still drugs involved) and then from cd7-19 I had 7 scans! All to check lead follicle growth. I never actually got one at all in the end, and was petrified the whole time that the cycle would be abandoned, but my lining was absolutely fine despite not getting lead follicle- so it suddenly became a viable cycle and embie was put in on day 25!

There was a lot of up and down planning with this natural cycle, but my body has had no where near all the hassle as with medicated. That being said, I never really ‘struggled’ on medicated cycles as I tolerated meds quite well. Even on this natural one, I’m on cyclogest 400mg x 3 daily, clexane daily and PIO every three days. I was encouraged to do the natural cycle as I had an embolism couple of years ago due to sky high eostrogen due to stim treatment, so this was a safer option for me.

Ultimately, it’s what you feel most comfortable with. But I think the most natural you can have, is maybe the best? But that’s just me. I wish you lots of luck with it all. Sam

[Corchi in reply to Fairsy2021]

thank you so much for your advice. Hope it works out for you ❤️ I’m sad because my endometrium has always been ace and it’s the actual combination of meds for this specific protocol that in the end ruined it for me not helped me 🥺

[Fairsy2021 in reply to Corchi]

oh no. That’s so awful. Especially when you got so close. So sorry. I would maybe try the natural route next then, if no lining issues ? What meds did they have you on? Can you get going next cycle? It’s just all the time and energy though isn’t it, of gearing up again 😢

[Corchi in reply to Fairsy2021]

cyclacur x3 a day for last 10 days or so, before that arvekap injections for about 2 weeks. Then salospir every morning and prolutex injection every day

[Star3129 in reply to Fairsy2021]

I read you saying transfer happened on CD 25 mine is scheduled to be on CD 20.. I have regular cycles my question here how does the doctor gets to know which day is the actual 'day' for transfer when not doing era.

Another, how come before transfers some patients have continous scans and some a few only. This thing has been on my mind and confuses.

[Corchi in reply to Star3129]

what is CD 25 ?

[Fairsy2021 in reply to Corchi]

cycle day - so it had been 25 days since last period x

[Fairsy2021 in reply to Star3129]

I have regular cycles too- but never ovulate, so was shocked when they suggested the ‘natural’ cycle. Regarding how they knew when to transfer, they started my progesterone on cd20, so knew my 5 day blast needed to go in on cd25.

I had so many scans as they were waiting for ovulation/lead follicle from the letrazole - but this day never came. If it had of done, they would have triggered me, started progesterone and then popped embie in 5 days later. The reason they have be sure you’re going to ovulate etc is because if you ‘popped’ early, the corpus luteum would begin producing progesterone (preparing the womb) and then the implantation window would be off as the receptivity to the 5 day embie, would of been earlier. If they control your ovulation, they can then control the progesterone, and depending on embie age - it goes in those days later.

I never ovulated so was totally shocked they would even consider it, but I think they absolutely knew I’d had no progesterone exposure as no egg release, so knew they could still do it.

[Star3129 in reply to Fairsy2021]

Thanks xx

[Corchi in reply to Fairsy2021]

are you currently pregnant? Did it work this protocol for you?

[Fairsy2021 in reply to Corchi]

I’m currently 9dp5dt (with a 6 day 4BC embie) with positive tests since 4dp5dt. So yes, pregnant but still super early- official test day next Tuesday.

[Fairsy2021 in reply to Fairsy2021]

sorry, I’m 8dp5dt - I wish it was 9 lol

[Corchi in reply to Fairsy2021]

congrats are you testing every day since day 4?

[Fairsy2021 in reply to Corchi]

thank you - I’m cautiously optimistic 🤞🏻

I have been testing daily 🙈 I’m addicted, some nights I do one just to be sure as I think quite negatively!

[Corchi in reply to Fairsy2021]

bless you. Sending amazing good thoughts your way ❤️❤️

[Star3129]

I have not much experience but have read and heard from the doctor that if your cycle is regular then natural fet would be good as the body does most of its work every month naturally though in natural too they will put you on drugs but rest would be best doing it whereas medicated is mostly for people who have pcod or any such other issues with lining where it is prepared by the drugs so that the doctor could time the transfer.

