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"Supernatural" cycle for FET with stage 4 endometriosis?


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#1 Janni_bee

Janni_bee
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  • Location:Kamloops
  • Dx:Endometriosis
  • My Clinic:VFC

Posted 05 March 2017 - 11:46 PM

Hi there! 

I'm unfamiliar with this kind of protocol.  I have an endometriosis nodule in the posterior cul de sac likely involving bowel. (never had a lap, only seen via MRI and US)  I've had 4 cycles of FET.  1st - successful.  2nd and 3rd unsuccesful, and 4th cancelled due to poor endometrial lining. 1st one involved BCP, suprefact, dexamethasone, estrace and progesterone.  2nd and 3rd involved BCP, suprefact, progesterone,estrace, and medrol for assisted hatching. Estrace was aggravating my endo.  4th go was BCP, suprefact, dexamethasone, estrace, progesterone. Started breakthrough bleeding and lining was too thin so FET was cancelled.  Now my Fertility specialist wants to do something called a "supernatural" cycle that involves: 

Birth control pill, Letrozole 5 mg for 5 days starting on cycle day 3

Ultrasound and blood work on cycle day 10

If endometrium satisfactory, monitor for LH surge

2 days after a late surge start Endometrin 100 mg intravaginally twice daily and Estrace 2 mg orally once daily

Doxycycline

Medrol for assisted hatching

 

However, the surgeon I saw last week said I should do 3 months of lupron before our FET as she has seen success with endo patients that way. She mentioned that surgery to remove the nodule would not help our IVF success.  I can't seem to find any literature on the success of a "supernatural" cycle with patients that have Endometriosis, and to top it off my cycles are no where near regular.  What method do you suggest? We have only one good quality embyo left. (day 3) 

 

Thanks so much for your opinion! 


TTC since July 2013Me 31 Dx: Endometriosis (Unknowingly treated with BCP for 16years! Symptoms began when I went off the pill July 2013)DH 30 Male factor, 0% Morphology  Aug/Sept 2014 : IVF + ICSI Antagonist Protocol: Puregon, Repronex, Orgalutron Sept 2014: 10 eggs retrieved (7 mature, 3 immature)           

7 mature eggs ICSI'd, 5 fertilized, 3 immature eggs matured overnight, but never successfully fertilized via conventional IVF

4 great quality embryos frozen on day3

Nov 25, 2014  FET One 18 grade 9 cell embryo transferedBeta Dec 8th --  Fingers crossed!th_abfp.gifCould we be so lucky!?  Beta 291 13dp3dt
Due Date August 15, 2015
Perfect little girl born Aug 11th via scheduled c-section because she was breech! Hayley Victoria, 8lbs 1oz.  Words can't even begin to describe

 Emoticons09710.gif

Trying for #2! FET Sept 9th/2016 (Same protocol as FET#1 ..MINUS dexamethasone)
Beta #1 Sept 21 sad.pngth_abfn.gif 

FET #3 Trying again October 21 (No suppression as they felt it was still active from the last FET..no dexamethasone) 

Beta - th_abfn.gif

 

FET#4 Scheduled for Jan 2017 -Realized I was NOT on the same protocol as the first one with the last 2 failed FET, they left out Dexamethasone! th_angrywife.gif   This one will be the exact same as our only successful FET.  Fingers crossed that's the trick! 

FET#4 CANCELLED, breakthrough bleeding, poor lining. 

 


#2 Roller coaster

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Posted 06 March 2017 - 12:42 AM

I have severe endo and did 1 fresh ivf cycle that resulted in a BFN. Followed by 3 FETs that were BFN's and a chemical. I had best lining on my fresh cycle but had problems with estrace pill and patch not getting a good lining for FETs initially so tried natural cycle and a few other protocols. I did another fresh cycle and had a poor response but transferred 2 day 3 embryos and felt so defeated.......but that lucky golden egg was there and I got my miracle. The journey is a roller coaster but I would trust the doctors at VFC. Wishing you the best on your journey.

#3 socialgirl

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  • Location:Ottawa, Ontario
  • Dx:Endometriosis
  • My Clinic:Hannam Fertility

Posted 06 March 2017 - 08:24 AM

Hi Janni_bee,

 

I have stage 4+ endo with 2 surgeries under my belt (August 2006 and December 2011). We did IVF in March/April 2016 and froze all  4 embryos to do PGS testing (3 normal, 1 not). We did a FET on December 21 (transferred a 4AA 5-day blast) which resulted in a BFN (heartbreaking).

