ET progesterone testing- please help

[IvfStruggler]

I hope someone can help me.

I have an FET on Thursday and because all my previous ET have ended in early bleeding, I have been trying to arrange a progesterone test around my transfer- it will hopefully rule out the issue of low progesterone and relief some of my anxiety if I know the level is fine. My clinic has been so difficult about it. I'm paying privately but the clinic uses the testing facilities of the hospital it is partially based. Honestly it has been as if I'm asking something really bizarre (like asking to test my blood for evidence of alien abduction) and after insisting I'm finally told it is possible but the consultant will explain to me on the day about some research. Whether I'll be part of the research is unclear but I do know that my clinic is adamant that the correct levels of progesterone for ET's have not yet been established. So I'm worried that I will be tested but if the level is not looking great there is nothing they will do. At the same time- in the past I have had three tests for which I had to wait for and repeatedly follow up to get the results- I don't want to add this stress to my TWW.

So I'm looking for suggestions and other options to test. There is little in my area- just a Nuffield hospital where it is very expensive. I looked at medichecks where you can do a progesterone via the post but I'm worried as it says it's to check whether you've ovulation and you wouldn't get the exact values. Has anyone got any experience with these or any other tips.

Thank you so much for reading my (too long) question ♥️

[Dorekhani]

Hiya

How u said that ur progesterone is low.. My clinic even didn't check it and prescribed me 2×400 passaries a day.. But I was not satisfied so after 4th day of transfer I added one to it and took and still taking 3 aday

Yesterday I told my Dr that apologies but I used 3 day so she prescribed 3 day a day for further 3 weeks.. But do research on your own and take advises.. And then do what is good for you🤞best otf luck for your transfer 🙏🙏

[IvfStruggler in reply to Dorekhani]

Thanks for the reply! I'm on two shots of Lubion a day which is quite high. When I had early bleeding last time round I called the clinic who said I could increase my dose but it wouldn't make a difference (they didn't want to test either)- so I did and if anything the bleeding seemed to go worse not better. So I'm not sure low progesterone is the issue but I just want to make sure via a test. If it comes back low I would do what you have done and increase the dose again without input from my clinic.

Happy to hear the higher dose worked for you! Thanks again xxx

[Dorekhani in reply to IvfStruggler]

Thanks.... Nothing can say dear just can pray and wish u best of luck🤞🤞

[Lisichka]

Hello

I’m sorry to hear that your clinic are being so difficult about testing. I’ve been there too and had to be super pushy to get it tested. I don’t have any advice apart from insisting on it and asking for the number (it should be over 50).

[IvfStruggler in reply to Lisichka]

I'm happy to hear I'm not the only one that has had to push for it. I've been feeling really bad about insisting as everyone is acting like I'm asking for something very unnecessary, difficult and inconvenient. I just don't think I can trust my clinic. This week when I mentioned to the nurse I was worried I was getting thrush again she suggested I pay for a swap because the result would take a day and then we could solve the problem before ET. But the result never came even with me calling and leaving messages. I'm worried this will happen with my progesterone as well and it will only increase my anxiety.

Thanks so much for sharing your experience- it really helps knowing I'm not the only one xxx

[Lisichka in reply to IvfStruggler]

No problem! For what it’s worth, my old clinic in New Zealand (in NZ they have the same healthcare model as in the UK) were pretty much like yours - not wanting to test anything! I bled on day 3 of the 5day ET. Did they care? No! They were like no, you’re on enough progesterone even though was never measured. I had 4 ET cycles there. We had to move to the US last year for my husband’s job and so started the treatment here. And wow, what a difference! They test everything all the time. So anyway, I’m on 2.5 times more of progesterone than I was on in NZ! And it just makes me so angry because they should test this because other clinics in the world do! How many chemicals and bfns we could avoid! So push your doctor as much as you can. Good luck xxx

[IvfStruggler in reply to Lisichka]

It is so crazy all these different approaches. Here in the UK there are clinics that do much more testing and closer monitoring and they have much better success rates. Surely other clinics look at that and recognise the value? These clinics are really expensive and I don't even want to be scanned and tested everyday- but something as simple as a blood test- surely that's just common sense. I respond extremely bad to progesterone. It makes me really anxious and depressed so I don't want to take a really high dose if I don't need it. So a test would be so valuable.

