Lubion / Low Progesterone

[RiverRiot]

Hi I’m wondering if anyone can give me advice/their experiences of Lubion and/or low progesterone?

In my fresh round I started spotting from 6dp5dt and although I got a BFP the bleeding continued to get worse and ended in a pretty horrific MC.
Even though my Beta HCG was always good, my progesterone was only 35 and I’m convinced this had something to do with the bleeding and MC.

My clinic don’t believe low progesterone has anything to do with pregnancy outcomes and are totally unconcerned about the bleeding because it’s ‘so common’.
They have, however, agreed to give me 1 x Lubion for my FET but this is purely because I had a reaction to the cyclogest last time.

My concern is that I’ve only ever heard of either having Lubion alongside pessaries or 2 x Lubion a day.
Has anyone had just the single injection a day and it turned out ok?

@RiverRiot In 4 IUIs I never once made it through the TWW without my period stating early. On my first fresh IVF transfer I started bleeding/period from 4dp5dt BFN not surprisingly when period started so early. My clinic also said not a progesterone issue as was on cyclogest but they never tested levels. Following FET though I had 1x Lubion a day for 5 days prior to transfer and estrogen and Utrogestan 3 X day and had a chemical pregnancy. My current cycle is a freeze all, so we'll do all transfers as FET from now on as only thing that's ever remotely worked. Best of luck to you

@RiverRiot Warning, Lubion was really expensive, and only injection to give my bruises.

Hi @RiverRiot I'm sorry about what's happened. I started spotting from 7dp5dt in my fresh cycle and was told this is normal given my BFN as it's the equivalent of 13dpo. They don't tend to be as concerned in fresh cycles with progesterone levels as the follicles should have formed corpus luteums and should be releasing progesterone in addition to the prescribed progesterone. There is no minimum level of progesterone that specialists are happy with, some are happy with over 20, others 30 and my specialist likes it to be over 50. Clearly as your pregnancy resulted in a miscarriage making sure the progesterone is appropriate is going to be important and you may want to aim for over 50.

I have progesterone hypersensitivity which has complicated my situation. I reacted to utrogestan but it turns out it's progesterone that I'm reacting to rather than one particular formulation. An immunologist is content that I'm ok to take it though.

I take 1 x lubion and 2 x 400mg cyclogest as when I took 1 x lubion and 1x 400mg cyclogest my level was 46. If you're on a medicated FET rather than a natural/unmedicated FET then I agree that starting on a higher regime would be better, as you won't have any corpus luteum there.

You could ask to add in 2 x utrogestan 200mg to the lubion in the first instance. Insist on a progesterone level taken the day before the transfer so they can titrate it up if needed.

Thank you ladies, I’m sorry you’ve had this happen too and it sounds like you’ve both been through the IVF mill. It’s so rubbish.

@Gardenlady543 This is exactly my point. For the fresh cycle I had 18 eggs collected and was on 2x cyclogest so there ‘should’ have been enough progesterone but I’m going to have to rely solely on the Lubion for the medicated FET, which I’m not happy about.

As you say, there’s no agreed cutoff so my clinic flat out refused to monitor me.
They did say I could have a beta on test day but that feels entirely too late and they wouldn’t up the progesterone anyway even if it was low.

@2mumlife I’ve heard the Lubion is expensive and this is an NHS round so maybe that’s why they’ve just given me the one a day and as the cyclogest caused burning/itching the Dr was reluctant to give me any type of pessaries this time.
I really don’t mind paying for more progesterone on top if it’s a financial thing but I just feel like I’m bashing my head against a brick wall.

I’m currently chasing my Dr about upping the dose but I’m pretty sure she’ll refuse so I’ll be left with the choice of either taking a risk (and probably waste an embryo or go through another MC) or cancel this cycle. Gah, as if IVF isn’t hard enough as it is!

@RiverRiot did you try the cyclogest rectally? That's how I use it, I'm not keen on any vaginal medication as I've had issues with my uterine microflora and I don't want to risk that happening again.

If suppositories are out then I think you've got two options:

1. Ask them if they can increase to 2 x lubion.
2. Consider progesterone in oil, this has to be injected into the muscle, it's easier if someone can inject you, if that's not a possibility people have reported doing well with an autoinjector.

