- Hi, this is Dr. Hossam Elzeiny.
I am a fertility subspecialist with Melbourne IVF,
having experience in this field for 20 years,
and welcome to the Fertile Minds.
Today, we are going to talk about
how to prepare the endometrium,
or the lining of the uterus for implantation.
We are talking here about patient
who had embryos in a storage,
or even patients who are egg recipients.
So that's how we are going to prepare them for implantation.
The whole idea is that we try to synchronise
the age of the embryo.
Most of the time, all of the embryos will be frozen
by day five, or six, or seven.
Although there is day six and seven,
when we transfer them back, we put them back on track.
So we want them to be day five, after ovulation,
or after we start the progesterone.
So how we prepare the cycle?
So if it is a donor egg and recipient eggs,
it's easy.
We can get them, if both of them having menstrual cycles,
then we can synchronise the start
or the beginning of the cycle
by giving them oral contraceptive pill beforehand,
and then we stop them.
Both of them will start their period at the same time,
or just one day difference.
And then, we are talking here about the egg recipient,
how to prepare the endometrium.
So we give her sequential, oestrogen and progesterone.
The common form of giving the oestrogen is via oral tablets.
You will take the oral tablets
from the beginning of the cycle,
and then around, say after probably 10 days
from taking the oestrogen,
we do an ultrasound to check the lining of the uterus.
We like it to be above seven millimetre.
And then at that point,
we add the progesterone to the oestrogen.
And then five days from starting the progesterone,
that will be the time of the embryo transfer.
And about nine days after the embryo transfer,
we do a pregnancy test
to check if pregnancy has been achieved or not.
And nowadays, we check the progesterone level as well,
we like it to be above 40.
So we can supplement with extra progesterone if we need to,
according to the progesterone level.
So that's one type of cycle.
In general, if you have frozen embryos
and you want to do the transfer,
the most important question to the lady
who is going to have an embryo transfer is,
do you have a regular cycle or not?
If you have a regular cycle,
then we can do what we call natural full cycle.
And here we don't give the lady any medications at all.
And we will just monitor when she's going to ovulate.
That will involve doing an ultrasound close to ovulation
to see how big is the follicle.
And then we do a blood test to check for the surge
that happens one day before ovulation.
So we can pinpoint exactly
when ovulation is going to happen.
And again, five days after ovulation,
we do our embryo transfer.
So, what about patients who will not have a regular cycle?
Then they have one of two options.
Either we give them sequential, oestrogen and progesterone,
like the one we talked about in the egg recipient cycle,
or we can induce ovulation.
These patients usually have a condition
called polycystic ovarian syndrome,
and they don't get regular periods.
They can have a period every two months, three months,
or even no periods at all.
You can induce ovulation here
with certain type of medications.
There are tablets that can be used.
There are injections that can be used.
And here you are inducing ovulation.
You get them to ovulate, and monitor them the same way,
you do an ultrasound.
And then in most of the time,
when you are inducing ovulation, we trigger ovulation.
We give them a shot of injection that will make them ovulate
after a day and half from the trigger injection.
And that will be the day of ovulation.
And then again, five days after that
you do the embryo transfer.
So these are the three modalities
of preparing the endometrium.
And as you can see here, that all what is needed
to prepare the lining of the uterus
is just oestrogen followed by progesterone.
So you tried to mimic what happened in natural cycle.
Sometimes there are some additional medications
that can be used,
but that all depend on the condition of the patients,
and the history, and so on.
But most patients will achieve a pregnancy
through this kind of preparation.
The last question that we get,
"Doctor, what is the best method
of those three methods that you have told us about?"
Is there a, you know,
like a higher pregnancy rate when you do natural
compared to the artificial cycle?
All of the studies that has been done before
comparing those two types, didn't show any superiority
of one modality of treatment over the other.
But we go first with if the cycle is regular or not,
and then we choose one of two.
Either the natural cycle, or ovulation induction,
or artificial full cycles with the supplemented hormones.
And I really wish every couple
who is going through this kind of treatment,
a successful outcome.
And if you like this video, please subscribe,
so you can get more videos from Fertile Minds.