Natural Cycle with Frozen Embryo Transfer- What's Involved?

[Katiluna]

Hi everyone,I'm thinking of trying a natural cycle with a frozen embryo transfer (a day 5 or day 6 embryo) after our fresh transfer failed (donor eggs). I believe a natural cycle would be milder and more gentle to the body (although embryo quality remains the main factor).

When I asked my ivf clinic (based abroad) if we could try a natural cycle with frozen embryo transfer instead of a medicated one, they said because my AMH is very low (I'm 42), it would be a bit of a challenge for them to schedule a natural cycle. So they suggest I take Letrozole 2.5mg twice per day from day 3-7 of the cycle. I don't think I have an issue with ovulation as I ovulate every month. So I don't feel like there is a need to take Letrozole or anything else apart from progesterone.

The clinic also said the ERA test is not recommended for me as I had been pregnant 3 times before (all ended with a miscarriage) so they think I shouldn't have a problem with implantation window!

- Did you have to take Letrozole with a natural cycle?

- How was your natural cycle outlined (timeline, what was involved in the cycle, ovulation monitoring, progesterone etc)?

-When did you start taking progesterone?

-How much progesterone are/were you taking?

-When exactly did you have your frozen embryo transfer with a natural cycle?

-Did a natural cycle work for you (successful pregnancy)?

Any input would be much appreciated.

Many thanks

[Ghaidheal]

Hi Katiluna, Sorry to hear your fresh transfer failed x

I've just had my embryo transfer as part of a natural cycle. I had 3 scans between day 10 and 14 to see how things were progressing with lining thickness and a dominant follicle. After the day 14 scan I started ovulation testing at home and let the clinic know once I surged. Usually I ovulate around day 18 so was preparing for this to be a few days wait and to need a day 17 scan, but in the end it was day 15 that I got my lh surge. They booked me in for the transfer on day 21 (6 days post +ve lh). Progesterone wise, I'm taking Lubion (every 3 days) and Cyclogest (2 a day) because my period started early during my fresh cycle so they think I need an extra boost even though my body should be producing it's own this time round. Progesterone started on day 19, 2 days before transfer. Those were my dates, it's all a question of what your body is doing that month. I've definitely been able to be more chilled this month but have felt a slight loss of control without taking any medication daily. Wishing you all the best with whatever you agree is the right thing for you to try next xxx

[Katiluna in reply to Ghaidheal]

Hi Ghaidheal, thank you for taking the time to reply to my post and for all the information you have included XX. I think with a natural cycle, it's all about monitoring what the body is doing during that time, catch the LH surge then plan the rest accordingly. I believe my clinic should be able to do this without me having to take Letrozole. I'll see if they agree to do more scans for proper monitoring (together with the use of home ovulation kit) if we decide to do a natural cycle. I hope this transfer will work for you and will bring you a positive result XX May I ask how much progesterone level your clinic recommends on the day of transfer and post transfer?

[Ghaidheal in reply to Katiluna]

Thank you, keeping everything crossed xxx I haven't had any progesterone testing through my cycles so it feels a bit trial and error with the medication based on what's happened previously. Have read that you can't have too much progesterone though. Taking Cyclogest 400mg and Lubion 25mg xxx

[Katiluna in reply to Ghaidheal]

I see. Yes too much progesterone may cause an issue. It feels like this whole process of IVF is trial and error xxx

[Bimsie1310]

Hi,

I haven't taken letrozole on any of my natural transfers. I also have no problem ovulating. It sounds more like your clinic want to control when you come in rather than you needing it.

The timings of my current one are.

Start ovulation testing day 8

Scans day 10 and 13 to check lining and dominant follicle

LH surge at day 13

Stared taking progesterone (2x Cyclogest 400 a day)

Transfer day 19 (LH + 6)

Currently in TWW so no idea if it worked but I hope so!

I've had previous natural that failed but medicated also failed for me so don't think it was the protocol and my lining and progesterone levels are better on natural transfers .

Hope that helps.

