Natural/Modified Natural VS Medicated Protocol- Which one works best on a frozen transfer

[Katiluna]

Hello everyone,

After our fresh embryo transfer with donor eggs failed (implantation failed), we are now left with two frozen embryos (grade1 day5 embryo and grade2 day6 embryo).

We had the fresh transfer done on 5th November (a good-quality grade1 day5 blastocyst) using a medicated protocol.

I'm not sure if a different protocol would work better for me (I'm 42 now if age makes any difference!) as we didn't have luck with the medicated one.

Which protocol worked best for you and actually helped you achieve a successful pregnancy with a frozen embryo? Natural/modified natural or a medicated protocol?

I understand everyone is different and we all react differently to different things, but I would like to have an idea before we make a decision on our next transfer (frozen embryo).

Any input or advice would be much appreciated

Many thanks

[Tnthketnf]

The clinics i used (NHS and abroad) said both medicated (hrt) and natural protocols have similar success rates and the important is the embryo. I have tried

-hrt with downregulation,

-hrt without downregulation and

-true natural (no trigger) with progesterone.

I think there are other protocols such as natural with trigger (modified) and mild stimulation(meds to stimulate a follicle to produce estrogenand which will thicken the lining) but I have no experience of these.

I personally prefer the natural as it is easier on the body and quicker recovery and moving on to the next when it fails.

With my OE I only had BFNs. This could be because of my eggs and not the protocols.

When I moved to DE I first tried hrt with downregulation which failed. The next transfer was true natural with progesterone and I am currently 25 weeks pregnant.

With true natural the NHS clinic meant no monitoring of the lining just a blood test to confirm ovulation, first tracked at home with urine tests.

My clinic abroad with true natural offered lining and lead follicle moniring through scans and blood test confirmation of ovulation. Much more reassuring.

[Katiluna in reply to Tnthketnf]

Hello Tnthketnf, thank you for taking the time to respond and CONGRATULATIONS on your pregnancy🎉. 25 weeks is reasuring That's great! I totally agree that the embryo is the most important factor, 70-85% is down to the quality of the embryo. Monitoring through the scans and blood test confirmation of ovulation are definitely more reasuring. It may require a few more visits to the clinic and a longer stay abroad, but I wouldn't mind that as it's worth a try. Can I ask when exactly you had to start taking progesterone with your last transfer and how much progesterone were you advised to take?XX

[Tnthketnf in reply to Katiluna]

Thank you very much! I still can't believe it, if I am honest. Still checking every morning that it isn't a dream. If I remember correctly I started taking progesterone 5 days before transfer. Transfer was day 6 of progesterone. I took one lubion injection per day. I think the doctor said that I was already producing progesterone so I didn't need more. I was also on low dose aspirin, 80 mg per day. This was because of my age I think rather than to help implantation.

Yes, if you can stay longer abroad it is worth it. I think it was a total of 9 days abroad from arriving to transfer.

I had the first scan on day 2 of my period here. And the next 2 scans abroad. I have a generally regular cycle with short follicular phase but still risky to plan in case it was later this time or an anovulatory cycle. In the end it worked out!

All the best!

[Katiluna in reply to Tnthketnf]

Thank you for sharing that information. I completely understand how you feel. Enjoy every moment of it. Wishing you a healthy, smooth pregnancy X

[Wishinandahopin]

hello! Sorry to hear your fresh was unsuccessful.

In regards the options, it really depends on the person. Studies show that they are all very similar in regards getting pregnant.

In some studies the fully medicated option has a very slightly higher chance of miscarriage and problems in pregnancy such as preeclampsia. But as I said it’s only slightly higher.

I had two fully medicated ones which didn’t work for me, I couldn’t do a fully natural cycle as my periods weren’t regular. So I did a modified natural (the modified part of it can mean a variation of things) for me that was a mild stimulated prep, a trigger and then progesterone supplements (pessary and injection) and a frozen transfer 5 days later. That is what ended up working for me.

But I have many friends who worked well with a fully medicated one. I was 38 when I did it.

Even if you go fully natural route, it would still be worth supplementing progesterone for peace of mind.

Good luck with whatever you choose!

[Endofitall in reply to Wishinandahopin]

Can I ask what your mild stim for the modified FET protocol was? Thanks

[Wishinandahopin in reply to Endofitall]

Yes it was Menopur, just until one follicle was big enough, trigger to release it and then progesterone.

[Katiluna in reply to Wishinandahopin]

Hello Wishinandahopin, Many thanks for your response and congratulations on your successful pregnancy That's awesome if the modified natural helped you get the happy ending. I agree everyone is different. As the first transfer didn't work with the medicated protocol, I thought maybe we should try a different one. Not sure at the moment... I'm still waiting for my clinic to get back to me on their recommendations and suggestions. It's been over a week since I contacted them on this...We will see what they have to say about this XX

[Wishinandahopin in reply to Katiluna]

Hey just to clarify a fresh transfer is not a medicated protocol in the same way a frozen one is, even though it uses medication, as it’s working alongside your natural cycle.

A medicated frozen protocol is when it completely shuts down your ovaries and preps the body that way using HRT etc. so that’s what it means by a fully medicated frozen transfer.

Hope that makes sense! Xx

[Katiluna in reply to Wishinandahopin]

I understand what you mean. Thank you for the clarification XX

[Vix12345]

I have had 5 transfers. One fresh fail, two medicated frozen both chemicals, and two natural frozen, one was successful but miscarried at 9 weeks, the other failed. My clinic very much prefers the natural process if it is possible as that is much kinder to your body. I plan on doing this again for my next cycle, we now have PGTA tested embryos so more chance of success there, and it's the protocol we got the furthest with and it is much easier and less stressful.

[Katiluna in reply to Vix12345]

Hello Vix12345, thank you for taking the time to reply and for sharing your own experience. I'm so sorry for your loss It's heartbreaking and hard to endure. I agree a natural process should be more gentle and kinder to the body. My clinic hasn't got back to me yet on how we should proceed with the next transfer, so I'll discuss this with them then we'll see how we can move forward. I wish best of luck with your next transfer. I think a PGTA embryo is more promising and gives that extra reassurance. Hang in there XX

[Vix12345 in reply to Katiluna]

Thank you so much. I hope your next round is the lucky one, best of luck x

[Katiluna in reply to Vix12345]

Many thanks XX

[Doodlebug23]

Modified natural was the one for me. I monitored ovulation with POAS sticks, had progesterone pessaries, then trigger shot. I also had clexane and prednisolone.

[Katiluna in reply to Doodlebug23]

Hello Doodlebug23, many thanks for your response and for sharing what worked best for you I'm pleased this has helped you get your little one and experience motherhood. I will discuss these various protocols with my clinic then we will take it from there XX