What was your progesterone med regimen for your FET?

[Meliana]

Hi everyone, I'm preparing for my seventh and final FET transfer in two days, so I want to do everything possible for this to work. I have been taking 50 mg IM progesterone daily and a 200 mg progesterone capsule suppository at night. This was the same regimen I did last time, but today my doctor checked my progesterone level and it was high at 59.

I read research that a progesterone level over 20 ng can negatively affect implantation and live birth. So when I asked my doctor if my dosage needed to be changed- her nurse replied that I should switch to 50 mg IM injection every other day and 200 mg suppository three times a day. Anyone else check their levels before FET- and what was your successful progesterone regimen? Would love to hear what your clinic does and if they check progesterone levels - what was your number before FET? Hoping all of us determined women on this incredibly difficult IVF journey have success.

[Twiglet2]

I had 2 pessaries a day (one in the morning and one at night) and one lubion injection daily.

My levels were high but your body just absorbs what it needs so there isn’t really a ‘too high’ is what my clinic said. Also your progesterone fluctuates through the day so the test isn’t always helpful. I’m 36 weeks pregnant on that protocol. I wouldn’t ‘drop’ a dose of progesterone personally once you’ve had transfer but perhaps before hand could be okay….I would defo double check with your clinic though as wouldn’t be my choice to bring levels down at 59. That’s doesn’t seem that high at all! Good luck with everything! Xx

[Meliana in reply to Twiglet2]

Thanks for taking the time to reply and congratulations on your pregnancy! Good to know that your levels were high and you were successful. I'm wondering if you don't mind sharing - what was your dose of progresterone that you were taking when you say you were doing two pessaries (one in morning and one at night) and an injection daily?

[Twiglet2 in reply to Meliana]

Thank you! Pessaries are 200mg but sorry I can’t remember the dose of lubion it’s the standard dose though from one vial of that helps! X

[Tinkertinkerbell]

Hi, mine was 3 Cyclogest suppositories a day. That was my clinics standard and they didn’t check levels prior x

[Meliana in reply to Tinkertinkerbell]

Thanks for letting me know. The last clinic didn't check my levels prior either but this one does. So of course I made the mistake of looking online about research on ideal levels of progesterone and got worried. Glad that protocol worked for you.

[Goldenfeather123]

Hi, I'm still a learner. Just want to share my limited understanding and hopefully to get much needed advice.

First, there are two types of unit for progesterone: ng/ml and nmol/L. 20 ng/ml =64 nmol/L, 59 ng/ml =188.8nmol/L.

Second, the progesterone support (close monitoring and optimal levels) seemed to be more important for estrogen medicated FET protocols. A research article indicated that the optimal range of progesterone levels on the transfer day was 70-100nmol/L. But in the clinic my daughter is attending, the bottom threshold is 50nmol/L and top ceiling is 200nmol/L.

My daughter has had two failed medicated FET cycles. Next, she may try different protocols. We need to better understand how progesterone support is used in natural, modified natural, and mild-stimulation FET protocols. I thought for these protocols progesterone support was not essential because your own follicles would produce enough. But I could be wrong. Perhaps, moderate progesterone doses could help and wouldn't do any harm? And no need to do close monitoring?

Hope to get advice from more acknowledgeable people.

[Brillanni25 in reply to Goldenfeather123]

I used a modified natural protocol. You are correct that with natural protocols, progesterone support is not indispensable as your own follicules will be producing progesterone. My doctor explained in sub fertile patients sometimes the progesterone production isn’t enough, or simply even when that’s not the case “it can’t hurt”. That’s very much a safety net more than anything and is proven to lead to higher pregnancy rates so many doctors will supplement at least with pessaries.

Also the measure of progesterone isn’t ways accurate from what I understand as it will vary depending on the time gap between the patient sample and last supplementation dose. Therefore results can vary quite dramatically throughout the day. Serum progesterone also isn’t always representative of progesterone actually absorbed by your uterus. Because of that, clinics usually have a wide range of what’s acceptable and in mine doesn’t even have a ceiling.

Hope that’s helps.

[Goldenfeather123 in reply to Brillanni25]

Thank you, it's helpful!

[Meliana]

This is very thorough your research and thanks for sharing it in such detail with me. It's hard when you have had several failed transfers to not over analyze every aspect of the next transfer. In my case, this is a fully medicated cycle. I'm sorry to hear your daughter hasn't had success with the last two fully medicated cycles. Has she discussed possible modified natural protocol with her doctor? I understand that can be equally as successful. In my case this change in protocol did not work but I have other immune issues and later was diagnosed as having likely silent endometriosis so I think those issues have been a barrier for me. Wishing your daughter the best and hoping we both have success on this IVF journey!