A Poll – Estrogen Protocol or OC/Lupron FET?

I have a dilemma.  I need to decide sometime in the next week whether to use a fully-medication, suppression-based FET protocol that relies upon oral contraceptives (OC) and Lupron to suppress ovulation and precisely time the date of transfer or to skip the OC and Lupron and go with an estrogen protocol in which ovulation may have to be monitored if it is not suppressed by the estrogen treatment.

There are pros and cons to each and I am having trouble weighing out which is better for me as my past experience was with a natural FET protocol in which the only medications I took were Ovidrel to ensure precise timing of ovulation and accurate pinpointing of transfer day as a result and micronized progesterone for luteal phase support. Both of the medicated protocols I’ve outlined below include progesterone support in the luteal phase and for 5 days before transfer.

Maybe you lovely folks can help me decide?  I’ve included a poll at the end of this post, after the descriptions of each protocol and their respective pros and cons from my perspective.  If you have personal experience with either or both, I would be especially keen to hear from you, including whether your FET was successful.  Even if you have no experience but thoughts on what might be best given what I’ve described below, I would be very grateful to hear from you, too.

Thank you!

OC/Lupron Protocol

On this protocol I would start oral contraceptives or OC on the third day of my next cycle (which will likely be around the end of next week).  I would take OC for two weeks and it would be overlapped with Lupron and followed by estrogen priming, an end to Lupron and start of progesterone supplementation (while estrogen would also be continued).  Immune meds would begin around the same time as estrogen priming. I do not yet know how many days of estrogen priming Dr. Braverman suggests generally.

Pros

The OC/Lupron protocol has the added convenience of reducing the number of monitoring appointments and in my case would allow me to book flights without risk of expensive changes as well as allowing me to book a very limited amount of time away from work, at least in principle.  If all goes as planned, I would only need to travel to New York the day before transfer and stay there for about 2-3 days (depending on return flights, time of transfer and if I wanted to wait until the day after to return home).

It would allow me to miss the minimum amount of time from work, assuming all goes according to plan.

I would know our date of transfer well in advance, assuming all goes according to plan.

I start the immune meds after two weeks on OC.

There is some evidence to suggest Lupron helps with implantation.

Slightly lower travel costs.

Cons

If I cannot get quality images of my uterine lining while on the estrogen priming portion of this protocol to send to Dr. Braverman, I would still need to travel earlier than transfer day (on day 8 of estrogen priming), making this very similar to the Estrogen Priming Protocol though probably still slightly less time missed from the office.

I bleed through on OC and feel quite sick to my stomach, bloated and generally lousy.

I get bad headaches on Lupron even when I drink buckets of water and take supplements to support liver function.

The monitoring appointments would be done by ultrasound technicians who are not trained to do what I would be asking of them because I do not have a RE where I live.  This makes me nervous but perhaps unnecessarily.

Two more needles per day for about 3 weeks while I am on Lupron.  I’m not super fussed about needles so this is a pretty minor “con” (hence it’s place at the end of the list).

Estrogen Protocol

The estrogen protocol would have me start estrogen supplementation on cycle day three (again, late next week or next weekend, most likely).  I would be monitored through ultrasound and blood tests to track for ovulation (which my last two cycles was on day 15 and 16 respectively).  I do not know when immune meds would start but I suspect it would be the same time as estrogen, given that is when they are started in the OC/Lupron protocol.

Pros

I would allow my body to function somewhat normally (i.e., I will be permitted to ovulate rather than suppressing it), which could assist in my body producing its own progesterone rather than relying entirely on supplementation.I avoid the Lupron headaches.

The RE at Dr. Braverman’s Manhattan clinic would be doing the critical monitoring appointments, as opposed to the less skilled technicians in my local facilities (because I do not have a RE here and the wait to get into one is > 12 months so I’m not going to try now).

I avoid the OC nausea and bleeding.

I would take additional hCG injections to assist with implantation (replacing the possible implantation support Lupron would provide).

Two less needles per day for the approximately 3 weeks I’d otherwise be on Lupron.

Cons

I will need to book more time away from work.

I will be unable to precisely predict my travel dates to return between when ovulation is triggered (I am assuming Dr. Braverman would trigger it to ensure precision in timing the transfer and I would want this).

Increased travel costs unless I can couch-surf in the Big Apple for part of my stay.

Poll

Here it is, your chance to participate!  What do you think?  Feel free to comment as well as or instead of taking the poll.  Thank you!

 

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25 thoughts on “A Poll – Estrogen Protocol or OC/Lupron FET?

