QuestionHi
My husband and I have been TTC for 6 years and are on our last to frozen embryo's. BUT they cannot get my lining thick enough to do a transfer. I am taking 4mg of Progynova orally every 8 hours and using a Estrogen Patch which is changed every 4 days. My lining is only getting to 5.9mm and does not increase at all, my natural lining actually got me to 6.5mm, so as you can imagine I am really upset and confused.
I have moderate Endometriosis which was last removed by a lap in March this year, other than that I have a perfect 28 day cycle and my ovulation each month is exceptional.
Please can you make any comment.
Kind regards
Answer
Dr. Ramirez
Hello,
It is unusual that with so much estrogen on board that you cannot get an adequate lining (9mms). You don't mention how much estrogen you are taking, but I would recommend 0.2-0.4 mg estrogen patch every four days, and change the estradiol tablets to use vaginally instead of orally. Vaginally, it is more effective to get to the uterine lining that orally because the liver will disable most of the estrogen through what is known as the "first pass effect."
You could also consider using low dose aspirin 81 mg tablets orally each day and heparin 2000 U injections twice per day, which will increase the blood flow and hopefully help the estrogen to get to the uterine lining.
Finally, you might want to consider doing the frozen embryo transfer on a "natural" cycle without the estrogen supplementation if you make an adequate lining during natural cycles.
I hope this helps,
Sincerely,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
