This information leaflet is regarding the use of your frozen embryos. Before we can transfer these embryos we need to prepare the lining of the womb to receive them. There are three different regimes for preparing your womb to receive the embryos. The regime that is suitable for you will be discussed in detail at your appointment with the Clinician.
- A Natural Cycle
this is where we monitor you throughout your cycle and track a developing follicle along with measuring your lining until they both reach optimal sizes prior having to having an embryo transfer. This is exceedingly rare that we do this type of cycle as it is very unpredictable.
- A Stimulated Cycle
This is for women who have a regular menstrual cycle (less than 35 days) and have documented evidence of ovulation. The procedure to prepare your womb is quite straight forward and it involves the use of two hormones, these are oestrogen and progesterone (discussed below). The advantage of this regime is to have more control over the cycle and cuts the risk of ovulation before the embryo transfer.
- A Downregulated/Stimulated Cycle
This is for women who have irregular anovulatory (no evidence of ovulation) cycles. The drugs involved include those below and the use of a down regulation drug either an injection (Buserelin/ Prostap) or a nasal spray (Synarel) which is taken for approximately two to three weeks before then commencing the Oestrogen and Progesterone medication.
Down Regulation (Buserelin/Prostap/Synarel)
The down regulation drug switches off your hormones and therefore you may get some menopausal symptoms e.g., hot flushes, night sweats and mood swings. The drug is started on either day 1 or day 21 of your cycle. The drug can be given either as an injection (Buserelin/ Prostap) or as a nasal spray (Synarel) whichever is suitable for you. We will arrange a scan to check that the drug has ‘switched’ your hormones off from working, the lining of the womb will be thin, and the ovaries will be inactive.
Oestrogen (Progynova)
Oestrogen is the hormone that causes the lining of your womb to thicken. In a natural cycle it is produced in the first two weeks after your period starts. In an artificial cycle we need to replace your oestrogen with a tablet called Progynova. This tablet will be started on the first day of your period and you will need to take three tablets a day. You can take these tablets all at once, but this may increase the risk of side effects, (e.g., headaches, stomach upset) some women find it easier to take one tablet three times a day with their meals to reduce the risks of these side effects.
If you have been using a down regulation drug also you will continue this until we tell you to stop it.
You will need to continue to take the Progynova tablets for a minimum of 14 days and we will arrange a scan for you. The scan will measure the thickness of the lining of the womb (endometrium) and check that you are not producing any eggs yourself.
When the thickness of your womb lining has reached 8 mm or more you will be ready for the embryo transfer. After discussion with yourself and the embryology team we will decide on a time and date for the embryo transfer to be carried out. It is important that you continue to take the medication as prescribed daily.
If the lining of the womb is less than 7 mm we will ask you to continue to take the Progynova tablets and we may increase the dose to encourage the womb lining to thicken and re-scan after one to two weeks.
It is important to note that your embryo transfer will be at least one week up to four weeks after your final scan. This is to ensure safety within the laboratory on the day of your transfer. This does not affect your treatment in anyway. It may be that you will find one date better than another for personal reasons and we will try to accommodate for this. Once the lining of the womb has reached 7mm plus it will stay.
Progesterone (Lubion/Cyclogest)
Before the date of the embryo transfer you will be advised on when to start your progesterone medication. The combination of oestrogen and progesterone supports the lining of the womb and allows as much time as possible for the embryos to implant.
After 12 days you will need to have a blood test to check for the pregnancy hormone. Hopefully this will be positive, and if so, you will continue to take the combination of Oestrogen and Progesterone until your 12th week of pregnancy as the hormones are important to support the pregnancy in the first few months.
If the pregnancy test is negative you should discontinue the medication and expect a withdrawal bleed within a few days. We will offer a follow up appointment to discuss your cycle and if you have further frozen embryos to use we can get you booked in for your next cycle when you feel ready.
For certain patients, the NHS will fund the embryo freezing and subsequent replacement cycles. However, this is dependent upon individual circumstances, but can be discussed in more detail with a member of staff.
The cost for a frozen-thawed embryo replacement cycle is £1,445 (this includes anHFEA administration fee of £85)it does however exclude any drug costs but is the same cost irrespective of how many embryos are thawed or replaced. It is important to be aware that there is always a potential risk that embryos may not survive the freeze-thaw process.
There would be a refund of £615 if none of the embryos survived.