I really do share your anger- they are discovering that many women can prevent miscarriages by taking progesterone supplements- not just those doing IVF. I just don't see how there is not more research about this because it is such an obvious element of a healthy pregnancy. IVF is 40 years old- has it only crossed their minds now?

Thanks again for sharing xxx

[Montgomery2]

I have had the exact same issue. I've been tested twice for research, but they are very shaded about for information purposes. Yet when you have a fresh transfer they test your progesterone levels to check they aren't too high?! So clearly they know an appropriate level it needs to be!

[IvfStruggler in reply to Montgomery2]

Thank you so much for replying. I really don't understand why it's so difficult. This research thing annoys me- so it's ok for us to be of use to research but it's suddenly a problem when we want the information for ourselves? When they took your blood for research did they let you know your levels or did you specifically have to ask for it? My worry is that if my levels are low they won't want to do anything because that would impact on the research outcomes. At least I'm not the only one who had to struggle with this- I've been feeling mad for even asking. Xxx

[Montgomery2 in reply to IvfStruggler]

I haven't asked for it but I've had a BFN again this round. The amount of progesterone should be high enough technically but they said that about oestrogen and it wasn't. I want a full review front to back by a consultant who's not seen us before. Because they never told us the quality of my husbands sperm could mean it arrests and stops the embryo growing. And I don't know if I have a high level of NK cells.

[IvfStruggler in reply to Montgomery2]

I'm so sorry to hear about your BFN. It's absolutely heartbreaking everytime. I hope you are ok. I'm dreading my OTD as that's all I know now- so much dissapointment. I hope you can find a new consultant who can look at your individual circumstances. I feel I'm always treated as part of a conveyer belt and told: well for other women it is enough. What other medical conditions are there were you're just prescribed something and if it doesn't work you're told there is something wrong with your body because it works for other people. I had the same with oestrogen- clearly people respond to medication/treatment differently- why not look at individual cases? Take care xxx

[Hopeful2021]

Hi ivf struggler as far as

I understand bleeding early can be a sign of

Low progesterone. I bled a week after my first fresh ivf transfer. Since then I have always had mymprogesterone levels checked the Day of or before Transfer. As my clinxi is far from my home this time I have asked my GP for the blood test and they are doing it for me- it’s worth trying ur gp explain that ur clinic want your progesterone level checked to avoid u travelling far can they please organise blood test for u and I don’t see why any gp would say no.... I would fight for the test - doesnt do any harm and me knowing my progesterone levels were good have me more reassurance xxxx

[IvfStruggler in reply to Hopeful2021]

Thank you for your reply. My GP clinic is awful. Everytime I ask for help with any issue slightly related to my reproductive system- I'm told I've already been referred even though I'm now paying privately. I called them last time I was in such a panic because I started bleeding again and they were brutal. They didn't want to help me whatsoever, not even in terms of offering advice or reassurance. I still get upset when I think about it as I was crying on the phone and I was treated as if I was just trying to get a freebie or cheating the system. Even when I explained that I have been having problems with spotting for years and that the fertility clinic is simply not interested in this whatsoever- they said it must not be that important.

I'm sure other GP will be kinder and more helpful. All the doctors at my surgery are awful but I was one helped by a locum doctor who was so kind and helped me to get some test.

I'm happy to hear it worked for you and hope your treatment was successful! Thanks again xxx

[StressedIRIS]

Hello!!!! I am sorry for all this extra added stress! I completely get whAt You are going through!

What about calling your GP and asking them to do a progesterone test as you are going through IVF? My GP is pretty good with tests! The progesterone test is usually done 3 days prior to the morning of embryo transfer (my clinic does this) but i think i would prefer to have it a day earlier!

Different clinics have different cut offs with progesterone i heard of 30 ng/ml might be the standard but i also heard of 100 (so it varies a lot)!