My doctor after scanning me told we will go with natural fet though she has given me the meds but not as the medicated ones.

[Corchi in reply to Star3129]

thanks for this. I originally did medicated with my first fet ivf baby. It worked. My doctor then told me between the two the medicated has most success rate as “they” control it. Don’t ask me why he did different protocol this time and changed progesterone etc. He says they 2,5 years ago when I did first ivf meds were different and now more advanced and they change with science bla blah blah

[Jay0]

I’ve had both. Natural just included trigger shot but unfortunately didn’t work 8 days later. My cycle can be a couple of days early or a couple of days late which they said was fine but wish I knew more before agreeing to it and at least did a modified cycle with progesterone support. I had 5 no go’s with trying a med cycle. Reasons - couldn’t go ahead with not reacting well to suprecur and follicle still growing, in the end needed a hysteroscopy due to a polyp they could see on scan but not in a previous hysteroscopy. Finally after that I was just on estrogen and then progesterone and it worked! Hoping your next cycle goes to plan whatever you decide. X

[Tnthketnf]

HiI had both in the past. For each type I had a completed cycle and an abandoned. No success with either.

I will never choose a Hormone Replacement cycle (medicated) again. My lining doesn't thicken with the estrogen tablets. It struggles even with increased dose. The timeline is longer and the recovery/reset if it doesn't work equally as long. It took me 2+ months to get my period back because of the prostap. Also when I managed to get the thickness and transfer an embryo I bled early because I didn't have enough progesterone.

I now want to have a mildly stimulated cycle ( what Fairsy2021 calls Natural) but my clinic does not really want to do it. So I am having a natural. I had to abandon a natural before because they couldn't pinpoint the ovulation time with the blood test therefore couldn't schedule transfer accurately.

There are 4 types of protocols for FET.

-HRT cycle -the classic prostap with estrogen tablets and progesterone pessaries

-The mildly stimulated with either letrozole tablets or fsh injections

-Natural with trigger to pinpoint ovulation, can add progesterone

-True natural, can add progesterone

My understanding is that studies show there isn't a great difference in terms of success in the above four protocols. I think HRT is slightly worse but not significantly. Also an embryology and IVF blog I follow recently mentioned a study that said the HRT protocol has higher chances of miscarriage.

I am sure if clinics still use it it's good enough but personally I will try and stay away from it.

[Corchi in reply to Tnthketnf]

thank you so much. Very informative and helpful so much appreciated. I have to wait now till January and make a choice. I have no idea 🤷🏼‍♀️ but I think natural sounds best in this instance OR doing the identical of what i did for my first ivf baby. It’s just incredibly frustrating because I have never ever had an issue with my endometrium and before I took the meds a couple of weeks ago it was perfect as it’s always been. Last Friday was also perfect at 9 mm and 5 days later went to 4,5 and subsequently bled and got canceled 😞

[Tnthketnf in reply to Corchi]

Good luck with what you choose. I had problems with my lining getting thinner instead of thicker so I can empathise. All the best.

[Corchi in reply to Tnthketnf]

thank you. Got thinner because of meds??

[Tnthketnf in reply to Corchi]

I don't know what caused it. I was in an increased dose of estrogen from start. At the first scan -13 days of estrogen was 6.7 or something like this and 4 days later got down to 5.3. I had the tiniest amount of spotting and a bit of cramping. Then they cancelled the cycle. When it measured 6.7 I asked to get more meds and they said no. And when I asked later if this could have helped they said they don't know. Everything in the IVF world is so uncertain, nobody knows anything!

[Corchi in reply to Tnthketnf]

ugh it’s so hard. Thank you for explaining 🙏🏼

[SadieBarts]

I have done both. First was medicated & my body didn't respond to the estrogen, so it was canx as my lining was very thin, Second was natural and lining got thick enough, day after I took progesterone I bleed and cycle was canx. Third was modified natural (took a trigger shot) and again lining didn't get thick. On my 4th now, which is a diff type of modified natural and lining is good and FET due next Tuesday. Medication started after ovulation, which is estrogen, cyclogest and lubion. I had to force the 4th one to go ahead, they wanted to do tests but there is a long wait, so I said just try again - glad I stood my ground!

