GHOST - FET vs Fresh

[kez01]

Hi Ghost,

I have asked you lots of questions recently regarding the receptivity of the endometrium. Now reading this post, could you tell me what protocol your clinic uses.

I have had 1 FET and I was downregulated and then on oestrodial valerate tablets to prepare my endometrium, then the progesterone post transfer. Each time I have had IVF my endometrium had always thickened up nicely, sometimes too quick I think.

IVF 1 ; 7 days before ET my lining was already 11mm and I asked them wont the lining be old and they laughed at me.

The same with the FET. Then with this last cycle, I finished my withdrawal bleed on a SUNDAY having started stimms the previous THURSDAY. When I went for an ultrasound on the TUESDAY my lining was already 9mm. then I had ET on the SATURDAY.

Sorry if its confusing. Do you think my lining is past it receptive phase by the time they transfer.

I was down regulated as my cycle is irregular and i dont always ovulate. I am hoping not to be down regulated this time, as I dont want to artificially thicken my endometrium.

What do you think

thanks Kerry x

[Ghost]

hi there.. I've been reading this entire post and i really find it so interesting. I am scheduled for a FET next week sometime... and i'm so excited. Ghost I looked at the link you gave (see below )
Thawed Embryos From Non-Donor Oocytes <35 35-37 38-40 41-42
Number of transfers 26 7 7 2
Percentage of transfers resulting in live births 80.8 4 / 7 2 / 7 1 / 2
Average number of embryos transferred 2.1 2.9 2.9 3.5

my question is under the age group of 35-37 it only gives a 4/7 -- it doesnt give a percentage like the first age group does..what does that mean?
thank you so much for responding.

If the number of embryo transfers is 20 or more, SART will show the rate as a percentage (such as the 80.8% figure for thawed embryos in patients under 35). If it's less than 20, they just show the fraction (numerator is live births, denominator is number of transfers), but they don't do the division to show the percentage.

4/7 is, of course, 57%.

[bey1214]

ohhhhhhhhhhhhh
thank you so much for clearing that up !!!

[kerpupples]

Ghost do all the clinics with this type of success rate use vitrification to freeze their embryos?

[Ghost]

Ghost do all the clinics with this type of success rate use vitrification to freeze their embryos?

No. We've never used it. But we plan to try it out and see if the claims hold water. We have some reluctance because, while many report their programs improved after the switch, I don't know any using vitrification that are doing any better than we are.

One objection is that vitrification takes more time. Yes, they say it takes less time, but that's if you are freezing one or two embryos. We freeze entire cohorts from many of our patients, so we suspect vitrification may be difficult logistically.

Interestingly, all frozen embryos are vitrified, whether by slow or rapid freezing. Cryoprotectants are used to prevent ice crystal formation, with a resulting "glass like state" within the embryo. That defines vitrification. However, nobody calls slow freezing by the name "vitrification".

[Ghost]

Hi Ghost,

I have asked you lots of questions recently regarding the receptivity of the endometrium. Now reading this post, could you tell me what protocol your clinic uses.

I have had 1 FET and I was downregulated and then on oestrodial valerate tablets to prepare my endometrium, then the progesterone post transfer. Each time I have had IVF my endometrium had always thickened up nicely, sometimes too quick I think.

IVF 1 ; 7 days before ET my lining was already 11mm and I asked them wont the lining be old and they laughed at me.

The same with the FET. Then with this last cycle, I finished my withdrawal bleed on a SUNDAY having started stimms the previous THURSDAY. When I went for an ultrasound on the TUESDAY my lining was already 9mm. then I had ET on the SATURDAY.

Sorry if its confusing. Do you think my lining is past it receptive phase by the time they transfer.

I was down regulated as my cycle is irregular and i dont always ovulate. I am hoping not to be down regulated this time, as I dont want to artificially thicken my endometrium.

What do you think

thanks Kerry x

Progesterone started post-transfer in a down regulated FET cycle??? I would be surprised if implantation occurred. Progesterone timing in FET should match the natural cycle. That is, progesterone exposure should be about equal to the number of days of embryo development.