If your levels are low you will need to increase the progesterone medication but this again only your clinic can do it as you will need to stay on the high dose until week 12! Have the test and discuss with the consultant and tel them that this makes you very very anxious and stressed so they will need to work with you and if its low to increase the dose accordingly! I hope this helps

[IvfStruggler]

Thank you so much for reply. I tried my GP before and they were horrid- not helpful at all. Thank you for letting me know the levels- that is really useful. I think they have a better idea about the minimum levels- not the maximum. It also really interesting to hear your clinic does it 3 days before the transfer- I've not heard that before. I guess it makes more sense as you still have a chance to increase it before transferring the embryo. I'm now on day 4 so I certainly won't make that for this round- but useful to know for next time. I hope your doing well! Take care xxx

[StressedIRIS in reply to IvfStruggler]

Hiii, sorry it was thE way i wrote it! There are clinics that do the test three days before ET and others the day before or the day of ET! Mine is doing it on the day! I am so sorry for the horrible GP. If you can get the progesterone test done even privately do it for your own sanity! What if you say that this test was requested as urgent from your private clinic? On the same note if its a private clinic that you are having the treatment ask for the test to be charged!

[IvfStruggler in reply to StressedIRIS]

I got the medichecks in the end- so it's a blood test at home. I'm not sure if it is the right decision but at least I will have access to the results relatively soon and I avoid any additional stresses from clinics and GPs. Thanks again for your support- I really appreciate it! Xxx

[StressedIRIS in reply to IvfStruggler]

Test the levels as you said for your own sanity as you need to calm down and try to be as positive as you can be! If the level is below 30 to 50 talk to the consultant to increase the dose. If they refuse maybe ask for a private consultation in regard to the dose from Another clinic? A one off maybe wont be that expensive? But take it a step at the time! Your levels might be ok and there wont be an issue! I hope all is well!!!

[sunset212 in reply to StressedIRIS]

Yes i had mine on the day of transfer. What level do your clinic like to see? My reading was 52 do you think that is ok? x

[IvfStruggler in reply to sunset212]

My clinic did not have an ideal level. They claim that there is no research in this area apart from their own current study- although there definitely are some studies. However it is true that scientific knowledge about progesterone is very underdeveloped. I had 23.2 mnol which they claimed was fine but most studies suggest you need at least 25 to encourage implantation and to sustain a healthy early pregnancy. I have read that a large number of clinics in the UK aim for 30 or 50. Clinics in the US aim for much higher numbers 100+ but there are (early) studies that suggest that this may be too high or make no difference to success rates. I think you are totally fine with 50! Good luck xxx

[Kseye]

I felt the same on my last transfer. Clinic wouldn’t do it so I tested myself with an at home medichecks test. On day of transfer it came back in the low side and then I was so panicked and had no one medical to tell me what to do. After a lot of research I realised that as I was on suppositories the local progesterone in my uterus was likely much higher than blood and the blood test actually wasn’t that accurate. With a lot of worry I decided to stay on the dose I was on. I am now 15 weeks and all is good. I know it’s hard to trust the doctors when they are being obstructive but sometimes doing home tests with no support to change treatment can cause you more stress and worry. If you are on 2 x lubion and suppositories I would think that should be plenty of progesterone for a FET. (I was taking one lubion and 2 crinone a day).

[IvfStruggler in reply to Kseye]

Thank you so much for your reply. I think you are completely right in terms of home testing without medical support- it can be very difficult and cause extra stress. Can I ask what your level was when you got your result? And was this also for a FET or a natural cycle? Xxx

[IvfStruggler in reply to IvfStruggler]

Sorry I forgot to say congratulations!! All my best wishes for the rest of your pregnancy! You really make a good point about localised vs blood progesterone. I'm only on lubion because my consultant doesn't believe injections and pessaries should be mixed. I think he's making it up as he goes along 😂 Thanks again xxx

[Kseye in reply to IvfStruggler]

I only had the pessaries for my first 2 transfers which both failed. This time with the lubion in addition I think it may have helped with higher blood levels than progesterone alone so my body knew it was pregnant. But who knows really. 🤷🏻‍♀️

[Kseye in reply to IvfStruggler]

Mine was an FET. On day of transfer mine was 40.9nmol/L (12.7ng/ml) the studies I saw on line suggest best levels on egg transfer day are between 50-100nmol/L.