 

My FS recommends taking Lupron for 2 months before doing another FET. Studies show that Lupron increases your beta-3 integrin levels, which is an important hormone for implantation. Because we have endo, our levels are lower than normal women. I've never heard of a supernatural cycle before. I'm sorry I can't give you more info about it. I'll do some research and let you know if I dig anything up. All I know is that the Lupron protocol is the recommended protocol for women with endo. My twin is a family doctor, suffered from infertility after the birth of her son, and has endo (stage 2). She had surgery, did Lupron, had a roller coaster of cancelled FETs for different reasons, and finally conceived twins on her very last FET. They were born in July 2016.

 

I'm seeing my endo surgeon in a few hours to see if surgery will improve our chances for the next FET. My FS "may or may not" have seen hydrosalpinx on U/S for the last FET. He said there was something that looked like it but it could have been fluid in my pelvic cavity...likely due to my endo.  I'll let you know what he says! If he doesn't do surgery, he's giving me my 1st Lupron injection (since today is CD 1...perfect timing) and we'll transfer in late May or early June.

 

I'm sorry you're on this roller coaster too. I wouldn't wish it upon my worst enemy.


Me: 34, DH: 57

 

Me: hypothyroidism (treated with daily Synthroid), stage 4+ deep infiltrating endometriosis and was told when I was diagnosed that a natural pregnancy would be very unlikely.

 

IVF#1 at Hannam Fertility: March/April 2016. 5 eggs retrieved, 4 mature, 4 fertilized with PICSI. 3 genetically perfect grade 6AA, 5AA and 4AA embryos.

 

FET #1: December 21, 2016 = BFN

FET #2: expected May or June 2017; same protocol as the last time and adding 2 months of Lupron before

 

 


#4 socialgirl

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Posted 07 March 2017 - 09:10 AM

Hi Janni_bee,

 

My endo surgeon echoed my FS's reservations about surgery. Since this is your last good quality embryo, I suggest giving it the best possible chance at implanting and doing 2 months of Lupron before the supernatural cycle. Lupron is expensive and isn't covered by all plans. I paid about $860 for the monthly injections. If you can get your endo specialist to prescribe it, it might be covered by your health insurance. Mine was prescribed by my FS and they denied coverage. When I asked them if it would have been covered had my endo specialist prescribed it they said "the chances would have been higher".

 

Despite the expense, I think it's worth it. I got my first Lupron injection yesterday.

 

Here's what Lupron entails:

- wait until your next CD 1 to get the 1st Lupron shot

- 4 weeks to the day later, get the 2nd Lupron shot

- your period should return 4-6 weeks after the last Lupron shot

- Call in your CD 1 and follow the protocol your doctor set up

 

My protocol is as follows:

- Call in CD 1

- Test TSH on CD 3 before proceeding with Estradot patches

- CD 3: Estradot Patches x4, change every 2 days and continue until lining is ready

- CD 10-12: Lining check, if thick enough and triple stripe add prometrium (first dose at noon) and progesterone in oil every other day (start the following morning)

- Transfer on the 6th day of prometrium

- Transfer day: PIO injection x1 on the morning of the transfer

- Continue using patches, prometrium and PIO until pregnancy test

 

Good luck and let me know what you decide to do!


Me: 34, DH: 57

 

Me: hypothyroidism (treated with daily Synthroid), stage 4+ deep infiltrating endometriosis and was told when I was diagnosed that a natural pregnancy would be very unlikely.

 

IVF#1 at Hannam Fertility: March/April 2016. 5 eggs retrieved, 4 mature, 4 fertilized with PICSI. 3 genetically perfect grade 6AA, 5AA and 4AA embryos.

 

FET #1: December 21, 2016 = BFN

FET #2: expected May or June 2017; same protocol as the last time and adding 2 months of Lupron before

 

 


#5 DrMichaelHartman

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Posted 08 March 2017 - 02:35 PM

Hi Janni-bee

This is a loaded question!

Certainly if there are issues with estrogen supplementation a natural cycle makes sense to try. Sometimes instead of estrace we will use either no estrogen or methods of ovarian stimulation (usually gonadotropin injections) to try for a frozen cycle. There isn't a huge amount in the medical literature about letrozole for a frozen embryo transfer cycle, but it does tend to thicken the lining of the uterus.

I would agree that surgery may not be helpful.

Lupron prior to treatment wmay help minimize the endometriosis and could have a positive effect. 

I would revisit this with your RE if you aren't certain or have concerns.

Good luck!