Termination of the preparation cycle

Dear Vida Fertility team,

Today it was decided to cancel my preparation/build-up cycle for EZS transfer as the uterine lining has not built up any further and fluid was also seen in the uterus. After 10 days of taking estradiol (Estrofem 2-2-2 + gel 1-0-1) only at 3.5 mm and then increasing the dose (to Estrofem 2-2-2 plus 2 vaginal plus gel 1-1-1) no change. So far I have never had any fluid, no surgery, no fibroid, etc. In the past HRT cycles, I always got to 3.5 mm even with a much lower dose.

Now I am unsure how best to proceed. Is it enough if I simply stop the estradiol and then wait for a bleed? That's how the clinic described it. Or should I also take progesterone for a few days - if so, how many? - progesterone (e.g. Utrogest, which I have as HRT) for a few days so that a defined stop bleeding is triggered? I had always understood that only the administration and subsequent discontinuation of progesterone ensures a "proper" bleed and completes the cycle, so to speak. And I'm a bit worried that otherwise the bleeding won't be sufficient and I might not bleed properly (again).

I also have the question: should I start a new build-up cycle and a higher/adjusted estradiol dose straight after my period? Or is it better to take a "HRT break cycle" first and then only start a new build-up cycle in the cycle after next? I am dependent on HRT as I no longer have a natural cycle.

Would this make any difference to the medication or the protocol?

Thank you very much for your assessment. Best regards

Dear Vida Fertility team,

I already have an additional question and would be very pleased to hear your opinion.

My clinic has explained to me that it is normally sufficient to simply stop estradiol in the case of a broken build-up cycle. Within a few days there should be a discontinuation bleed, which is usually enough to reset the mucous membrane. Progesterone is not necessary in this case, as it is only used for a planned transfer - I wasn't that far along yet. Bleeding without progesterone may be a little lighter or shorter, but is usually sufficient. The fluid in the uterus could be related to incomplete rejection, but does not necessarily have to be problematic. I am therefore thinking about having an ultrasound scan to check whether the mucous membrane has completely bled off before the next attempt at reconstruction.

Now I'm wondering whether - if there is no natural cycle - you can simply start again on any day with a higher dose of estradiol after a cycle break-off and plan the transfer date in advance (conditionally, of course). Specifically: I am now stopping estradiol and waiting for the bleeding. Then: either a) a HRT break cycle first or b) start the new build-up attempt directly - and not necessarily on cycle day 2, but also a week later, for example, if it fits better organizationally.

Thank you very much and best regards

Thank you Oskar for your quick reply.

And thank you for mentioning the risk of endometrial hyperplasia.

Yes they said that if you have an abortion you can do it without progesterone because the hormone drop will also shed the lining.

With regard to the risk of endometrial hyperplasia, they said that this is not increased if the progesterone is stopped once. Only if estradiol is taken over a longer period of time without progesterone.

I always take progesterone in my "normal" HRT.

I had asked myself about the progesterone mainly in relation to the discontinued build-up cycle, not primarily from the point of view of the risk of endometrial hyperplasia, but rather because, as described above, I had the thought that perhaps the SH was not bleeding properly.

Kind regards

Thank you Vida Fertility Institute for your detailed reply. It helps me a lot.
LG