2nd FET protocol for 4th embryo transfer

[Naturewalks]

Hi all,

I’m looking for some advice on FET protocols.

I’ve had 2 fresh rounds of IVF treatment and one frozen.

The first cycle of IVF resulted in two embryos. We transferred one embryo, which resulted in a BFN. For our frozen round we also got a BFN.

For our next fresh round our consultant suggested ICSI, not due to a sperm issue but due to a low rate of blastocysts at the day 5 stage on round one. This cycle resulted in three embryos, we transferred one back in December which unfortunately ended in a chemical pregnancy, the other two embryos have been frozen.

I’ve been diagnosed with mild to moderate endometriosis via laparoscopy and had this removed back in 2022. I’ve also got a slightly underactive thyroid so I've been put on thyroxine. Other than that it’s unexplained infertility. My husband’s had multiple tests and all seems fine there.

On my first frozen cycle we did a non-medicated Natural cycle, as my cycles are regular and they hoped this would work. I’m wondering what protocol I should follow for my next round.

My current clinic is an NHS clinic (which we are really grateful to have) that only offers a Natural FET and a short medicated FET using Progynova and progesterone.

We decided to seek another opinion from another clinic (a private clinic), as it will be my 4th transfer and I am getting more and more anxious that this will never work. Due to my endometriosis the consultant suggested doing the frozen transfer using the long Day 21 FET HRT protocol, using GnRH analogue then estrogen medication and progesterone.

We are lucky that we have one more frozen embryo round on the NHS, however as my clinic doesn't offer the long medicated protocol I’m wondering whether it’s worth moving to go private.

Does anyone have any experience of the long medicated protocol working more effectively for them or any advice in general on this?

Thank you so much in advance for your help xx

[neonpg]

Hi Naturewalks. I'm afraid I don't have experience with long medicated protocol, but I did the short medicated protocol with oestrogen and progesterone and this resulted in a BFP. Unfortunately miscarried but this protocol seemed to work well for me with my lining thickening up as expected and thankfully no side-effects from the progynova (I know some folks don't get on well with these).

Hopefully someone else on here has experience of the other protocol and it helps you reach the decision that's right for you. Good luck!

[Naturewalks in reply to neonpg]

Hi neonpg

Thanks for your message.

So sorry to hear you miscarried, I hope you are doing ok.

I’m glad you felt ok on the short medicated cycle and your lining thickened nicely. Did they choose to put you on this protocol due to irregular cycles?

Thank you!

[neonpg in reply to Naturewalks]

Thank you, I'm okay and currently on cycle #2

My clinic offered natural or short medicated FET. As my periods are regular-ish (cycles vary between 28 and 35 days) they actually recommended natural for me (so tracking ovulation and then starting progesterone once i'd ovulated) but I opted for medicated as I was a little inpatient and didn't want to wait ages to ovulate (on my first IUI I didn't ovulate until day 21!). However, I think if I was to do a FET again though I'd probably consider unmedicated. Hope this helps.

[Naturewalks in reply to neonpg]

Good luck with cycle number two. Fingers crossed for you.

Thanks for the information, wow day 21! That’s crazy! My cycles are pretty regular, between 28-32 days so I found the natural cycle worked well (in terms of timing ovulation). The consultant is suggesting long medicated due to the endometriosis but my current clinic doesn’t seem to offer this strangely

Thanks again.

[Twiglet2]

the long down reg protocol is what our clinic uses for FET (nhs and self funded) and gave us our little boy. It has also not worked though but 3/4 times using it I’ve had implantation where as natural FEt (and IUIs) was a straight BFN so it did seem to help me although it’s a very long process and the meds aren’t fun. I haven’t tried the short medicated FET as our nhs clinic didn’t do it and I always wished I could have did that as seems a good balance of the 2. I would probably be tempted to try that nhs funded with your last embryo then move clinics as you would need to get all your tests done at new clinic, arrange for shipping of the embryo and do the long protocol and in that time you could probably have had your nhs go and (hopefully not needed) then start a fresh cycle at a new clinic. Just my thought process though 💜 xx

[Naturewalks in reply to Twiglet2]

Hi @Twiglet2 Thanks for your message and your advice. Congratulations on your little boy!

That’s really helpful to know that you’ve used both protocols and found the medicated long one to be the most effective. Can I ask why your clinic put you on the long protocol? Was it due to irregular periods or endometriosis? My new consultant has said there’s no point in trying the short medicated protocol instead of the long as that wouldn’t be effective. So probably we will just be going with a natural cycle again this time.

What was the long protocol like in terms of drugs and number of scans for you?

That’s what we are thinking to try again with another frozen embryo and then move clinics after that. It’s difficult as I don’t want to waste the embryo by not doing all I can but we don’t know if it is a numbers game for us and this round could miraculously work 🙏

Thanks again 💛 xx

[Twiglet2 in reply to Naturewalks]

It’s just what our clinic do for everyone unless they specifically Ask for a natural or don’t ready well to eostrogen. It helped them time the transfers as they take over your cycle. Mt periods are regular and I don’t have endo.

The protocol was a prostrap injection date 21 to down reg and scan 10 days later to make sure lining thin enough (you should have a bleed in those 10 days). When thin enough they give progynova to start building back up the lining and then there is a scan about 7-10!days later to check it’s thick enough and bloods. When it is they will schedule in a transfer date (the following week) depending on when that is we take burselin to keep us down reg for a few days as the prostrap only lasts one month and you start progesterone 5 days before. So all in all it takes about 6 weeks from that day 21 down reg injection until the transfer. The prostrap gave me horrible side effects which is why I wish we could have had medicated without the down reg! But if it works can’t complain eh! Xx

[Naturewalks in reply to Twiglet2]

That's interesting to know that's what your clinic recommends for everyone, it's so confusing when all the clinics work differently!

Thanks for listing out what you did for the long protocol, it sounds like a lot but I guess it helps to regulate the cycle a little more. Sorry to hear you had bad side effects on the prostrap though, sounds nasty. Definitely hard to complain if it works but it is a lot to go through so complaining is necessary at times I'm sure! xx