Medicated pro is they can time it, so will always go ahead. Natural, you could miss the window and it could get cancelled due to no one being available to do FET. My body responds better to natural cycles for some reason.

[Corchi]

very informative. Thank you so much good luck 🍀

[Cinderella5]

Hey Lovely, so I was always nervous at the thought of a natural cycle as we did it in your lovely City so couldn't predict for travel as I'm sure you remember. However, I've read your posts and I think you should go with your previous tried and tested protocol. I was never a fan of down regulating which I think you've been doing....on the arvekap (fake menopause). I always think it switched my body off too much to recover with meds and my lining to terrible. Hope you can add to your gorgeous family soon.xxx

[Corchi in reply to Cinderella5]

thank you so lovely to hear from you 💕 I told him that and he kept banging on about how medicine has changed and the patches (estrogen) I did then with my second don’t exist and how they are paramount bla blah did you do medicated or natural here? Was it at iaso ?

[Cinderella5 in reply to Corchi]

I think there are a shortage of patches these days. So my protocol was on day 2 start estrogen (cyclacur) then when lining was OK started progesterone (prolutex and utrogestan). I think they like the arvekap as they can control your cycle. Go with your gut. We were at Rea clinic (Pea).xx

[Corchi in reply to Cinderella5]

thank you so much for your advice. Did you ever do the arvekap?

[Cinderella5 in reply to Corchi]

I did a similar drug in the UK snd I really felt it didn't agree with my body and affected my lining.xx

[Missl73]

Natural worked much better for me, my body doesn’t respond well to synthetic estrogen and my lining won’t grow. Also my cycles would go all out of whack after drugs whereas on a natural I could go again immediately the next month if I wanted to. We used a trigger to time ovulation still for control but otherwise all my own hormones. Our reason for IVF is male factor though so I had very regular normal 28 day cycles when I’m not messed about with which is part of the reason I preferred natural. Cheaper too!

[Corchi in reply to Missl73]

interesting by. Thank you !! I may try that next time as definitely something messed with my endometrium 🥺 could have been anything in this protocol and I wish I knew what.

[Missl73 in reply to Corchi]

The more estrogen they gave me the thinner my lining got not thicker! Just did not agree with me at all. Swapped to natural and my lining was absolutely fine just like it would be on a fresh cycle. I found the whole experience a lot more positive. Plus down regulation drugs never agreed with me either - they’d switch my body off so much I wouldn’t be able to do any kind of cycle for 2-3 months either while my natural hormones recovered. So hard because the only way to learn how your individual body responds is to try it!

They did a baseline scan at the start, then no scan until about CD10, once it looked like the lead follicle was getting to a certain size I was asked to take daily OPK tests to check I wasn’t ovulating and once it was the right size I took a trigger so we knew ovulation would be at a particular time so I could start the progesterone. I’d say it was fewer appointments and scans as well as fewer drugs.

[Corchi in reply to Missl73]

wow amazing 🤩 I will try it thank you so much

[Lolalules]

I’ve never done a medicated but had two natural (completely with no meds at all). First one cancelled because i ovulated on the wrong day (which is the downside of it) but the second went well and after the meds of fresh cycles it felt way less intrusive, fewer appts, and less strain on your body. I’m currently 11+6 weeks pregnant from that round so not out the woods yet but most success I’ve had so far and other than progesterone it’s felt v natural. So I’d recommend, so long as you can be ok with less control x

[Corchi in reply to Lolalules]

very informative thank you. I presume when doing natural they test you every other day??

[Lolalules in reply to Corchi]

i had scans from day 10 after my period, then every other day until i ovulated. Then one once i confirmed ovulation. As my last had cancelled, i expressed this concern and they confirmed they could trigger me if needed this time. Fortunately i ovulated in time to stay meds-free!

[Corchi in reply to Lolalules]

did it work???

[Lolalules in reply to Corchi]

yup i ovulated at the right time and transferred after. I’m 12wks tomorrow - and whilst super anxious due to recurrent loss I’ve already had some scans that were good so hoping for the best x

[Corchi]

fantastic news ❤️❤️❤️❤️