I'm currently on a 2ww and I'm on 3x 400mg cyclogest AND 2x 25 mg lubion a day. The clinic I'm with are very hot on progesterone, they give everyone high dossages (maybe not as high as me, I'm over 40). Their view is that they don't want low progesterone to be a cause of MC (or atleast that's how they've explained it to me).

*Just to add, this is private treatment so they don't hesitate to give medication. Not sure whether that much progesterone is needed (but happy to pay for the medication).

I had 2 x cyclogest per day and 2 x lubion per day. This is because I started bleeding before my OTD and have a short luteal phase. My consultant said it would be worth trying lubion until OTD. After that I increased cyclogest to 3 times per day. Due to some bleeding at 5weeks I asked to be put back onto lubion which they did.

@Gardenlady543 I did, it wasn’t ideal but definitely better. I wish I had done it from the start really but the nurse at EC was adamant it had to be vaginally.

@Bryterlayter1 Wow that is thorough! My clinic pride themselves on being evidence based so they won’t entertain anything new until it’s been tried and tested to the absolute nth degree. But as they do private as well, I’m really hoping they let me pay for the extra, even if it’s just to shut me up! Ha.

@MeAndZig My luteal phase is generally fine but we’re in the annoying ‘unexplained’ camp so something somewhere is not quite right. I don’t blame you for going back on the lubion, hope you didn’t have any more bleeding after that and all is going/went well?

Same here, in the unexplained infertility camp too. I’m currently 29 weeks pregnant and so far going well. I didn’t have some bleeding early on but that’s cleared itself now. Wishing you the very best of luck for your next round and hope lubion is the missing link for you

@RiverRiot We only had the Lubion on the run up to transfer, then just the Utrogestan. You have to take that vaginally though. I found it better than the cyclogest (which I also took rectally). I think my hormones were just completely out of whack on our fresh cycle - I felt emotionally awful, massive crash from right after egg transfer.

@RiverRiot oh, well I've got no idea why the nurse was adamant about the route. Utrogestan is only for vaginal use but cyclogest can be used either rectally or vaginally.

@MeAndZig Thank you and congratulations!

@2mumlife I’m sorry you had such a hard time on your fresh transfer, I think all these drugs we’re pumped with definitely do crazy things to us! I hope your next one goes a lot better. Will you be having the lubion up to and beyond OTD for your frozen transfer?

@Gardenlady543 Yeah and I only asked because I was planning to do rectally and just wanted to double check. To make matters worse I was on a thread where the ladies who did back door all got pregnant (and I assume stayed pregnant) so now I have such regret about listing to that grumpy little nurse!

So I chased my Dr yesterday and sod’s law she’s on holiday. 🙄 I have some leftover cyclogest so I’m just going to tell the nurse at my scan on Friday that I’m going to take one a day on top of the lubion whether they like it or not.

@Gardenlady543 I meant to say before, I’ve not heard of progesterone hypersensitivity. Does that mean it’s really unpleasant for you to take? That’s got to be a right PITA on top of everything else.

That sounds like a good plan @RiverRiot I would do the same if I was in your situation. Just make sure you can get a prescription for when you run out.

Progesterone hypersensitive is a rare condition where people react to either the progesterone produced by their own body or external sources of progesterone. It's essentially an allergy. It would be me that got it! In my fresh cycle I got a symmetrical rash on my body which was itchy and hot, my specialists said we had to cancel everything but we ending up going ahead and changing me to another form of progesterone, which also caused me to react. At this point if I stopped taking the progesterone the embryo would have died but it I carried on I might go into anaphylaxis, so I had to have an epipen on me all the times. A few months later I was seen by an immunologist, they concluded that I'm ok to carry on with progesterone. So I still react but it hopefully won't kill me! Just another stressful situation I've had to deal with during this process.

Hi all.
We had a failed fresh ICSI cycle in May/June and recently a failed fet. Both privately funded as sadly no nhs funding in our area. It was only on the fet that they did a blood test (on transfer day) to check my progesterone levels. My results were lower than they would like (16 and they wanted atleast 30 by transfer day) so they added Lubion ... 48 hours after transfer. Bearing in mind I had been on 2 x cyclogest and 1 crinone gel for over a week it clearly wasn't enough. Progesterone was never checked on my first cycle, god knows why given its a key hormone needed for pregnancy, nor was it checked on my earlier on my fet. I was disappointed after spending thousands of pounds this hadn't already been done, especially given they test for all sorts of other things at the beginning of treatment.
Just wanted to highlight it on here - as it is something so simple yet not tested routinely. We have unexplained fertility and I am healthy so I'm now wondering if progesterone is the missing ingredient. I just assumed as I had some prescribed in my meds it would be enough, but clearly not. Maybe early checking would prevent some failures? Who knows! X

Hi @C1aire85 after I bled early in my fresh cycle (even though they told me this is expected), I insisted on a progesterone level which I paid for with my clinic (I think it was about £50), they did this the day before my transfer on my next FET. It isn't done routinely at most clinics and I agree it probably should be, at least in the first FET cycle.

