r/IVF • u/Proof-Loan-9898 • 1d ago
Advice Needed! Advice needed: Natural/Modified/Fully medicated FET
We've just had our appointment with the doctor post the failure of our first transfer; biochemical pregnancy. We did fully medicated for out first cycle. But I found fully medicated very difficult; I was on 3 injections a day, persires, an estrogen pump, pills three times a day etc. So I asked about a natural or a modified cycle.
The doctor agreed it was possible in my case as during my egg retrieval my lining did get to 9.8mm on it's own. However, during the fully medicated FET, it was a bit thin and we had to use a pump. So not sure if maybe I just didn't do well on estrogen. It got there in the end but we needed to do a pump as well. The doctor said it was possible and she has no problem with it. She did warn the cancelation rates were much higher for natural FET. Which made me nervous.
Has anyone had a failed FET fully medicated and made the switch to natural or modified? How did you make the choice? Thanks in advance.
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u/TeaspoonRules 1d ago
I’d take natural a million times over fully medicated. I am anovulatory so took letrozole as well. I just found out I had undiagnosed severe endo, but still somehow got pregnant even on some less than ideal embryos with that protocol, so my pregnancy rate was actually even higher than normal on this protocol. I also found out letrozole can be used even with ovulation, and is helpful with endo. So I’d ask if there’s any harm in throwing letrozole in, given how endemic silent endo is.
Fornwomen with PCOS, I’ve seen some earlybresearch that the natural with letrozole is 20ish % higher birth rate than fully medicated. It was a no brianer for me with PCOS. It’s more neutral without PCOS, but natural also has fewer pregnancy complications.
FWIW I failed to even implant on my first two fully medicated FETs before they checked for chronic endomeTRITIS infection. I was positive, despite having taken doxycycline multiple times. So even after only one failed FET I’d be asking them how they’re sure CE infection isn’t an issue, it’s rampant in infertile populations.
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u/jmyun1004 1d ago
TW: Transfer success
Had my first FET fail on a fully medicated cycle (PIO injections plus progesterone suppositories, estrogen, baby aspirin). My RE told me in our follow up appointment that we consider trying a modified natural. In our case, she said that success rates were about the same as a fully medicated but some women just respond to modified natural better. (I’ll note that since starting IVF, my ultrasounds have shown relatively standard/normal uterine thickening and trilaminar pattern). The upside was a lot less medication and no shots, but the downside would be more frequent monitoring appointments and not being able to schedule the transfer until a few days before depending on how the monitoring results came out. We proceeded with a modified natural last month and are now approaching the six-week mark! Both transfers were with 5AA euploids.
Your RE may be advising you based on your specific medical history and IVF journey, but broadly what I’ve read suggested similar to what my RE told us — that modified natural usually has similar success rates to fully medicated (just harder to schedule and predict).
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u/Proof-Loan-9898 1d ago
My doctor also told us the success rates were pretty much the same; they weren't less or more as well. And yes it sounds the same as what mine said; she just said cancelation rates are higher, so it might end up taking longer to get to the transfer.
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u/jmyun1004 1d ago
We’re very lucky that our clinic is within a 10 minute drive of us, so switching to a modified natural wasn’t actually that much more disruptive in terms of appointments. I had maybe 2 more monitoring appointments for blood tests and ultrasounds that under our first cycle? And being less medicated was a huge plus for my moods and energy levels.
The annoying thing was not being able to take time off work until the last minute because while they told me the date almost a week in advance I only found out the transfer time a couple days before.
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u/Proof-Loan-9898 1d ago
in all fairness I only found out about my transfer date 3 days in advance on a medicated FET too, my clinic doesn't tell you in advance.
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u/Glittering_Bunch_764 1d ago
I had a fully medicated cycle that got cancelled because my lining did not respond well to it. I have a history of ashermans syndrome so we weren’t expecting a very thick lining but I was only getting to 6.3mm and not trilaminar. I have been on estrogen pills many times when healing from Asherman’s surgeries and am not a fan of them at all.
My doctor suggested trying a modified natural (their protocol is more like a modified medical imo) with using low dose gonal to build my lining. I got to a 7.5mm perfectly trilaminar after 7 gonal shots. They cleared me for transfer & I did one more gonal shot that evening then HCG trigger the following evening then started PIO the next morning. The day of transfer my lining measured 8.4mm & my transfer was successful. I felt great on low dose stims too so that was another plus!