F.E.T. # 4

The time has finally come... Our 4th FET cycle. We are doing a medicated FET cycle, meaning that we are using hormones to prepare the uterus. The first step is to suppress ovulation. At least 2 weeks of daily Lupron injections is used to suppress the pituitary gland, which in turn reduces the chances of ovulation occurring unexpectedly. The next step is to use hormones to duplicate the changes that normally occur in the uterus during a regular menstrual cycle. This requires the use of two hormone medications: estrogen and progesterone. During a normal menstrual cycle, estrogen is produced by the developing follicle. This estrogen acts on the uterus to thicken and mature the uterine lining. Estrogen is given in a FET cycle for the same reason. Once the uterine lining has been thickened sufficiently, progesterone is added and the Lupron injections are stopped. Progesterone matures the uterine lining and makes it receptive to an embryo to implant. Once the progesterone has begun, there is a certain “window of implantation” during which the embryo must be transferred. The stage of the embryo must match the stage of development of the uterus. Therefore, the only factor that locks the date of the embryo transfer is starting the progesterone. Once the progesterone has begun, if the embryo transfer is not performed on a certain day, the cycle must be cancelled and a new preparation with hormones must be begun after allowing a period to occur.

Now that I've explained about the general FET process, let's get a little more specific about my FET. My December period arrived on the exact date as predicted. Yay me! My nurse was even surprised when I called her that day. So she emailed me a tentative FET calendar; I will get an updated calendar when I get my next AF. In it showed the exact date I would need to have my P4 level checked. The P4 level needed to be greater than 5, indicative that ovulation had occurred. If it's one thing I can do, I can certainly ovulate. My P4 level was 7.7, so my nurse gave me the go-ahead to start the Lupron injections. Jerry has been giving me the shots in my lower abdomen for almost a week now.

Originally, I was supposed to be on 10 units of Lupron. But I was concerned that 10 units would not be enough to suppress my ovaries. I explained to my nurse that for my 1st FET here in Pensacola, I was on 10 units plus BCP and that didn't suppress me. So my 2nd and 3rd FET, my Pensacola RE put me on 20 units of Lupron plus BCP, and that seemed to do the trick. She brought my concerns to Dr. Schoolcraft, and he said that it was ok for me be on 20 units all the way. Because I'm taking 20 units, I will need to buy another Lupron kit. I guess I'd rather spend an extra $600 (remember, we're all out-of-pocket) than for this cycle to be canceled due to nonsupression. (Dr. Schoolcraft also said that if this was a fresh IVF cycle, he wouldn't put me on 20 units, as that much Lupron would oversuppress me. However, when I went through my 1st IVF cycle here in Pensacola, I was on 20 units and I still ended up with OHSS, even though I was on only 75 units Follistim and 75 units of Repronex. I shouldn't have developed OHSS but that's another story...)

I get another calendar once AF arrives. Estrogen replacement therapy will usually start on the 3rd day of the cycle. I am using the Vivelle patches for estrogen. Instead of reducing the Lupron injections by half, I will continue on the 20 units. I will replace the Vivelle patch(es), every other day. Before increasing the number of patches, I will have a blood test to check my E2 level. A doppler ultrasound and another E2 level check will be done before adding the progesterone (Prometrium vaginal suppositories) in addition to the Vivelle patches. Once progesterone is started, Lupron is stopped. As our embryos are frozen at the blast stage, the embryo transfer will take place on the 6th day of progesterone.

So the next step is to wait for AF to arrive. Let's just hope the hag shows on time so we can get this show on the road!