IVF Update: What I Did Differently This Time

Starting a new FET cycle is challenging.

Starting a new FET cycle after a FET failure adds a whole new level of complicated.

As a quick reminder, this the fall after preparing for nearly a year, my husband and I went through IVF again to have a second child. This was my first cycle in this second round, and my third cycle/transfer total. When it failed and I lost our baby boy, I was thick in the devastation, confusion and discouragement that many of you know all too well.

During our WTF appointment, I worked hard to identify what could’ve gone wrong - there’s always a variety of potential answers but it’s usually impossible to identify what, if anything, ultimately caused the failure, and discussing my options on when and how to move forward. I share more about that appointment here.

I chose to immediately launch into a new transfer cycle prep that included one additional test - an endometrial biopsy. We didn’t honestly expect for it to give us much, if any new information, but it was worth a try. Well, that biopsy diagnosed Chronic Endometritis, and cancelled my transfer cycle.

Treating Chronic Endometritis (Uterine Inflammation)

I traded in my twice daily Estradiol pills for twice daily Antibiotics, and hoped that a repeat biopsy would announce my uterus cleared of inflammation & ready for a new embaby.

Spoiler - it did not.

So, I moved forward with a hysteroscopy under anesthesia to scrape out the inflamed tissue, and finally an additional outpatient biopsy gave us the thumbs up.

With cautious hope, my doctor agreed that the Chronic Endometritis was the most likely culprit for my fall transfer fail, and that with the uterine inflammation in the rearview mirror, we should be in good shape for a new transfer.

Autoimmune Protocol

Also referred to as the “antihistamine protocol,” my clinic uses a combination of Prednisone, Claritin and Pepcid for individuals who perhaps have too active an autoimmune response which may prevent embryo implantation. This is sometimes recommended to individuals after repeated losses or failed IVF cycles. Anti-inflammatory and/or anti-histamine medication can be used to suppress the immune system, preventing it from potentially “attacking” the embryo .

As someone who lives with Crohn’s disease and Rheumatoid Arthritis, we already know that my immune system likes to live in overdrive. While I did not use this protocol for my successful 2018 transfer, I decided it was worth trying this time around.

Anti-Anxiety Medication (Valium)

I shared this on Instagram last week, but I think it’s worth repeating here. One thing I specifically asked my doctor about when developing my protocol for this FET was about was medication to help me relax going into the transfer. I know several clinics prescribe something routinely to help with that anxiety, but I haven’t asked about the option for any of my previous cycles.

On the day of my last transfer, my full bladder was so uncomfortable that waiting for the doctor to come in the room and then for the lab tech to bring in my embryo was really painful. I actually had to leave to pee a little, and return for the transfer. Do you know how HARD this is??

My doctor prescribed low dose Valium (5mg), to be taken the night before transfer, the morning of transfer, and then a few hours after transfer.

The thought is that valium helps make a full bladder more comfortable, and theoretically relaxes the uterus, but the addition of this medication has not been shown to increase transfer success rates.

I’m grateful that I opened the conversation with my doctor, and that she was more than willing to offer something to help. Hey - anything to try to make this process more tolerable, right?

Less of a Full Bladder for Transfer

For anyone who has experienced an embryo transfer before - the actual transfer is pretty unremarkable. Stirrups, speculum, catheter, ultrasound machine. Nothing big. Except, the instructions every clinic gives every patient is to arrive with an UNCOMFORTABLY FULL bladder.

I get it. A full bladder helps the doctor guide in the catheter and ensure the embryo is released in exactly the right space.

But, it also causes a huge amount of discomfort and anxiety for the patient.

At my clinic, I’m asked to arrive 30 minutes PRIOR to my scheduled procedure. Then, once I’m finally called back, I have to undress from the waist down, and wait for the doctor to come in. Sometimes this is a reasonable amount of time. Other times it can be close to 10-15 minutes. The doctor has to go over some things, then they call for the embryologist, who you have to wait on as well. By the time your embryo is in the room and ready to be inserted into your uterus, you’ve been pants-less for at least 20-30 minutes. So, if you were desperate to pee arriving at the clinic, you’re then supposed to clench for dear life for an entire hour? UGH. As mentioned above, I really struggled with this last time. I was basically crying because I had to pee so bad that everything hurt and I could hardly move. Not ideal. Not great for staying calm, either.

This time around, I used logic + my own rules. I knew that my bladder needed to be full by the time the catheter was inserted, but it did not by any means have to be unbearable upon clinic arrival. So, I paced my drinking, doing most of it in the clinic waiting room. I had to pee by the time I took off my clothes, but it wasn’t a 10 bell alarm. This, friends, was SIGNIFICANTLY better for my anxiety.

Honestly, if you’re not sure what your bladder thresholds are, think about doing a trial run at home. Notice how much you’re drinking and how long until you have to pee, and how much longer until it’s uncomfortable or unbearable. This will help you to not get to utter painstaking desperation while you’re waiting for your embryo to be dropped off in its new home.

Testing at Home

Prior to my transfer, I decided what my plan would be for testing at home during the TWW. In the past, I’ve done it a few different ways - testing at home the morning of my beta, testing at home the day before my beta, not testing at home. Based on how much I struggled with anxiety surrounding testing (and the results of our transfer), this time I decided to take a different approach. I’ll share more about this once we know our FET results and I can decide if my current method is or is not something I’d recommend.

—

So, there you have it friends. This is a comprehensive list of what I did differently after my fall failed transfer in hopes that this transfer will be a success.

If you’ve altered your plan, prep or protocol between a failed and a successful transfer, I’d love to hear what you did differently below!

Thinking of you all,

Amanda