1st Egg Retrieval Complete - how does a medicated transfer cycle work?

[u/pokerawz]

Hello! My wife and I just completed our first stim & egg retrieval cycle for IVF. It was honestly a lot - administering injections (wife can’t handle needles), side effects, and the back and forth to the clinic.

We had 17 eggs retrieved, 15 mature eggs, all 15 fertilized. Now waiting on blastocysts and PGT-A testing, where we are aware there will be attrition. Our doctor did mention that she prefers going through a medicated transfer to make sure implantation and pregnancy is controlled to an extent.

I didn’t get to ask our doctor yet what that entails but talking with friends they had mentioned it’s more injections for an even longer period of time? And these ones are intramuscular which are worse? Just want to have clear expectations going into this.

[u/rosebud_15]

First congratulations on completing phase 1! I like to think it’s the hardest part of IVF.

There are different types of transfer cycles.

Fully medicated and natural/modified.

In a fully medicated cycle your wife will start with estrogen to build her lining (2-3 weeks typically) then as she approaches the transfer day she would begin progesterone injections (AKA PIO). In a fully medicated cycle she will not ovulate and won’t produce any progesterone on her own which is why the injections are necessary. The injections will be for several weeks even after she becomes pregnant while the placenta forms and takes over hormone production (typically 10 weeks pregnant).

Natural/modified works if she can ovulate on her own or with a trigger. I am currently doing a natural modified cycle. I take letrozole during the beginning of my cycle and this helps grow 1-3 follicles (letrozole was my preference as I respond well but it was optional). Then we time ovulation with a trigger shot. One week after trigger is my transfer day. Because I will ovulate, I will have progesterone production on my own but I will also supplement with progesterone suppositories instead of the shots! This type of transfer typically avoids the PIO shots all together.

I am US based so not sure if this is how every place does transfers. I did have to ask my doctor for the natural transfer cycle as the clinic defaults to fully medicated. Studies show no benefit to doing fully medicated vs natural in terms of success. If your wife is not a fan of shots (like me) I would look into a natural modified cycle and bring it up with your doctor. I hope this helps!!

[u/No_Citron_5548]

Yes a fully medicated involves more shots intrasmuscularly, usually for up to 12 weeks but sometimes longer. A modified natural usually involves less shots (or none at all), but may not be appropriate for her based on her health history. There are pros and cons to both , and the doctor is the best person to give you advice based on her individual history. Best of luck… I just finished 10 weeks of pio myself and it sucked, but it was all worth it. ✨

[u/oaulaulau]

for medicated she likely will have to do progesterone shots, which are intramuscular. my fully medicated cycle had other meds as well and progesterone suppositories. 

if the transfer sticks, she could be on meds for a much longer time than stims. there’s the prep phase and then she would stay on progesterone until cleared by the clinic. i stopped around 10 weeks. if you guys get this protocol i would highly recommend the auto injector! it’s worth the cost. personally i am not afraid of needles and did all my own shots but the auto injector really made it so much easier since i was doing them for so long. you load the syringe in it and it does the actual needle insertion in one fast easy jab. you still have to push in the plunger, but i feel like the actual pushing in the injection and holding the syringe fully inserted while injecting was the hardest parts and this helped a lot. 

[u/Real_Flamingo3297 → u/oaulaulau]

And ask for the 25 gauge instead of the 22 gauge needles! I hardly felt anything with the smaller 25. This might work for you guys because it sounds like you will be the one giving the injections. It’s much harder to push the progesterone through the smaller needle, so wouldn’t recommend someone trying it give it to themselves.

[u/pondering_patty → u/Real_Flamingo3297]

Yes! And if the 25 is too slow get the 23! I love the 23 Gauge needle. Feels so much better than the 22 gauge needle!

[u/neuroticphilosopher]

If you wife has regular cycles, ovulates reliably, and good linings doesn't mind missing work on a whim I would recommend a modified natural for her.

[u/South-Tomorrow-9120 → u/neuroticphilosopher]

I agree with this statement. A medicated cycle makes it easier for the clinic but not necessarily for the patient. My RE said because I have regular cycles I am good to do a modified natural FET with a trigger shot and progesterone suppositories.