progesterone testing during ivf cycle

[Pinkyflower]

hi everyone!

I wonder if anyone can help or has any advice if you have had similar.

I’ve had two failed rounds and transfers this year and both times I have bled full period 3-4 days before the official test date set by clinic. On the 2nd round my clinic agreed to up my cyclogest dose from 2 a day to 4 a day but still the same thing happened.

We have recently had a frozen cycle cancelled due to spotting that started a few days before transfer which we think may have been down to the oestrogen medication that my body did not take to. On this cycle my clinic had agreed to test my progesterone levels on the day of transfer. Which of course never happened as we didn’t get that far.

We have now decided we are going to try a natural frozen cycle next year as we think I may respond better. But the clinic have said they won’t test my progesterone as my body will be naturally producing it and they don’t want to interfere etc. but surely this is the whole point? As if it’s tested and it’s far too low we can do something about it? Even on a natural cycle where I think I’ll be on one or two cyclogest I may need more.

I haven’t had my progesterone tested in about 2 years where it was normal but on the lower normal side. And it hasnt been tested at all during the ivf this year.

I know it may not be the cause of the bleeding before test days but I won’t really like to rule it out and just know my levels are where they should be and it’s not something like that so simple causing the issue.

I’m thinking of booking a private progesterone test over Christmas to time with my cycle now which I’m obviously not taking any ivf medication currently so would be a true reflection of what my body is producing.

has anyone had the same or any thoughts? It’s really playing on my mind.

Thank you so much x

[Thierry101]

hey, not exactly the same but I have had 3 failed cycles in the last year, currently in the 2WW with transfer 4.

We have changed clinic + this one tests all hormone levels for the 5 days leading up to transfer and then every other day after transfer. On day 4 after the transfer my progesterone levels did start to drop so they added cyclogest back in, on top of the progesterone injections I’m doing already,

It’s definitely given me huge peace of mind, so I will push for those bloods!

Sending love x

[Pinkyflower in reply to Thierry101]

thank you so much for your reply lovely! And sending you so much luck and positive wishes for your two week wait.

That’s really interesting that your current clinic do so many hormone tests around transfer. Can I please ask where you are based in the uk?

So good that they were able to increase your progesterone when it was lower than they wanted it to be.

I think I’m definitely going to pay to have a private test this month to see where my levels are at and then if it’s all normal it will be peace of mind. And if it is low I can take the evidence with me on our transfer.

Thank you so much for your reply and wishing you all the best x

[Thierry101 in reply to Pinkyflower]

I’m in Surrey, but travelling up to London to ARGC x

[Pinkyflower in reply to Thierry101]

Thanks so much! Have had some good things about them and how in depth they are

[Thierry101 in reply to Pinkyflower]

It’s like a military procedure, but after the last year I felt like we had no choice but to trust them!

[Pinkyflower in reply to Thierry101]

Aw bless you! Definitely worth it all if you get the results xx

[Thierry101 in reply to Pinkyflower]

I got a positive result, the first one in 4 transfers 🥹❤️💫 they will continue to monitor levels for the next few weeks too so 🙏🏼 everything continues xxx

[Pinkyflower in reply to Thierry101]

Aww this is amazing news! Huge congratulations to you 🫶🏼 all that hard work at your new clinic was worth it! Xx

[Thierry101 in reply to Pinkyflower]

Thank you lovely, obviously very very early days but we’ve never got this far before so absolutely over the moon 💫 good luck with everything, sending loads of love xx

[Sarah770 in reply to Thierry101]

Best answer. I second this and find that your clinic is not doing the right thing.

[Pinkyflower in reply to Sarah770]

Thank you, yes sadly it seems quite a few clinics don’t do progesterone testing which seems such a simple thing in the grand scheme of it! X

[Sarah770 in reply to Pinkyflower]

Of course, very important. Too low levels of progesterone prevents a pregnancy from keeping going. I have never experienced such a thing personally as the clinics I have worked with always test for progesterone! For me it would be a prerequisite! Last pregnancy I had last month we identified that my progesterone was too low on the day of the transfer and we supplemented. Usually I take high levels of progesterone since the beginning as opposed to after the transfer, and it is the first time that I miscarried, with a 4BA euploid embryo. I am sure the lower than usual progesterone level is part of the equation. I will never know. In any event, monitoring the progesterone level is absolutely key and in my view a clinic that does not do that simply does not do it right.

