Timing of Progesterone blood test and embryo transfer in FET

[Goldenfeather123]

Dear ladies,

I joined this forum on behalf of my daughter. She has done several IVF cycles without success. I have questions about the protocols used in her two FET cycles.

First, she undergone a FET early this year as a modified natural cycle: scans on day-9 and day-11 (lining =7mm); trigger shot on day-12; blood test for progesterone on day-13 (P4 =104 nmol/L); cyclogest (2x 400mg daily) start on day-14, the same day as embryo transfer (of a day 5 blastocyst).

That cycle was failed. Afterwards, I realised the embryo transfer was done only 2 days after trigger shot. According to what I have ready, the gap between embryo transfer and trigger shot should be 5-6 days! Am I wrong? Or has anyone else used a similar protocol and got a successful outcome?

Second, my daughter is undergoing a new FET this month using a medicated protocol. She has started taking oestrogen tablets (4x 2mg daily) and will be for 10-14 days. Then when lining is ready she will start to take cyclogest (3x 400mg daily) for 3 weeks or longer. On the 6th day of taking cyclogest, she will have a blood test for progesterone and embryo transfer.

Again concerned based on my own understanding, a P4 blood test should be ideally taken 1 day before embryo transfer so she can increase progesterone dosage as soon as possible if needed. Will the 1 day delay in P4 test affect the outcome? Has anyone got experience or better knowledge on this?

If this new FET fails again, my daughter might try a mild stimulation protocol in her 3rd FET. Has anyone used? What are the pros and cons?

Thank you for reading my message! Any advice and comments are highly appreciated!

[Twiglet2]

In my experience progesterone should start 5-6 days before transfer and continue on. I’ve never had a blood test for it as my clinic say it can fluctuate throughout the day never mind whether you do it the day of or day before so it’s a bit pointless so I just make sure I take plenty of progesterone (2 x pessary and a lubion injection) and I’ve had 2 successful FETs (fully medicated down reg ones with prostrap) so I’m not sure the timing of the blood test will matter too much 🤗 hope this one works for her but remember it is also hugely down to the actual embryo so sometimes the exact same protocol can work the next time and sometimes it’s a case of just keep trying to find the right embryo that’s gonna stick 🤞🏽 xx

[Goldenfeather123 in reply to Twiglet2]

Thank you for your reply. It is helpful! Good luck to your journey!

[Ginger1984]

Hi I was successful with a day 2 transfer it was my first ever go of IVF. They collected 16 eggs but they all died apart from 1 so they suggested doing a day 2 transfer. I now have a near 9 year old who was born on Xmas day so definitely can work! I have since had 4 failed IVFs after that and they were day 5 ones.

[Goldenfeather123 in reply to Ginger1984]

Thank you for your reply. Best wishes for your family!

[Toffeepudding99]

Both of my cycles I took Cyclogest 5 days before transfer and the trigger shot within 36 hours of transfer. On the day of each transfer I had to attend a clinic/ GP about 5 mins from my clinic for a progesterone blood test so the results were available that afternoon. After both transfers my test results for progesterone were similar, marginally less on the second cycle but in light of my miscarriage with a euploid embryo on my first transfer I was advised to take prontogest progesterone injections every 3 days until 12 weeks.

Both of my protocols were medicated and that was all I was advised due to my age (40). Both of my egg collections I was also advised to PGTA test the embryos. Second checked successful and now 32 weeks.

Best of luck to your daughter. It is a stressful process but the best thing to do is to keep asking her clinic questions until concerns aren’t concerns anymore xx

[Goldenfeather123 in reply to Toffeepudding99]

Thank you for your reply. It is helpful! Good luck to your own journey!

[Goldenfeather123 in reply to Toffeepudding99]

Hello, I was in a hurry yesterday and may have misunderstood what you said. Were your transfers with fresh or frozen embryos? Did you take anything to stimulate follicle growth? Did you take any form of oestrogen and for how much how long?

[Toffeepudding99 in reply to Goldenfeather123]

Both of my transfers were with frozen eggs. As I was recommended to have the eggs PGTA tested they were cultured to day 5 to see which had reached blastocyst stage in order to take a biopsy for PGTA.

From my baseline scan I took menopur on first cycle and pergovaris on second to stimulate follicles. Both had similar outcomes in terms of eggs retrieved.

For transfer on my second cycle - I took estrogen from baseline all the way to 12 weeks pregnant, Cyclogest pessaries from 5days before transfer to 12 weeks and prontogest (progesterone injections) every three days, again will 12 weeks.

[Goldenfeather123 in reply to Toffeepudding99]

Thank you again.

[Sarah770]

On your second point, once the lining is good (8mini), progesterone is started and the transfer is done exactly 5 days after.

With respect to progesterone, there are two differents ways of doing it:

1. Some clinics will give max levels of progesterone since the beginning in order to ensure implantation and will test for progesterone at some stage before the transfer just to check that the levels are ok. The reason why they do that is to ensure the levels of progesterone are high at all times.

2. Some clinics will give a certain level of progesterone, test the level of the day of the transfer and make her take additional levels the day following the transfer if they consider the levels insufficient. The reason why they do this is because they believe that too high levels of progesterone may create a miscommunication / dephasing between the endometrium and the embryo and not be optimal for implantation.

I am pregnant for the fourth time now. I had my first two babies with method 1 and had my last positive test (November transfer) with method 2.

What you describe is absolutely classic. They test the levels of progesterone the day before the transfer and will ask her to adjust her treatment if they consider it necessary. Whether they test the day before or on the day of the transfer has no impact. In my situation, the clinic that did my transfer considered that my level was too low (56) and the doctor who did my endometrium prep considered that the level was good. He told me to start injections of Prolutex if I wanted too. I did it as my two previous successful transfers had worked with high levels of progesterone since the beginning so I started Prolutex the day following my transfer.

I don’t have the knowledge to answer your first point, as my protocole is different:

Good luck with everything to your daughter.

Nora Bene : progesterone is continued until 8 to 12 weeks depending on her situation and clinic.

[Goldenfeather123 in reply to Sarah770]

Hi, thank you for your reply. Very thoughtful and informative! Just one quick question: what's the unit of your progesterone figure (56)?

Good luck to your own journey!

[Sarah770 in reply to Goldenfeather123]

I believe it is nmol.