Your lining thickness (9mm, 11mm, 13mm) all sound fine. Of course, there's the pattern. None of these tell you if it will be receptive at the proper time.

I don't know about the lining being too old, but it can get to be too advanced. Not a rare phenomenon, actually.

[kollegeqtee]

That is interesting. My RE with the clinic I work with out of Cinicinnati had the oppertunity to learn from the doctors who worked on the first IVF baby. ANYWAYS, his clinic only produces a 60% of a positive pregnancy test with a FET. As far as LIVE BIRTH rates on the FET, I am sure its lower....

[Ghost]

That is interesting. My RE with the clinic I work with out of Cinicinnati had the oppertunity to learn from the doctors who worked on the first IVF baby. ANYWAYS, his clinic only produces a 60% of a positive pregnancy test with a FET. As far as LIVE BIRTH rates on the FET, I am sure its lower....

Most clinics are lower with FET than with fresh.

Most clinics use the best embryos in the fresh cycle. The FET gets the 2nd best embryos.

[Mellie_1233]

(baby mentioned)

Ghost, I am hoping for a bit of strategy help here...........

I am the originator of this thread. I am now getting ready to try for baby#2 and I just re-read what you said. It's time to make some decisions so I'm hoping to borrow your brain once again

I had my sweetie-pie in October. In Dec I set up a consultation w/Dr. Schoolcraft for baby #2 (he was my dr for sweetie-pie). I have DOR and am turning 38 in May so I am eager to get going. I mentioned to him that I had heard about a strategy of freezing everything and transfering later to improve implantation rates. Specifically, since insurance will pay (partly) for 2 more IVFs (I live in IL thank goodness!) I could do two fresh retrievals, freeze everything, then transfer later. He said that it could be a good strategy for me and that he was currently running a study on this subject.

I had my 1-day workup in March. Of course, I asked my odds of success. I was shocked when he said 50-60% live birth per cycle. It seems that despite my lousy response to the drugs and my AMH of 0.69 we had rockstar embryos. (OK, maybe not THAT great, but very good).

So, here's the dilemma: Do we freeze two cycles, "hoarding" our embryos for a FET later? Or, do we do it the old-fashioned way?

What would you do?

Here's a bit of detail on my last cycle in case that's helpful:

---Last check before stims showed two follies >30mm, two follies around 22mm, and three follies 12mm and smaller
---Retrieved 6 mature eggs, 5 fertilized
---On day 3 had 5 embryos
---On day 5 had 4 embryos (not quite blasts) (3 were graded "1" and 1 was a "2-3"; they tell us the "2-3" is probably the one that worked)
---3 day 5 embryos transferred resulted in one sweetie-pie
---Remaining frozen embryo made it to day 6 and was frozen. Dr. S. gives it a 25% chance.

I am hesitant to do anything different like a FET when it worked so well last time but I want to maximize my chances.

Thanks!

[Ghost]

(baby mentioned)

Ghost, I am hoping for a bit of strategy help here...........

I am the originator of this thread. I am now getting ready to try for baby#2 and I just re-read what you said. It's time to make some decisions so I'm hoping to borrow your brain once again

I had my sweetie-pie in October. In Dec I set up a consultation w/Dr. Schoolcraft for baby #2 (he was my dr for sweetie-pie). I have DOR and am turning 38 in May so I am eager to get going. I mentioned to him that I had heard about a strategy of freezing everything and transfering later to improve implantation rates. Specifically, since insurance will pay (partly) for 2 more IVFs (I live in IL thank goodness!) I could do two fresh retrievals, freeze everything, then transfer later. He said that it could be a good strategy for me and that he was currently running a study on this subject.

I had my 1-day workup in March. Of course, I asked my odds of success. I was shocked when he said 50-60% live birth per cycle. It seems that despite my lousy response to the drugs and my AMH of 0.69 we had rockstar embryos. (OK, maybe not THAT great, but very good).

So, here's the dilemma: Do we freeze two cycles, "hoarding" our embryos for a FET later? Or, do we do it the old-fashioned way?

What would you do?