[Pinkyflower in reply to Sarah770]

I’m so sorry to hear of your loss sending lots of love 💗 I do wish our clinic would test for this I can’t believe how many don’t! As you said it should be standard. Thank you for your help and wishing you all the best x

[Hidden]

It might help reassure you if you get your progesterone levels checked out prior to restarting treatment Also wanted to wish you good luck for when you restart treatment

[Pinkyflower in reply to Hidden]

Thanks so much! Yes I’m going to get it tested privately this month for sure it will give peace of mind x

[soccerkt6]

Hi lovely, look into the Proov Confirm tests - proovtest.com/products/proo.... I think they're also available on Amazon. They're at-home (pee on a stick) tests that test your progesterone levels on days 7-10 post-ovulation to make sure that your progesterone levels rise and then stay high enough to be able to sustain a pregnancy.

Before they became available, I was having bloods taken (privately) monthly for about 6 months to check my progesterone levels while we were ttc naturally in between IVF cycles. While this worked, it quickly became quite expensive. I've since used the Proov strips and they were brilliant. Easy to use and you don't need to faff around with scheduling appointments for bloods, etc. xx

[Pinkyflower in reply to soccerkt6]

Ooh that’s so helpful! Thank you so much I haven’t heard of these xx

[Goldenfeather123 in reply to soccerkt6]

Hi, I'm really interested in the progesterone test kit you recommended. Does it give you values with a unit (for example 20 ng/ml or 64 nmol/L)? Can the urine levels be converted to progesterone levels in the blood?

[soccerkt6 in reply to Goldenfeather123]

Hi there. No, the Proov tests don't give you units. The way it works is that you first take a test early in your cycle (before ovulation) to establish what your baseline progesterone levels look like. Then you track your ovulation and take the tests again on days 7-10 post-ovulation. The tests only show a line (like pregnancy tests), but you scan the test strip with your phone using the Proov app and it analyses the strength of the line to determine how much your progesterone has risen. After you've tested on all four days, the app gives you an ovulation 'score' to tell you whether your progesterone rose and then stayed elevated enough to sustain a pregnancy.

If the app shows that you didn't have successful ovulation (meaning your progesterone levels either didn't rise post-ovulation or didn't stay elevated for long enough), then I would look into bloods during your subsequent cycles to find out what your actual levels are.

xx

[Goldenfeather123 in reply to soccerkt6]

Thank you for the clear explanation. My daughter has had a failed medicated FET last month and will do another one in January. We want to find a easy and quick progesterone home test kit because her clinic only offers one test on the day of FET.

It seems the Proov tests may not serve her purpose. We will keep searching.

Thank you very much!

[soccerkt6 in reply to Goldenfeather123]

Ah yes, the Proov tests wouldn't work for checking progesterone during an IVF cycle/transfer. Your daughter definitely needs a blood test for that.

I don't think you'll find a home test kit that would get you the results back quickly enough to be of use; I think paying privately for a blood test at a hospital would be her best bet. She could enquire at her IVF clinic if they'll do additional tests if she pays for them, or she could also look at private hospitals like Nuffield Health as they have a self-referral blood test service.

To be honest though, if her clinic tests progesterone on the day of transfer then I'd be pretty happy with that. If her levels are good on the day of transfer and she takes her progesterone as prescribed, it's unlikely that her levels would then drop enough to be problematic. xx

[Angelikid88]

my clinic tests my progesterone one week before the FET, on the day, and 2 days after. It does sound weird that they do not do it at all….

Good luck!!!!

[Pinkyflower in reply to Angelikid88]

Thank you! It seems like there are quite a few clinics that don’t test progesterone. Which does seem crazy really doesn’t it! When it could be something so simple x

[Angelikid88 in reply to Pinkyflower]

you can do it privately and inform them about the results, it's a really cheap blood test

[Pinkyflower in reply to Angelikid88]

Yes definitely going to do that! I’ve found somewhere local where the test isn’t expensive so will get that done and see what the results say. Thank you! X

[Twiglet2]

Personally at my clinic they say the testing isn’t that helpful as your levels can fluctuate day to day and hour by hour but that they take bleeding before test day as a sign that progesterone could be low. Upping pessaries doesn’t help everyone as some people need it also in another form as they do t always absorb the pessaries as well as others. For me lubion injections from 5 days prior to transfer alongside the pessaries solved the bleeding before test day issue. I didnt take it in fully natural FET cycle though as like you said your natural progesterone is also present but defo maybe something to try adding in the lubion as well as the pessaries rather than upping pessaries more or having the back and forth on testing levels etc? Good luck for your next transfer xx

[Pinkyflower in reply to Twiglet2]

