Progesterone for frozen embryo transfer

[Yurtle]

Hi all. I’m really unsure about what my clinic have prescribed for my upcoming frozen embryo transfer. I’ve got a complex history of pregnancy loss and have previously been prescribed injectable progesterone rather than or as well as pessaries. This time I’ve got pessaries only and am now really anxious about it.

Please can those who’ve had IVF say what your progesterone protocol was (type of medication and dose) and if possible if it was a fresh or frozen transfer? I’m boring poor DH with all my worrying!

[LillyLeaf]

My fresh was only X2 Cyclogest a day. My FET started with X2 Cyclogest (or maybe 3, sorry I can't remember, but did end on 3) and x1 lubion injection that increased to 2 lubion on OTD as my progesterone was low, I did have a MC and always wonder if that had something to do with it. I get my next FET drugs protocol tomorrow so I will update. I'm also going to ask them if I can have an earlier progesterone test to check my levels.

It's so stressful isn't it.

[Mmr224]

I had a fresh donor egg transfer and had 3 x 2mg estrogen tablets and 3 x 200mg progesterone pessaries over the day. Because its donor ivf I don't have a corpus luteum producing hormones until week 9-10 when the placenta takes over so all my progesterone is coming from the pessaries.

[itwasalovelydreamwhileitlasted]

I've had 2 frozen transfers both times did 3x 400mg cyclogest suppositories per day

[SnappedandFartedagain]

I had cyclogest but later in pregnancy switched to gestone injections. Try to think of it as a good thing - if you have a history of pregnancy loss whilst doing the injections, surely it’s good that they are doing it differently this time?

[Yurtle]

Super stressful Lilly! Good luck with getting your protocol tomorrow.

Thanks so much everyone for your answers, that’s really helpful. 2 x 200mg a day just seems like too little to me given the previous pregnancy losses (a couple of those I was just using suppositories - I lost those earlier than the ones with injectable).

I agree something different would be good, definitely. But I also read a report of a robust looking 2018 study which found vaginal progesterone to be significantly inferior to injectable (but that was PIO not Lubion). A little knowledge is a dangerous thing, would probably better to just go along with what I’m told!

[Eggcellent29]

For my FET I started with 4 Cyclogest and 3 Progynova per day and gradually reduced them over time

[JeNeBaguetteRien]

I've never done a FET but with your history OP I'd push for good progesterone support.
My progesterone levels drop off after ovulation leading to spotting. My last IVF cycle I started bleeding before official test date when really progesterone should have prevented that (not saying I would have got pregnant but the progesterone support didn't seem to be sufficient).

Always question what you're told, it's a fairly invasive and emotionally draining treatment so at least understand their rationale. If it doesn't work out don't have regrets wondering if you should have asked for this or that. Good luck with the FET.

[Yurtle]

Gosh 4 a day eggcellent that must have felt like loads. Was that 4 x 400mg do you recall. And was it a successful cycle (I hope it was)?

JeNeBaguette (great name btw) that’s just it isn’t it. I don’t want to be a pain but also there’s so much riding on this I don’t want to have another loss because I was afraid to ask. I’m surprised really how little they know about progesterone as it seems pretty important for FETs particularly.

[PrayingandHoping]

4x cycolgest and 1 lubion a day

[Yurtle]

Another one with 4 cyclogest, I got bored of having to do just the 2! Was it a successful one for you prayingandhoping?

[PrayingandHoping]

Was 2 twice a day

Yep! Being induced in 10 days!

[Yurtle]

Ah that’s lovely news, congratulations . Good luck with the induction! Can I just double check something please - if this was a FET did you take the 4 cyclogest for the time before the transfer too? This is the bit I’m unsure what people are doing if that makes sense. Lots of women have loads of progesterone after transfer but what about before?

[PrayingandHoping]

Umm yes I did as i remember being told not to
Insert vaginally the day of transfer. I can't remember how long before I was taking them though. Sorry

[Yurtle]

That’s really helpful thank you!

[JeNeBaguetteRien]

Thanks Yurtle
I know what you mean about being a pain but you can frame it as you want to really understand your treatment. At the end of the day we're consenting to a procedure and need to give informed consent.
Also even if they do think you're a pain would you care if the treatment worked?
I delegated some of the questioning to DH as he is naturally more assertive than me anyway.

[MindatWork]

Hi OP, do your clinic test for progesterone levels?

I only ask as I had 4 failed cycles that all ended in either bleeding before test day or chemical pregnancies. I was only ever prescribed crinone gel or cyclogest, despite asking for injectable progesterone as I was concerned I wasn’t absorbing it properly.

With our last (and successful) frozen cycle with a different clinic in London, I was put on the max dose of progesterone in tablet, gel and injectable form. I started taking it around 5 days before transfer I think?

A blood test at transfer day showed good levels of progesterone but when they tested again on OTD my levels had plummeted and I was urgently put on another injectable form called Lubion.

Not sure exactly what happened or why, but had they not tested again then who knows what might have happened. Please don’t be afraid to ask for what you want, especially if you are paying privately.

Good luck!

[Yurtle]

JeNeBaguette yes good idea about delegating to DH, I do my fair share of this process after all

MindatWork I don’t think I’ve had my levels measured before but will ask this time. They do seem happy to add Lubion after transfer though which is reassuring to some extent. I’m just not sure how much levels before matter too (I know it’s vital to have some but no idea how much). It’s exhausting worrying about all this, I wish I could just be confident it would all work out.

[Blondeshavemorefun]

Started off on 2mg then went to 6mg over the next day so 2mg every 8hrs. Did 7am 1pm 9pm and set phone timer

This was till had scan to check lining around day 12. Then I had to take 800 a day of pesseries. 400 am and pm 12hrs apart so did 7am/pm

This went on till day of fet when didn’t take in am or too messy for them up there

Then I took for 14w - clinic said to take for 12 and stop - was 400 am and pm

I was worried about taking so much then stopping to nothing so weaned self off then and w13 had 400. And w14 200

Think clinic humoured me , they said no need and fine to stop at once as body and placenta then making own

Also took baby aspirin and had daily clexane injections all preg and 6w after due to blood clot years ago

[Yurtle]

Thanks very much Blondes - the phone timer will be essential I think! I’ve not even started properly yet and I’m on 8 tablets a day. Lovely to hear that it all worked for you.

[Blondeshavemorefun]

All crossed for you @Yurtle

I was told needed a steady continuous stream into the body hence every 8hrs and not take all at once in the morning

So yes def a phone timer