Trying to decide between a natural cycle or a synthetic cycle for implantation. As I understand it the major difference is doing either vaginal progesterone suppositories for one or progesterone injections. How bad are the injections? Thoughts on either cycle would be appreciated.

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If you ovulate on your own every cycle then natural cycle is advised. Having a corpus luteum reduces the risk of preeclampsia.
Signed, someone who delivered twins at 37.5 weeks without any health problems after a modified natural cycle.

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That’s awesome congratulations!

I did a medicated cycle for my transfer and started with estrogen patches, the progesterone shot every other day, and the vaginal suppositories 3x/day, every day. After a few days my doctor switched me to the progesterone shot every day and took me off the vaginal suppositories bc they were heavily irritating my cervix and caused a lot of bleeding. I actually like having the shot every day more - it’s simpler and the bleeding stopped. The shots aren’t bad at all but make sure you massage that area (I use a foam roller and Theragun sometimes) to make sure the progesterone is spreading.

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Fertility nurse here....I don't know if you're doing 1 mL or 2 mL on your PIO shot, but you can try a quarter turn trick.
Insert needle bevel up (facing toward the sky), - think of this as 12 on a clock. Pay attention to your finger holds on the syringe - this will guide you through the turns.
Then inject quarter or half mL (depending on your dose), rotate the syringe w/ needle still in skin to the 3 o'clock position.
Do same (inject quarter or half), then rotate to 6 o'clock.
Do same, then rotate to 9'oclock and inject the last little bit.
*Once needle is in, you'll use your finger holds to tell how you turn it... If you insert and they're facing vertical, do a quarter turn to the right until vertical - this takes you to the 3 position on a clock.
And then so on...

This may not make sense from my words, but I can review if you want. :)

I get a lot of patients who say they have scars in their butt from the shots YEARS later - they call it lumpy butt.

This puts the medication in 4 spots in smaller amounts to help it absorb easier and faster, and most importantly it's significantly less painful for you. :)

I’m in the same situation and time frame as you - trying to decide which route to take as we only have 1 embryo. I’ll be sending positive vibes your way✨

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Fertility nurse here......I would say if you have only 1 embryo, do NOT do the natural cycle... Signed a Fertility Nurse who has not seen good results with natural cycle transfers. :(

The best way to put it: You relied on science to get you to where you are, I would continue to rely on the science to get you to the next step.

If you've only got 1 embryo and have had previous transfers, did they talk about doing an ERA or EndomeTrio or anything?

What does your doctor recommend? The injections aren't fun, but manageable so I wouldn't base my decision on that if you're concerned about them.

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This happened to us as well. “You could do either / same results either way” - my wife always prefers natural stuff (even goes so far as homeopathy), so we did the natural cycle for implant 1. Didn’t take. Based on that, doctor suggested medicated for implant 2. We did. Didn’t take.

Bottom line - I would press them more on the differences, on the circumstances unique to you, and possible scenarios ie if it fails, what’s next, why. That way, you can make an informed decision

You should also ask your doctor what impact the type of cycle has on your pregnancy. I think natural cycle has a reduced risk of preeclampsia.

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This is really great to know thank you!

I had to do both I didn't know one could do either or. In that case I would rather the vaginal tablets than the injections.

It just depends on whether you ovulate and they’re going by the date you ovulate or whether they are giving you medications to time your cycle.

Also probably varies by clinic.

I thought a natural cycle was completely natural - no meds? I did a medicated cycle and had to do PIO injections every three days and inserts 3x a day! Those inserts are the WORST! I didn’t have any issue with the PIO and would have gladly taken that over the inserts any day.

I did a natural transfer with a frozen embryo. My initial plan was fresh transfer on day 5, in which I would then have progesterone injections every day for three months post transfer (if viable pregnancy). However, I developed OHSS and had to freeze my embryo for two months while I healed. Due to this, I decided to do a natural transfer with less meds. The natural cycle, I only had to take one ovidrel shot. The tricky part -- you need to be flexible with your time. I had four appointments over a week in which every time I thought it would be the day to trigger, but my follicles just weren't large enough yet. I've been happy with the natural transfer and if your MD gave you the option, I would highly suggest it.

I’ve heard of a lot of people having better success with natural than medicated cycles, for FET

Two failed medicated cycles then success with a natural cycle. For us that meant Femara and Ovidrel, no progesterone or estrogen supplementation. I'd base it on your diagnosis. If you ovulate normally and have normal hormonal cycles (i.e., progesterone rises sufficiently after you ovulate), natural may be a better choice. Conversely, if you're having miscarriages due to low progesterone, natural might be a terrible choice.

I had success with a modified natural (basically the same as natural except with the boost of letrozole pills cycle days 3-7). It made two particular follicles juicier and gave the doctor solid guidance on where to place the embryo.

Fertility nurse here: We've had some patients attempt a natural cycle for FET (frozen embryo transfer). We've only seen 1 pregnancy result.

Personally I would do the injections. I can tell you a few tricks for the shots! Most of my patients are fine with them honestly (and I'm a giant baby who thinks I couldn't do them - EVEN AS A NURSE).

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