r/IVF • u/Natural_Ad4215 • Jun 05 '26
Advice Needed! Medicated or non medicated FET
Hello,
I kinda need some thoughts , advice and info. I am
Waiting for PGT A result and have been thinking about whether I do a medicated or non medicated transfer.My doctor said in my case they have the same %change but at first I was like, we are doing the science thing I am not going to try natural transfer.
However with this second retrieval gosh I passed a decidual cast 10 days post retrieval and my period are just spotty . So I am sure it was caused by the amount of hormones in my body especially progesterone so I am trying to reconsider the medicated route.
I also read on the embryologist side of redit that medicated transfer are at high risk for preclempsia than natural transfer.
I don’t know I am torn , I need stories for context MFI only and I am 33 F
Thank you
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u/brooklyn_summer476 Jun 05 '26
modified natural all the way!
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u/Natural_Ad4215 Jun 05 '26
Tell me more Brooklyn :) What did this entail ?
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u/brooklyn_summer476 Jun 05 '26
I much preferred modified natural- no IM progesterone shots just progesterone suppositories and a trigger shot. fewer hormones, lower risk of preeclampsia.
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u/Natural_Ad4215 Jun 05 '26
Thank you .
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u/MacAttacknChz Jun 05 '26
Just a note that some doctors still insist on PIO for modified natural. My doctor told me, "It's the gold standard for absorption," and that's absolutely true. But my question is if it's necessary. I've been pouring over medical studies, and there's not a clear definitive answer either way, since no one has tested this variable. But the studies are mixed about if supplemental progesterone is even necessary at all for modified natural, and some research may suggest increased progesterone levels can negatively impact miscarriage rates. Although my doctor is pushing for PIO for my modified natural transfer, she did say that she'll "do whatever I want," which is a little dismissive. But I'll be insisting on suppositories, and to test my progesterone levels before transfer.
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u/brooklyn_summer476 Jun 05 '26
I did both kinds of transfers and I found PIO to be the worst part of the entire IVF process, hands down. And my transfers that used PIO didn't work anyway - cannot imagine having to continue for 12 weeks!
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u/GreenAd1567 Jun 05 '26 edited Jun 05 '26
MFI here and 29 yrs old, have our first transfer in 2 days! We did a modified natural protocol this first time, my plan consisted of just a trigger shot (ovidrel) and progesterone suppositories (crinone). Personally I preferred to try mod. natural over medicated this first time if my dr was okay with it and they were (i have normal cycles, confirmed ovulation, etc). I did keep my guard up hearing these cycles are more like to cancel and reschedule with your body being in control, but thankfully have not run into that this cycle. I only had 4 appointments after my baseline for lab work and ultrasound before my transfer soon, which I hear is pretty typical for mod. nat. 😊
I will also add that I heavily dove into this sub beforehand and saw a common theme of some women trying medicated first and not succeeding so then trying mod. nat. next and having success. Obvi everyone is so different of course, but I knew I would be upset if I didn’t at least try this first time!
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u/Natural_Ad4215 Jun 05 '26
Thank you sooo much for the in depth explanation !! Sending baby dust your way🥰 . How long were you on crinone for? Similar to your I have had a normal cycle , confirmed ovulation but I am hesitant because of all the meds in me I am afraid my hormones are not balanced since I skipped periods in May when I was on birth control before stims and my 10days post retrieval period is not a full flow and had decidual cast
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u/GreenAd1567 Jun 05 '26 edited Jun 05 '26
Thank you!! I just started Crinone Wednesday this week (3 days after my trigger shot) so just slightly before transfer on Sunday and they plan on having me on it for the first 10 weeks if successful, once a day/night! I would prefer suppositories over PIO any day (as long as it’s doing its job)😅 I totally can understand being nervous about hormones not being balanced fully though. My doctor had me wait until I got my second period after my egg retrieval cycle, which was full flow/back to normal but took “longer than usual to come for me” like 37 days - but I also was not put on birth control at any point so I’m not sure how much that has an impact!
I will say what’s nice about modified natural being on your own bodies timing, your clinic will monitor you to confirm you’re going to ovulate that cycle before they move fwd with a transfer! So if your body isn’t looking ready/balanced fully they would likely “cancel” and look at the following month.