[IvfStruggler in reply to Kseye]

I would be happy if my levels are at least above 30. I also saw those studies but it shows that in your case it was fine. My clinic says that lubion is better absorbed so after I had bleeding during my first round with pessaries only- they moved me to Lubion only. With your warning in mind I did get myself a medichecks test. The last time I started bleeding my clinic said I could increase my dose- but it wouldn't make a difference. I don't expect the progesterone to be a problem but if it is below 30 I will tell them and increase my dose. I really don't have high hopes for this round because we had so much failure already but at least with test results I have clear information to try again. Thanks again for sharing your experience- it has been really helpful xxx

[Kseye in reply to IvfStruggler]

I really hope the lubion works better for you. It was the only thing I changed for this cycle. I was the same felt hopeless after the first 2 failed and just wanted all the info I could get to find out why it wasn’t working. Sending all the luck your way.

[LadyM2019]

Hello, I've had the same problem I bled heavily from 7dp5dt twice (once taking 3x 200mg daily and once using 1x lubion per day) . These were fresh transfers from an NHS cycle. I've had a second opinion at a private clinic in London who believe the bleeding is a consequence of low progesterone. This clinic is prescribing one additional injection of lubion, 6 x utrogestan oral and 2 x crinone gel per day for my upcoming FET. I've arranged to have my progesterone checked at the hospital (a different hospital to the one I'm having fertility treatment at) on the day of transfer. If I couldn't do this I'd have had it checked in London the day before transfer where I would be able to get the result the same day.

[IvfStruggler in reply to LadyM2019]

Thank you so much for your reply. It sounds like you've got an excellent plan! I hope it works well for you and that your treatment is successful! Xxx

[Hk12]

These posts are so helpful!! I didn’t have a bleed until I withdrew my medicines in my first failed FET.. I’m doing IVF privately with one of the clinics in london that have good reviews but no close monitoring and no testing. Getting really fed up with them. I actually gave them a call again and was little pushy saying what they can do to improve my cycle and they said they will measure my progesterone level next time! So why they didn’t do that in the first FET, I have no idea! But I think if my clinic sees the need to do this, you are right in pushing for this..it isn’t even a difficult test to do and I have no idea why clinics don’t do this

[sunset212]

Its true about low progesterone can cause early bleeding following transfers, but also it can just simply be levels naturally dropping if any ladies are doing a natural FET transfer without oestrogen and progesterone only like myself ( asprogesterone levels naturally fall in a non-conception cycle where the embryo doesn't implant ) to bring on a period, because when implantation occurs you naturally pump out increasing levels of progesterone too to help support your levels. Good luck pushing for your tests ladies. x

[IvfStruggler in reply to sunset212]

You are totally right @sunset212. Your embryo doesn't contribute to significant progesterone production until week 7 to 12. It is your corpus luteum from which the egg is released that produces the early pregnancy hormones. It's the HCG that your embryo produces that keeps the corpus luteum to continue to produce progesterone after your period would be due. This is why if you have a natural cycle you don't need progesterone in theory (because you have ovulated and released an egg) and early bleeding suggests it has failed. But progesterone is also really important for the creation of the environment of implantation. If, for example, you are like me and have only 18.3 5nmol/L (or lower) on day 21 of a natural cycle- the condition of the endometrium is not going to be great and an embryo is less likely to implant- release HCG and continue your progesterone production. This is when progesterone supplements are essential (in a medicated cycle it is always absolutely essential). It is also important to remember that if you are very stressed you may produce extra cortisol. Cortisol is a hormone that 'steals' progesterone. So for some women (this will be a small group though) the stress of fertility treatment may lower your progesterone and therefore your chances of it working. Also here (extra) supplements can be very helpful.

So long story short: If you bleed shortly after a transfer- push for progesterone tests! It may be for a different reason but you can rule out low progesterone quite easily with a simple blood test. If I had done this I wouldn't have lost all 4 of my precious embryos. Good luck everyone!