  1. I voted for the estrogen priming because I did the OC/Lupron protocol and it didn’t work for me, plus all the cons you listed for OCs and Lupron happened to me too and it never feels good to start a transfer cycle that way. I will say that this protocol seems to work for a lot of women though, and your concerns about timing and extra time in NYC and the additional time off work are very valid concerns, so it might make more sense to go with the assisted protocol. Sorry, I guess that doesn’t help you decide at all does it?

    • Ha ha – you sound just like me!!! I’ve flipped and flopped back and forth and forth and back on this. I don’t really want to thrust a bunch of unnecessary hormones into my system (and to me, while lupron and OC are not essential, the estrogen and progesterone may be necessary and slightly more comforting to me because I was a bit scared my lining wasn’t thick enough in my natural FET at 7.6 mm at last check before ovulation even though the RE said it was perfect). If it weren’t for having had a slow first half of the year at work I wouldn’t care about missing the time, I’d just miss our little one, but then I think maybe I should just do the standard predictable OC/Lupron protocol. I need an intervention or I will never sort this out!

      Thank you for your response, you made me feel less silly for even debating this and you raise a good point – it’s not good to start a cycle feeling like crap for 4 weeks.

  2. I can only speak to my present experience. That said, I just finished the pack of BCPs Sunday and am going on my second week of lupron injections. Starting Friday possibly (it’s my first scan), I will start progesterone (lady part pills and Intramuscular injections) and estrogen (both patches and pills). My doctor recommended this protocol because I’ve had lining issues in the past with IUI and IVF (never getting over 8 mm and often 7 at the time of transfer/insemination). My dr wants to do this to ensure we get a good lining for the FET. For what it’s worth, I have felt totally fine on lupron with no side effects to date. Wishing you success on whatever path you choose.

  3. Hi sweetie,
    Been a while since I stopped by to check in on your blog and wanted to comment on your dilemma. So for 2 of my 3 FET’s I did the Estrogen priming which actually should suppress ovulation! I had a few blood draws to ensure that my LH was not creeping up and that my E2 was rising to the level that they wanted. After each blood draw, think I had 3 or 4, I would be told to increase to the next level of estrogen pills. For instance, started out with 1 pill twice a day for the first 5 days then blood draw, if all was ok was upped to 2 pills twice a day for something like 5 days then blood draw and then 3 pills for a few days. I had an U/S around day 12 to check my lining and to ensure I had no dominant follicle. I was actually told my transfer date when I started AF so all of the blood draws were pretty much prescheduled, I had one extra because my E2 was going higher than they expected, which turned out normal for me. The only think I was told was that if I some how ovulated or lining wasn’t thick enough then and only then would my date change. To be honest this was fairly stress free and felt normal to a regular cycle (or as normal can be). Progesterone shots were started the day after what they termed ovulation. Since I hate Lupron , gave me really nasty headaches, I wouldn’t go this route. Hope this helps and I’m routing for you and praying really hard that this is it.

    Hugs

    • Thank you so much for stoping by and HUGE thanks for this very helpful information. I was told the estrogen priming suppresses ovulation for some but not all women and it is the “but not all” that could make for variation. Your information sounds so much tidier I can’t see why I wouldn’t do that. I wish the dr would get back to me in response to my question about dates because that might help me finalize the decision. He said I don’t have to make a final decision before I see him next week Friday but I have stuff waiting to be booked at work so I would like to have a plan before then if possible.

      I can’t tell you how happy I am to hear from you. Thanks again my dear friend.

  4. I have no advice, but I hope you get helpful advice from others. I hope you are at peace with whatever decision you make. ❤ Thanks again for all of your help today!

  5. Would this be a “six of one, half a dozen of the other” proposition though on Lupron? In other words, should you be building a few extra days off from work in the Lupron scenario because you have had such a horrible reaction to it? I also have to confess, I might be nervous about the monitoring situation as well.

    • Hmn, that’s a very good point. I had not thought of that, last time I was on Lupron and burdened by the headaches I was away from the office and could try to sleep it off or at least throw a pity party. It may well be that I have to do the lupron protocol or at least use OC anyway if I can’t line up monitoring here, which is causing me great stress today as I can’t even get approximate dates from Dr. B’s office – GRRRR…. Maybe my decision will be made for me, in other words. 😦

  6. I wish I could give you some advice on this one but it would be based entirely on guessing. Given how important this decision is that seems unwise. 🙂 That said my knee jerk is Scenario B. since Lupron sounds like it really takes it out of you.

    I hear you about the extra days in NYC though. Have you looked into Air B&B? Much much cheaper than getting a hotel.

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