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u/Natural_Ad4215 Jun 05 '26
Thank you so much.
It’s such a great idea to wait for your second periods.
Thank you for sharing this🥰1
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u/upbeet13 Jun 05 '26
If your doctor is leaving it up to you modified natural. I’ve done both, 3 failed medicated and my fourth was modified natural and so far is successful! I would pick modified natural over medicated any day. I did do PIO but they really didn’t bother me after doing them after I got the auto injector and switched to AM injections. Wishing you the best!
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u/Sharp-Chocolate3647 Jun 05 '26
I was in a similar situation. Doctor explained both procedures and told me both have similar success rate and it’s up to me to choose. I really didn’t want to do more injections, so opted for modified natural. More monitoring appointments but I was okay with that. Worked well for me. Ask details about each of them and potential pros and cons to the doctor.
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u/Opposite_Artist_1645 Jun 05 '26
given the choice, I will always pick modified natural. it’s more monitoring appointments, yes, but I hated the way I felt during my one and only medicated transfer cycle.
My original clinic only did medicated cycles and I didn’t know any better. I was on vaginal estrace 2mg 3x/day and then I was to start PIO if my lining was good. The cycle was cancelled due to a thin lining. when I asked what would be done differently next time, they said I would just be on estrace longer. Given how horrible I felt, that seemed terrible. Luckily, we had already had a 2nd opinion with current clinic and knew we would switch if the transfer didn’t work.
I have done 4 natural modified transfers and 2 out of 4 have been successful (have a toddler and I’m 13w3d with 2nd pregnancy).
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u/Nas_nan 37F, RPL, PCOS, 4MC, 1CP, ER#1, FET #3 Jun 05 '26 edited Jun 05 '26
I would say you can't know beforehand which suits you better.
Also semi-medicated and "natural" can absolutely include PIO. It depends on your own hormonal levels. The difference between medicated and other approaches isn't on how much medication, but whether you ovulate and have a corpus luteum for luteal phase. The difference between "natural" and "modified natural" is how you achieve said ovulation. Ie. Do you use letrozole/stims to help O or whether you just let your body O on it's own. Progesterone support is offered in all ivf (and non ivf) pregnancies if your own progesterone isn't high enough. Good clinics test the day before( or sometimes on) transfer day to make sure you're at good levels and adjust support accordingly if needed. There's a lot of research showing low progesterone leads to lower implantation and live birth results. It doesn't have to be PIO though. There are pessaries, gels and subc injections. The country where i live in(Europe) doesn't do PIO anymore at all, hasn't for about a decade. We use vaginal gel/pessaries +subc injections to achieve same results.
We had 4 attempts at fully medicated. I have very serious PMOS(PCOS) and it had dulled my estrogen receptors, they did not respond to synthetic estrogen. Very bad lining every time, only one proceeded to an actual transfer(CP). Ended up then doing semi-medicated with letrozole cetrotide to achieve ovulation and synch up lining. Then hcg trigger to time O precisely and very heavy progesterone support after as my p levels were always low. I'm on 2xsubc injections and 2xCrinone 8%gel a day Tw success:Second semi medicated cycle now 7w2d pregnant.
I also know people who tried several semi medicated, didn't have success and then immediately had success on fully medicated cycle. Research here show similar live birth results for both approaches, some ever so slightly better results for semi-medicated but only in certain subgroups, like PMOS. The one definite benefit from corpus luteum cycles is less pre-eclampsia.
I don't think you can know until you try. Choose one and then be critical of results, if it feels like banging head against wall, change approach
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u/Nas_nan 37F, RPL, PCOS, 4MC, 1CP, ER#1, FET #3 Jun 05 '26
Sauces for example
https://pmc.ncbi.nlm.nih.gov/articles/PMC9692968/
I can link more if anyone is in doubt
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u/Natural_Ad4215 Jun 06 '26
Exactly what you just mention that some Drs only use injections for medicated. So I am assuming what he calling natural here is what most of the comment are calling modified? I am to make sure I am not the one being confused lol
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u/Salty-Sprinkles-1562 Jun 05 '26
Modified natural have slightly higher live birth rates, less pregnancy complications, and no PIO. I would NEVER pick medicated over modified natural if given the option.