Failed FET - Question to Ghost

[jes77]

Dear Ghost,

Our issue: Male factor

I have 30 to 35 days cycle. For the recent unsuccessful FET I was under Progynova (estradiol tablets). When I was talking with Doctor, she mentioned they would see the ovulation, and transfer the embryos a day or two after the ovulation. They were only checking E2 levels and lining, and not LH. On Day 16 I went for scan (scan performed by different doctor). She mentioned that it doesn't seems like I was ovulated as she couldn't see the corpus luteum. also she mentioned could see a dominant follicles.

Same day evening blood report came with E2 230. I met my RE, she said the E2 is good, hence perform the transfer next day. I talked with her saying I am not sure I ovulated, there is it better to check if I have ovulated. She replied to me that she would check only E2 and lining, both looks good, hence she performed the frozen ET next day. My embryos were frozen on 8 cell stage, and on Day 4 (after thaw), all 4 were beautiful morulas.

Since after the transfer, it was running in my mind that could be I might have not ovulated and no LH surge might have happened. And they didnt check LH through out my FET. also I was not under gnrh like lupron.

Ghost, please let me know if my questions make sense.

Thanks,
Jes.

[Ghost]

Dear Ghost,

Our issue: Male factor

I have 30 to 35 days cycle. For the recent unsuccessful FET I was under Progynova (estradiol tablets). When I was talking with Doctor, she mentioned they would see the ovulation, and transfer the embryos a day or two after the ovulation. They were only checking E2 levels and lining, and not LH. On Day 16 I went for scan (scan performed by different doctor). She mentioned that it doesn't seems like I was ovulated as she couldn't see the corpus luteum. also she mentioned could see a dominant follicles.

Same day evening blood report came with E2 230. I met my RE, she said the E2 is good, hence perform the transfer next day. I talked with her saying I am not sure I ovulated, there is it better to check if I have ovulated. She replied to me that she would check only E2 and lining, both looks good, hence she performed the frozen ET next day. My embryos were frozen on 8 cell stage, and on Day 4 (after thaw), all 4 were beautiful morulas.

Since after the transfer, it was running in my mind that could be I might have not ovulated and no LH surge might have happened. And they didnt check LH through out my FET. also I was not under gnrh like lupron.

Ghost, please let me know if my questions make sense.

Thanks,
Jes.

Interesting. You have legitimate concerns.

When did you start progesterone supplements? And what type of progesterone? Also, if you don't mind, could you please PM (message) me the name of your clinic? I'll keep it confidential.

[jes77]

Dear Ghost,

Thanks for your message !

On Day 4 of my cycle I started to have Estradiol tables (3 times a day)

On Day 16, I had scan and blood work (e2 was 236, lining 10). On same dayI had progestrone shot (Gestofit 50), and Day 17 was my transfer. (4 morulas transferred).
- On Day 17, they gave progestron shot Gestofit 100,
- Day 18 onwards until Beta test I was taking only Urogeston vaginal pessaries (200 mg, 3 times a day).

Jes.

[Ghost]

Dear Ghost,

Thanks for your message !

On Day 4 of my cycle I started to have Estradiol tables (3 times a day)

On Day 16, I had scan and blood work (e2 was 236, lining 10). On same dayI had progestrone shot (Gestofit 50), and Day 17 was my transfer. (4 morulas transferred).
- On Day 17, they gave progestron shot Gestofit 100,
- Day 18 onwards until Beta test I was taking only Urogeston vaginal pessaries (200 mg, 3 times a day).

Jes.

I was concerned about the progesterone (you did not mention any progesterone before), but you addressed that.

That sounds like it should work. Your lining was reasonably thick and the progesterone timing was about right, assuming you did not ovulate before the first progesterone shot.

[jes77]

Dear Ghost,

Many thanks !

Just one clarification:

Is it not required to check LH Surge in my case? Since they haven't seen the corpus luteum, how do they know if I have ovulated or not? Is E2 alone is sufficient to predict ovulation?

also you've mentioned that the progrestrone shots have to be started before ovulation? This also I m not sure !

Thanks again,
Jes.

PS: I have sent my case history as a private message.

[Ghost]

Dear Ghost,

Many thanks !

Just one clarification:

Is it not required to check LH Surge in my case? Since they haven't seen the corpus luteum, how do they know if I have ovulated or not? Is E2 alone is sufficient to predict ovulation?

also you've mentioned that the progrestrone shots have to be started before ovulation? This also I m not sure !

Thanks again,
Jes.

PS: I have sent my case history as a private message.

The only potential need for ovulation is for progesterone from the corpus luteum. You clarified that they gave you progesterone on day 16, the same day your ultrasound verified you had not yet ovulated. Your transfer was day 17 (morulae). I must admit the embryos were a little early in the uterus for their stage of development (morula would not normally arrive in the uterus until about 5 days after first progesterone exposure). Some think embryos can be a little ahead of the endometrium and they will wait the extra few days for receptivity to occur. Others suspect they can't do that. You might consider transferring embryos a little more synchronously with the endometrium. In other words, it would have been more optimal to transfer morulae about 5 days after progesterone (whether by ovulation or supplements). That would mimic the natural cycle, and there's a reason the natural cycle is the way it is.