review appointment post failed transfer

[CJohns]

I’ve requested a review apt. with my clinic following my failed implantation and period at 6dpt.

I’m assuming this is a progesterone problem, in that my period should have held off for a lot longer. Without sounding silly…because this is a medicated cycle, is it completely dependent upon what level of progesterone your clinic prescribe you or is there an element of you making your own progesterone at this stage too? How do they know how much to prescribe you?

I do feel quite frustrated about the whole bleeding early thing, and also feel that I’ve not once had a chance to discuss my treatment plan at all with my doctor.

This has been through a private clinic whereas when we were starting with the NHS two years ago, I had two long apts with my doctor before meds even started, face to face injection training etc, whereas this has all been via email and training videos online.

The NHS also arranged for my partner to have various blood tests and also for me to have blood tests at various stages in my natural cycle to check hormone levels etc, and also to check I wasn’t in perimenopause. The private clinic had never offered any of this, and it concerns me why this isn’t done as a standard course of action. Is this normal with private clinics?

Your feedback would be very helpful, and also any other pointers on things I should ask at the review.

thank you ❤️

[Nane22]

Hi Im sorry to hear about your failed transfer. I had the same problem on my first two transfers and then on my third one I requested progesterone checks. So my clinic did a progesterone check on Day 3 so 2 days before my transfer as I had a Day 5 embryo put back. The first time they checked it, so this was 3 days after using cyclogest, my progesterone was so low they cancelled the transfer. This was because my body doesn’t absorb the progesterone through the pessary. The doctors were really surprised.. so thereafter they started me on cyclogest and lubion injections twice a day and then checked my progesterone before the transfer and also the day of transfer and it was much better. I got pregnant on that cycle but sadly MMC at 9 weeks but that was most likely due to chromosomal abnormality. I also asked them to do another progesterone blood test during my TWW and they did it just for my peace of mind. I didn’t bleed early on any of my transfers while using lubion.

So I would definitely push them to do a progesterone blood test. My private clinic has been really good at doing tests and they show you how to do injections etc, so I think it varies depending which clinic you are with.

Good luck with everything xx

[CJohns in reply to Nane22]

Thank you, that is so very helpful!

It’s most frustrating as the NHS clinic out refer the egg collection and transfer to my private clinic, so you’d think given they are linked that the level of service leading up to those events would be somewhat similar.

I’m not sure we’ll do another cycle, but we’ll see what the outcome of the review is.

I can see you’ve also recently had a negative 💔 I’m so sorry, and really hope you get your happy ending xx

[Nane22 in reply to CJohns]

Thank you hun xx I hope you get your happy ending too 🥰

[Twiglet2]

they didn’t test my progesterone (nhs or self funded) but just upped the dosage and prescribed lubion. Some people dont absorb what they need from the pessaries so the lubion seems to have worked for me. They said the test results for progesterone can fluctuate so much day by day and even time of day that it’s safer just to up it if you’ve had an early bleed than do any tests your body won’t absorb ‘too much’.

If it was a fresh cycle with no down the yoj do make some of your own progesterone too but if down reg cycle like for a FET it’s mostly supplemented to begin with and then after implants your body starts to take over a bit more as the down reg wears off and the placenta takes over from about 8 weeks is my understanding .

Other considerations they might discuss is your thyroid function if. It tested lately and test for sticky blood. Hope you appointment goes well! Xx

[CJohns in reply to Twiglet2]

Thank you. It just feels like you get set up for failure if something as simple as progesterone isn’t being checked ☹️, feels like a huge waste of money.

Thank you so much for the pointers, and also mentioning thyroid function xx

[MagsGK]

Hi lovely, I'm so sorry for this. It also happened to me. After my first ever transfer I got period 7dpt. I was sooo frustrated that nobody bothered to check my progesterone level. After that I have been prescribed lubion along pessaries for my next transfer and it stopped period (pregnant twice but MC at 8 and 12 weeks). Still found it very strange that they prescribed lubion without any checks at all.

Wishing you all the best x

[CJohns in reply to MagsGK]

Seems like so many people have had this same experience - it’s baffling! The lubion obviously helped getting you pregnant, but im sorry to hear of your miscarriages 💔.

Thank you for your reply, it certainly helps xx

[Eloquentia]

Hi! I Am sorry the cycle failed, it is so soul crushing when it does...Early bleeding is definitely a warning sign for low progesterone. I had this with both my transfers. The first one I insisted they check progesterone levels on the day of transfer and it came back low, so they added Crinone gel and increased my cyclogest dose. For the second transfer, we agreed they would check my progesterone 2 days before transfer and on the day as well. It was low on both occasions, so they ended up doubling my progesterone dose once again. I am sure this is what made the difference with that cycle. I should add we are NHS-funded and were told that everyone absorbs progesterone differently, no way of knowing in advance or without testing. So in my experience, it is definitely worth insisting that they test before and on the day of the transfer to get your dose right. Very best of luck!

