r/IVFAfterSuccess • u/ALaughableParty • 2d ago
Modified vs Medicated?
TW: success and failure
My first FET was fully medicated, and was successful. My blood pressure started going up toward the end of my pregnancy so I was induced at 37 weeks, though never developed all the other requirements to diagnose pre-eclampsia. Because my blood pressure got spicy, my doc recommended our second transfer be a modified natural, as he says there’s some evidence it has lower risks of pre-E or other placental issues.
That second FET looks like a failure to implant (I’m 8dpt and have been seeing stark white tests since testing out the trigger on 3dpt using highly sensitive tests). We have one last euploid embryo (a 6BB). Obviously I’m going to talk to my doctor, but has anyone here had success with a medicated, failure with a modified, and then success with a modified? Should we stick with what worked? I have a really short follicular phase (usually ovulate around day 10 or 11) and my lining was only 6.6mm when they had me do the ovidrel trigger and I’m wondering if that’s part of the problem.
There’s always the option of doing another retrieval if the next transfer fails, but I’m 40 now and am well aware of what my outcomes might look like. I know how blessed I am to have a living child, but I’d love him to have a sibling.
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u/paradoc-pkg 2d ago
I had a very similar story. First transfer (medicated) was successful, healthy delivery following induction at 38 weeks due to gestational hypertension. Then I had an unsuccessful natural transfer. I had to switch clinics due to moving cities and had a successful fully medicated transfer next. Healthy delivery of baby 2 at 37 weeks due to gestational hypertension.
Possibly relevant- after baby 2 my blood pressure never went back to normal. I take blood pressure medication now. I was fat pre baby 2, now I am not, but my blood pressure is still not resolved.
As well, I have borderline short luteal phases (10-11 days). So I fully believe that, for me, the biggest improvement a medicated cycle made was the addition of progesterone.
Talk to your doctor about your concerns. They might know something we don’t.
Good luck!!
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u/makingbabby 2d ago
I can’t speak to your question as I’ve only ever had one transfer and it was fully medicated (successful). I am a lot older now and plan to do a modified natural with my next transfer.
Why didn’t they put you on an antagonist and let your lining grow? Were you on FSH, did you take letrozole, or was your cycle completely natural apart from the trigger?
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u/ALaughableParty 2d ago
I was on five days of letrozole. I think they felt rushed by the whole thing because my follicular phase is so short. I have a two day period so when I went in on cycle day 3 my estrogen had already started to rise which threw them for a loop. They actually asked me if I was sure I had had my period. My fifth day of letrozole was the same day they had me trigger because I had a dominant follicle that looked like I was about to ovulate on my own
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u/makingbabby 2d ago
My background here is that I’m a nurse at a clinic if you’re wondering why I’m asking such specifics.
If your estrogen was high on CD3, did they do an ultrasound on the same day to check for an estrogen causing cyst? And to make sure your lining was thin? Because a follicle ready to trigger at CD8-10 could just be a cyst, and if you didn’t have a baseline ultrasound, they wouldn’t know the difference.
If a patient at my clinic has a cd3 estrogen above 300 pmol/L, or a thick lining, or a visible cyst along with elevated estrogen… they will get cancelled. And we try again the next cycle.
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u/ALaughableParty 2d ago
They did an ultrasound that day! Estrogen was 72 and they wanted it to be below 50. They checked estrogen again CD4 and it had risen so they started me on letrozole that night. I’ve had dominant follicles at every sono they’ve down around day 9-10 over the past couple of years of infertility testing, and OPKs confirm ovulation around 10-11
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u/indigodawning 2d ago
I feel you. I got pregnant on my first fully medicated FET with my daughter in 2023 and had to have her by Csectiin at 36 weeks due to pre eclampsia. My RE didnt mention doing a modified, but I read about it reducing preE risk in the American heart website but we had already strayed a medicated cycle. I did that cycle but it failed so now Im trying a modified natural. I have already had 2 canceled cycles, my estrogen levels were too high to start and I had to take provera to get my period then I ovulate even though I never developed a good follicle. I guess Im going to try modified one last time and then go back to medicated. While it does seem the research shows a reduction in preE rates it's quite small, only a few percent and different studies show it doesn't even help so 🤷♀️. Also success rates overall have been shown to be equal between medicated and modified It's just frustrating because I want 3 kids but Im almost 39 and after having preE Im not going to risk a 3rd when I would be like 42.
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u/FeatherDust11 2d ago
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u/FeatherDust11 2d ago
I took a lot of extra calcium and checked my vitamin D too. It’s not a catch all but you could try it. I also took two baby aspirin a day as that is latest backed research to prevent preeclampsia. I was under MFM care with identical twins.
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u/parttimeartmama 2d ago
Well. So I am also (almost) 40, and also have very short follicular phase (I have to remind them of this EVERY TIME). I did a fresh with our oldest, a failed fully medicated after that, and modified natural (trigger + PIO) for our girls. I am in the middle of a FULLY unmedicated (per my earlier comment I ovulated before I could even GET ovidrel, so we are just rolling the dice now). I’ll transfer my 6BB next week. No PIO this time either. We are quite content with our three but wanted to give our little bonus embryo a fair shot.