From the Research
I strongly recommend waiting for your official beta hCG blood test before making conclusions about the transfer, as home pregnancy tests at 6 days post-transfer can be unreliable. If this transfer fails, consider consulting with your reproductive endocrinologist about immune testing, ERA/EMMA/ALICE testing to check for endometrial receptivity and microbiome issues, or possibly additional embryo banking. Your current protocol is comprehensive - the endometriosis excision, Lupron suppression, letrozole treatment, and supportive medications (lovenox, prednisone, sildenafil) address many potential barriers to implantation, as supported by studies such as 1 which highlights the importance of hormonal treatments for endometriosis. Your 8mm lining is favorable, and using PGT-tested embryos increases success rates. For endometriosis patients with PGT-tested embryos and appropriate suppression therapy, success rates typically range from 40-60% per transfer, as indicated by the most recent and highest quality study available, although the exact success rate in your specific case may vary. The addition of metformin may help if you have insulin resistance or PCOS, but its effectiveness in your case would depend on individual factors. Some studies, such as 2, have explored the efficacy of letrozole combined with oral contraceptives in treating endometriosis-related pain, showing promising results, but the direct impact on implantation success rates is less clear. Other treatments like elagolix and leuprolide have also been evaluated for endometriosis-related pain management, with patient preferences playing a significant role in treatment choice, as seen in 3. Historically, letrozole has been studied for its potential in reducing endometriosis and associated pain, with early studies like 4 showing significant reduction in endometriosis and pain relief, although more recent studies like 5 suggest that its effectiveness compared to other treatments like OCP may not be significantly different. Remember that even with optimal conditions and tested embryos, implantation involves complex biological processes that aren't entirely controllable, and sometimes multiple transfers are needed before success. Key factors influencing your outcome include the effectiveness of your current protocol, the quality of your embryos, and your individual response to the treatments, including any potential benefits from the addition of metformin. Given the complexity of endometriosis and its treatment, a personalized approach, considering your specific health conditions, medical history, and the latest research findings, is crucial for maximizing your chances of a successful transfer.