Thank you so much for your reply really helpful! Totally agree with you and I do understand that the bleeding may not be due to low progesterone which the clinic have told me but it may well be. I don’t think we will be offered lubion as we are on an NHS round and I think they only seem to give cyclogest. We can’t pay for anything extra

Hopefully getting a private test done this cycle may at least give a slight insight even though I completely appreciate levels can fluctuate. Thank you so much! Xx

[Twiglet2 in reply to Pinkyflower]

Such a shame! I did get lubion on nhs eventually but had to push for it ( clinic is the same one but gave me it no bother when I was self funding!) it was one less thing to worry about once we added that in as you can’t really have too much progesterone, the cost was about £150 for the full cycle so feels like lots of testing would cost just as much so not sure why the clinics don’t just prescribe it when there is a history of bleeding before test day! I can see why they wouldn’t on a natural cycle though but if you do another medicated one I would absolutely push hard lovely xx

[Pinkyflower in reply to Twiglet2]

Thanks so much for this! It’s so sad that you can be supported by the nhs which is incredible and such a help to so many but sometimes some of these extras which could make a difference you either can’t have, can’t pay to have or have to have a huge battle to get them! £150 is not much at all in the grand scheme of it as testing adds up a lot anyway. Xx

[Twiglet2 in reply to Pinkyflower]

I completely agree with you! Hopefully your private tests will give you some reassurance though for your natural cycle, some of us just have a progesterone wobble when on the eostrogen or down reg cycles so natural could well be the way for you 🥰🤗 xx

[Pinkyflower in reply to Twiglet2]

Thanks so much for your help it’s much appreciated! Xx

[WillowPark in reply to Pinkyflower]

My experience is similar to Twiglet2. I had early bleeding in my first fresh round and then was offered lubion for all subsequent medicated FET rounds (NHS) and didn't have any early bleeding again. My latest round was a natural cycle and they took me back to cyclogest only. I was terrified this was the wrong decision but ultimately went with their judgment. They told me that because when they last tested my progesterone during a natural cycle (18 months prior) it was absolutely fine they had no reason to prescribe Lubion in a natural cycle. They were right and I am currently 33 weeks pregnant. So don't assume what went before will happen again. Different cycles can be very different indeed! In the end I was delighted with the decision as not only was it a BFP but I didn't have to deal with the horrible side effects of lubion or the injections to week 12/16 x

[Pinkyflower in reply to WillowPark]

Aw thank you so much for your reply! And so lovely to hear your amazing news too.

I definitely am going to test my progesterone myself so we can see what it is on a natural cycle before we start the ivf cycle as I think that is key like you said.

And fingers crossed natural will work really well for us too.

Thanks for sharing and all the best with your new arrival soon x

[Pugs079]

This sounds frustrating that they aren’t listening to you. We had one failed medicated round of ivf, which we discussed with our doctor. At the time she said it could be any factor and strongly recommended donor eggs, which both me and my partner were dead against. I’m no spring chicken (45) but after pushing her a bit further she suggested we could test my progesterone levels on the day of transfer and upped my dosage by adding Lubion into the mix.

I know we’re not doctors, but if you are asking for further tests I don’t see the harm in listening to you. Try again to push your clinic, otherwise yes have the test done privately.

Sorry to play devils advocate, but what if the test comes back low and your clinic does nothing about it, what are you going to do?

Wishing you lots of success xx

[Pinkyflower in reply to Pugs079]

Thank you so much for your reply! I feel so frustrated

I feel like I’ve had to do so much research on things myself and if you take the results to the clinic they seem to act on it then but nothing gets suggested prior to that.

Totally agree we aren’t doctors but I do think sometimes we know our bodies and that gut instinct is quite often right.

I think if I get the progesterone levels tested this month and take it to them before starting our natural frozen cycle they will hopefully have to act on it if it is low? It could just be a missing piece xx

[Ginbaby]

I had 4 failed rounds and on all of them I came on my period before my OTD. Each time they upped my progesterone for the next round. For my progesterone to be high enough I had to be on 5 pessaries and 2 lubion injections a day and this was my successful round. I now have a 6 month old tomorrow 🩵.

[Pinkyflower in reply to Ginbaby]

Aww so lovely to hear that amazing news! 💓

It really does make you think that it was the missing piece the progesterone!