[CJohns in reply to Eloquentia]

Thank you - it still baffles me that they wouldn’t undergo these extra tests anyway. Surely it would help towards the clinic’s success rates 🫠.

Funnily enough when I rang the clinic on Monday to advise them of the bleed the nurse asked if I was on 4x pessaries a day, whereas I was only on 2, so she clearly thought it was a progesterone issue straight away, but obviously they won’t say that, she just said that my body probably overrode the progesterone 🙄.

Thanks so much for your reply, it’s helping to fuel my fire 😆 xx

[Eloquentia in reply to CJohns]

You go girl! Fire helps along the journey I couldn't agree more about the extra tests but my overall impression is that they are trying to cut costs at every corner, not just the IVF clinics but also later down the line...You have to be your own advocate and push to defend your interests!

[Eloquentia in reply to Eloquentia]

p.s. your body overriding the progesterone in my opinion is a rubbish take on it! Your body didn't absorb the progesterone in the form they prescribed it, so they clearly need to do better to meet your needs...

[CJohns in reply to Eloquentia]

I agree, it was a load of rubbish, but I suppose the poor nurse can’t say anything that would put the clinic at fault.

I’m just so angry that we’re £7k down and I have a partner that didn’t really want to do 1 round, let alone consider parting with more money for a 2nd, so I know that this is going to cause a lot of heated discussions in our house 😩.

I know that it may not have worked anyway, but I feel like we were destined to fail without being on the right progesterone meds in the first place 👎 xx

[Eloquentia in reply to CJohns]

It is so difficult. Try to think of it as a learning process, every round teaches you and hopefully your clinic about how your body responds to IVF. By incorporating the new information in the next round, you remove the obstacles to having a healthy pregnancy 🤞🤞So ask your clinic at the review appointment, what was learned from this round and how are they going to tweak your protocol to improve the chances of the next round working? xx

[Rain415]

Hi, on my first transfer I got my period 7dp5dt. I asked in the review about progesterone and they wouldn't check it or change anything for following transfers. This was on nhs. 2nd transfer bfp but unfortunately early miscarriage. 3rd transfer bfp and my son. All with the same progesterone amount. But it was horrible not knowing, they really should do checks. I hope you get some answers x

[CJohns in reply to Rain415]

Thanks for your feedback. Who knows whether it was the progesterone or not for me, but hopefully I’ll get some feedback from the clinic xx

[Cinderella5]

I personally had a nightmare getting my NHS clinic to believe that I wasn't absorbing progesterone. I was bleeding on all three cycles by day 6/7 if I remember correctly. I asked then to test and was told it wasn't possible that I wasn't absorbing meds. It took us a lot of time, energy and money to find out that my gut instinct was right. I would definitley urge you to pursue this line of thinking. I'm not sure if you had egg collection or an FET, don't think uouve mentioned it?! I was on lots of progesterone in the end and I'm convinced this alongside an ERA test timing made all the difference but I was doing FET and DE. Massive hugs, its awful when you don't even get to test day.😥 xxx

[CJohns in reply to Cinderella5]

It was a fresh transfer - unfortunately didn’t have anything to freeze either, so not even like we can do a cheaper retrial with a frozen embryo 😢. But thank you for your feedback. Still waiting for the clinic to contact us with a date for a review, and I’ll be really interested to see what they say.

It’s obviously hard to know what caused it to fail, whether it was the progesterone or another issue. But I am relieved in a way that I’m not still sat in that TWW as it was bleddy killing me 🥲 xx

[Cinderella5]

In theory a fresh cycle should have its own production of progesterone from the hCG trigger shot, follicles at egg collection and the supplementation of pessaries or injections...that being said I still firmly believe from progesterone was not enough as I always bled early and I've been on here a while and know a few others that believe higher progesterone helped. However getting your clinic to listen is another thing. What was your cycle like, did you have many eggs? How many fertilised and what were they like on day 3? How was your lining? All of these things can perhaps point to any issues that also need addressing. I know how devastating it is to be in your shoes......I hope you and your partner are holding on tight to each other and that you have some others to speak to....its a real heavy time for anyone.😪xxx

[CJohns in reply to Cinderella5]

And I suppose it could be a possibility that my body may not have absorbed progesterone through pessaries.

I had about 13 follicles, 10 on the day and only 6 eggs, with 4 mature and 3 fertilised and 2 blastos (I’m extremely low AMH). Lining was 10 point something, apparently super thick as I am still bleeding heavily now (which is unheard of for me).

Thank you for your help! Honestly, I do feel in it alone as I have a 14 month old and people think I should be grateful just to have one and not want another (my partner included), and my god I am super grateful to have him right now because crikey I’m really not sure id be coping and getting up in the morning! Xx