Hi all, first time poster here. Hoping to get some advice on my next IVF round. Feeling anxious and I don't know anyone who can think this through with me.
TLDR: should I do a Lupron depot or try another round without it?
Background
I am 38F, almost 39. I have one healthy child from when I was 31 (getting pregnant was easy then, but pregnancy was traumatic due to HG). My husband and I have been trying for a second for the last 2 years. We sought medical help a year ago: AMH was 3.16. Did first round of IVF in March this year: about 10-12 eggs retrieved, 8 fertilised, 5 made it to 5-day blasts (we did half IVF half ICSI due to lower survival but high motility sperm). PGT-A-testing is illegal here, so no idea about their state. We did a fresh transfer which lead to a faint positive and consequently early miscarriage. One didn't make the thawing proces. One FET lead to another chemical and two others didn't take at all.
I also did a parallel evaluation with an endometriosis specialist, and it turns out I have moderate adenomyosis (and a tiny bit of endo). It was visible on the ultrasound, not on the MRI. I already expected this due to severe pain during menstruation.
All 4 ET's were extremely painful. I have asked for pain management but none can be given, only valium.
The hardest parts for me have been 1. the pain (especially the transfer, but the retrieval was also no joke with just fentanyl) 2. the endless waiting. I need to feel like I am doing something to move towards our goal.
Next round: Lupron?
The clinic suggested next round (after retrieval, currently doing stims) I do a 3 month Lupron depot (probably in 3 4-week injections). But they didn't seem 100% sure about their own advice. They tend to do FET in natural cycles, so this means I would do 3 months of Lupron, then 1 month to ' build back' and another 20 days or so until my natural ovulation signals we can do a FET. So almost 5 months after retrieval until I can do FET. I would be 40 by the time a baby would be born, if at all. (Also, we are switching to full IVF instead of ICSI because the IVF embryos were more successful)
Clinic also told me the choice is up to me whether or not to do the Lupron. Their advice to do so seems to be based 50% on " you have adenomyosis so this might help your chances" and 50% on "we hate seeing you in so much pain during the transfer, this might help but it might not". Since I highly doubt the Lupron will do something for the transfer pain (and this pain is 20 min each month, not months-long emotional/physical agony) , I am not sure whether I find the Lupron protocol a bit too much, given that my adenomyosis is moderate and not severe. We don't know whether the 4 failed transfers/miscarriages were due to chromosomal issues (I am 38 and no PGT-A so it's likely) or due to adenomyosis.
I am scared that Lupron will put me through 3 months of sleep deprivation, more emotional rollercoasters than I can handle (also hard for husband and daughter to deal with), possibly more painful joints (I already have those), and that it might interfere with a possible 3rd egg retrieval (less eggs). Also, mentally, I am absolutely dreading 4/5 months of wait time before transfer. In the last few months we have been trying naturally each cycle as well, that would no longer be possible. I feel like my life has been at a stand still for the last 1 to 1.5 years, I don't want to add another 4/5 months to that.
Alternatives, not sure if possible
I have written my doctor to ask whether she would also advice Lupron if it were just about the adenomyosis (not about the painful transfers), and also whether Dienogest might be an alternative. Also, I've asked whether we can skip the natural cycle so that we can shorten the process by about a month, in case she really thinks Lupron is the way to go. I will hear back right before my retrieval, but I will need to let them know my decision very soon. I fear she will say: it's either Lupron or it's nothing (no alternative scenarios), since everything is done in quite a basic way in my country (upside is that insurance covers 3 rounds of IVF).
What are your thoughts?