Did they test your levels throughout the failed rounds? Or was they happy just to guess the bleeding came from low progesterone and just kept upping it next time? Xx

[Ginbaby in reply to Pinkyflower]

Thank you 💕

I just knew that the progesterone was the problem because the pessaries are suppose to stop you bleeding and they never did. I got my levels checked when I started bleeding and they were low. So I knew to ask for them to up it for next time. On the round that as successful I got my levels checks the day of transfer and a maybe a couple of days after to make sure it was still high. Xx

[Pinkyflower in reply to Ginbaby]

Thank you that’s really helpful. This is why I think my clinic should be a bit more fourth coming with it as we’ve had this bleeding twice and 2nd time with double the pessaries and I really don’t want the same thing to happen 3rd time. I think the progesterone should be taken more seriously. Thank you so much for your help x

[Goldenfeather123 in reply to Ginbaby]

Hi, when you say "5 pessaries and 2 lubion injections a day", do you mean 400mg Cyclogest pessary and 25mg lubion injection?

[Ginbaby in reply to Goldenfeather123]

Yes so 5 400mg cyclogest and 2 25mg lubion a day. Xx

[Goldenfeather123 in reply to Ginbaby]

Thank you.

In your successful round, what were your Progesterone levels before, after, and on the day of embryo transfer (in ng/ml or nmol/L)? And when did you reduce or stop the pessaries and injections?

This is for my daughter. She had a failed medicated FET in November. In that round (with 3x pessaries daily from 5 days before transfer), her Progesterone level one day before transfer was 38nmol/L (below 50nmol/L threshold). So her doctor advised to add a 100mg Prontogest intramuscular injection in the evening, and every alternative days afterwards. Then ~36h after 1st injection (1 day after transfer and ~12h before the 2nd injection) her blood Progesterone was 130nmol/L. I guessed her peak Progesterone level could be > 260nmol/L in the morning of FET (~8h after the 1st injection). It worried me terribly since I believe the optimal is 70-100nmol/L. But the doctor advised to carry on with all medications (until after a pregnancy test ). Sadly, it was negative.

She is going to have another medicated FET in January. The doctor has advised her to start with 4 pessaries daily and add Lubion injections later only if blood test on the transfer day indicates a low level. I think she should use injections from the beginning to achieve good Progesterone levels rather than rescue later.

Any thoughts and advice will be highly appreciated. xx

And, any help from other ladies?

[Ginbaby in reply to Goldenfeather123]

Aw bless her. Well I’m wishing her all the best for her next transfer 🤞🏼💕

I can’t remember all the levels but I do know that on my successful round my progesterone levels on transfer day was 76. On previous ones it was in the 20s or borderline 30s. I do know that I absorbed the pessaries better vaginally rather than rectally even though it’s a lot more messy.

Why won’t the doctor prescribe the lubion with the pessaries? It can’t do no harm in being high.

I also stayed on the lubion till I was 12 weeks and then gradually stopped the pessaries over time which was about 17 weeks. I was concerns about stopping cold turkey and the consultant was happy for me to wean myself off in my own time. Xx

[Goldenfeather123 in reply to Ginbaby]

Thank you very much! Xx

[Bimsie1310]

I think progesterone is so confusing. I did 4 transfers with a previous clinic and all failed. They tested progesterone and it was high enough with just pessaries every time but we tried adding lubion once in case it helped. It didn't. I'm now at a new clinic who don't test and I was super nervous. But I did a natural FET with pessaries only and finally got my BFP!

[Pinkyflower in reply to Bimsie1310]

aww huge congratulations so happy to hear that lovely news!

it really is such a minefield isn’t it. Heard lots of good things about natural frozen cycles so feeling hopeful.

Have a lovely Christmas and wishing you all the best x

[Bimsie1310 in reply to Pinkyflower]

Some people don't get on with natural FET but I am very regular so always preferred it as less drugs in your system. Also since you ovulate your body naturally produces progesterone and the pessaries just top it up. Just make sure your clinic are open every day if you opt for natural as some clinics don't so then there is a risk of cancellation.

[Goldenfeather123 in reply to Bimsie1310]

Hi lovely,

Hope you have had a nice Christmas!

Do you know a clinic in the UK that opens for all procedures in the weekend including Sundays? We tried a few in London, Basingstoke and Oxford but couldn't find one. The best we could get was scans on Saturday. At least two of my daughter's previous treatments were compromised by Sunday closures.

[Bimsie1310 in reply to Goldenfeather123]

Hi, I'm with TFP in Oxford and my last transfer was on a Sunday so I know they do those on a Sunday. I think they said they don't do collections on a weekend as anaesthetists don't work on a weekend but if you are due to a have a collection on a weekend then they give you low dose stims to keep you going till Monday.

[Goldenfeather123 in reply to Bimsie1310]

Thank you very much! Xx