[Katiluna in reply to Bimsie1310]

Hello Bimsie1310, I hope you're keeping well. Many thanks for replying to my post. The main reason for willing to try a natural cycle is to allow the body to do its own thing without disrupting it or trying to control it with any hormonal medicines (other than progesterone). I think with proper monitoring, my clinic should be able to do this without Letrozole. I normally get LH surge on day 10 or 11 of the cycle (very rarely on day 9 or 12). So if I travel at the beginning of the cycle and start monitoring from day 7, then I don't see the point in taking Letrozole. Wishing you best of luck with your current transfer XX

[Bimsie1310 in reply to Katiluna]

Hi, if your cycles are regular then I think natural are worth a try. As I said above my body actually responded better on a natural cycle and it's nice being on less hormones. From other posts on here though it does sound like most clinics prefer the medicated route.

[Katiluna in reply to Bimsie1310]

Yes my cycles are regular (24-29 days). It's good if your body responds better to a natural cycle. Some clinics may prefer a medicated cycle probably because there is less monitoring for them (less visits to the clinic, less scans etc) and easier/more straightforward for them to schedule a transfer.

[Bimsie1310 in reply to Katiluna]

I've also just thought you should check with your clinic if they are open every day. My recent transfer was on a Sunday which was fine at my clinic but I know some are closed on Sunday.

[Katiluna]

Yes I will check with them. If they are not, then it could be an issue.

[Solo45]

hi, wishing you every success with your transfer. I’m not familiar with the drug you’ve mentioned. However for natural (or modified natural) FET my clinic need the lead follicle to be Min 14mm and lining to be min 7mm before they then do blood test for ovulation. If you have low AMH I believ that can impact the pace of follicle growth, so this may be why they’re suggesting the additional med. this process can be so frustrating, particularly when you’ve had a tough ride, but generally I would say to trust the process and their advice as they have the research and stats to back it up, but of course ask their reasoning if you don’t understand something re a drug or timing. If it’s clearer in your head it will help you relax throughout the protocol. I ended up with 6 scans from day 10 because my lining ans follicle took a bit longer than expected and it felt very frustrating! Good luck.

[Katiluna in reply to Solo45]

Hi Solo45, thank you for your reply and for sharing your own experience on the natural protocol. That's helpful. It gave me some more information on what's required for this protocol. I completely understand your frustration esp when trying to do everying you can to make it work. It's exhausting and overwhelming. Wishing best of luck on the rest of your journey xxx

[Doodlebug23]

Modified natural was the one that worked for me with my 6 day frozen embryo. My lining was clears optimal so no monitoring. I tracked ovulation with POAS and took progesterone. I then had trigger shot when I got LH peak and transfer was a few days later.

[Katiluna in reply to Doodlebug23]

Hello lovely, I hope all is well. Thank you for replying to my post. Natural cycles should be kinder to the body (at least less medication). If you don't mind me asking, how many natural/modified natural cycles did you have until you had success? Or did it work first time you switched to that? xxx

[Doodlebug23 in reply to Katiluna]

Here’s my history:

1 Fresh single medicated BFN

2 Frozen single natural BFN

3 Frozen single medicated BFN

New donors

4 Fresh single medicated chemical

5 Frozen double medicated BFN

6 Frozen double medicated BFN

7 Frozen double natural BFP single pregnancy

[Katiluna in reply to Doodlebug23]

Thank you for sharing that xx. So it took you 7 transfers and 10 embryos. A long way to success considering the fact that you were having donation cycles. Glad the last natural one finally worked for you. Change of donors may have also helped. This may have resulted in better quality embryos or at least better blastuation rate compared to the previous one. You can now relax- no more ivf anxiety and stress after a long journey xx

[Doodlebug23 in reply to Katiluna]

I didn’t try natural again for a while as first time I had to have several scans and it was expensive as I had to pay privately in UK as clinic in Spain. When I had the last natural transfer the clinic allowed me to use home tests for ovulation rather than scans. I wish I’d tried natural again sooner. Makes sense to me that my body was doing its normal thing then just an embryo sneaked in!

Good luck. I know what a long stressful journey it can be x

[Katiluna in reply to Doodlebug23]

Thank you! Home ovulation tests can help and provide a bit of guidance. Scans are definitely expensive so ovulation tests can reduce the cost of having multiple scans as long as the home ovulation kit is reliable x