Here's a bit of detail on my last cycle in case that's helpful:

---Last check before stims showed two follies >30mm, two follies around 22mm, and three follies 12mm and smaller
---Retrieved 6 mature eggs, 5 fertilized
---On day 3 had 5 embryos
---On day 5 had 4 embryos (not quite blasts) (3 were graded "1" and 1 was a "2-3"; they tell us the "2-3" is probably the one that worked)
---3 day 5 embryos transferred resulted in one sweetie-pie
---Remaining frozen embryo made it to day 6 and was frozen. Dr. S. gives it a 25% chance.

I am hesitant to do anything different like a FET when it worked so well last time but I want to maximize my chances.

Thanks!

Very well-written post!

First off, if you have a frozen already, why not use it? You then have a 25% chance (Schoolcraft's estimate) of avoiding the cost and risks (and injections!) of another round of stimulation.

If it fails, then try a plan B.

Yes, the more embryos you build up the better the chance of success.

Since you obviously had no problem with receptivity last time, perhaps you are not as affected as some others? People vary in many aspects, and this may be one of them. So maybe you are correct in wanting to stay with what worked before. Makes sense to me.

Interesting they grow the follicles out to 30mm. There was a publication 5 years ago that found such extended growth is bad for endometrial receptivity, but heck, you seem to be immune!

Another thought - If they have a study going, perhaps you could enroll? Studies often save big $$$. Of course, you have insurance, so this may not be a big factor.

Just some ideas rolling around up here. I hope they help.

[Mellie_1233]

Thanks Ghost! Wise advice, as always. Now, I have to take what you've said and mull it over...obsess about it....think some more....

Thanks so much! It really helps to get your input.

[nicaliw]

hi, I don't have anything of great value to add to your discussion, just wanted to stop by and wish Mellie good luck with your upcoming adventures. I also have a little one resulting from a FET by Dr Schoolcraft just a couple of months younger than yours. I'm not as brave as you, don't think I'll be going through all that again. I don't enjoy being pregnant one bit and have 2 kids of my own and 4 step kids...phew! Hats off to you, though, I hope you have another one on board real soon !!!

[Pier2043]

Mellie/Ghost- I am new to this forum but the thread you started is very relevant to me right now. Can I ask some advice?

Our first IVF was successful and resulted in our DD. We had one Blast frozen on Day 6 and it was rated 1AB (1AA being the best). I was lucky enough to have insurance coverage but in Oct. 2008 my company was going through lay-offs and I was worried about my job. I quickly did another fresh round of IVF to Freeze-all for a future date. Figuring FET would be cheaper than fresh if we had to pay out of pocket. We now have 9 additional embryos frozen at 2PN.

Now I am approaching a July FET and am wondering do I thaw out the 1 Blast first and use it, or grow out the 9 and choose the best out of the bunch? We are going with eSet because we do not want multiples. I was originally pregnant with twins on the first IVF and lost one at 12 weeks. My gut says my body can't handle multiples so I don't want to increase the odds.

It looks like from what I read on this thread that there is a lot of success with Freeze all cycles and then letting them grow out and putting back the best.

Ideally we would like to have two more children (1 at a time), and I would LOVE to never had to do another stim cycle. I am turning 37 in June. The other option would be to do another fresh and hope for more embryos to freeze. FSH is 6.2 and good Day 3 antracle count, small fibroids that become problematic during pregnancy. Mostly male factor issues at this point.



Lorey

[Ghost]

Now I am approaching a July FET and am wondering do I thaw out the 1 Blast first and use it, or grow out the 9 and choose the best out of the bunch?

You might try the blast first (probably cheapest approach), but you could also try the 2pns as you described (odds are, the quickest route to a pregnancy).

We are going with eSet because we do not want multiples.

If you use those 2pn's, then eSET may be a great choice. The implantation rate is reported to be very high, and that's what we are seeing too.

If you don't mind me asking, which clinic are you seeing?

[Pier2043]

Ghost:

Greenhouse at Shady Grove. Meeting with him next week to discuss the plan. Right now insurance is covering everything. I was thinking use the blast first but after reading this thread I was thinking maybe thawing the 2PN's were the way to go. My big concern/question with that route is the ability to re-freeze anything that is left over since we are doing eSET. Not sure if Shady Grove does that.

Thanks for the Input!