It sounds like despite quite a lot of progesterone you are struggling to achieve good blood levels, have you considered progesterone in oil, this seems to be used in people in your situation.

If your clinic refuse to check your progesterone the day before transfer in the next cycle then you can arrange a check privately through medichecks, but it will be better if your clinic does it.

@Gardenlady543 Yikes that does not sound fun at all and probably pretty scary during your fresh cycle. I’m assuming natural FET is not an option for you either if you have to forge ahead with the progesterone, what a pain!

@C1aire85 I totally agree that progesterone should be checked, especially if private. I think it’s becoming more common but a lot of clinics still haven’t caught up yet.

My clinic just say that there’s no agreed level and plenty of women get pregnant and stay pregnant with low levels. It’s mad to me though considering the cut-off for ovulation to happen is usually 30, you’d expect them to want it to be at least this.

I personally believe that some women just don’t absorb the pessaries well - although again I’m sure my clinic would beg to differ about this.

There was a study that came out last week that saw a 44-46% live birth rate with the intramuscular progesterone vs 27% vaginal progesterone (it was an American study I believe and I think it was based on the vaginal gel rather than pessaries). In the same study half of the pregnancies in women receiving only VP resulted in miscarriage so I’m convinced there is something to it.

Hopefully there will be more research and at some point there’ll be a consensus but until then we just have to advocate for ourselves.

Hi all! I know this is an old thread, but it's been quite helpful for me. Thank you 🙏🏼

@RiverRiot we have an FET in 2 days, following 2 IVF early losses (5-6 weeks). We've since found out I have Hughes syndrome and today my progesterone results came back at 40.8, so I'm wondering how you got on? I'm catastrophising my level is still too low, but they've said no need for Lubion as it's over 30! Not sure if I should push for it or just over thinking 🙈

I hope everything has worked out for you x

@VioletCookie Have just seen this. I'm So sorry you've been through such a tough time, that sounds so hard and I'm not surprised you're feeling anxious!

I ended up taking 1x Lubion and 2x Cyclogest per day.

For me, I just felt like I had to feel as though I'd done everything I could my end and my Dr agreed that there's no known harm in taking higher levels of progesterone.

I don't want to upset anyone reading this but yes my round was successful. I did bleed on and off all the way up until 15wks which was pretty scary but stopped the lubion at 12wks and cyclogest at 16wks.

I think it's up to you whether you want to push for the lubion but I would suggest that you take your progesterone up to 16wks as the guidance for recurrent loss now recommends this I believe.

I wish you every success for your FET and will be keeping everything crossed for you.

@RiverRiot thank you for your reply and I'm so pleased it all worked out for you!

I spoke to the nurse yesterday, she said that my level is was very good and taken 2 days before the transfer, so it could well have increased by today. She also said if my level had been between 30 - 35 they would have given me the option of Lubion, but they didn't believe there was a need for it!

I've been feeling so positive, had the FET this morning, started on inhixa this evening and 2 hours later noticed brown spotting. I'm not sure if this is an effect of the transfer, the embryo failing or something to do with the inhixa! Feeling absolutely shattered and not prepared to deal with the heartache if it doesn't work again 😔

Hi all,

Know this is an old thread but this was very helpful to read as I am currently in the situation where clinic has asked if I want progesterone injection on top of utrogestan for my next medicated FET cycle after I asked if I could get extra progesterone support as my first fresh transfer failed. They said it was up to me and theyre happy to give me extra progesterone.
I am leaning more toward doing a long protocol (down regulation with Buserlin) and wondered if anyone had the long protocol with extra progesterone injection supporr?

I was given Lubion plus 3 X cyclogest for my frozen cycle as I bled before the test date after my fresh transfer. I also had short cycles so it was probably the right thing to do and resulted in a positive test. As far as I'm aware it doesn't hurt to take too much progesterone but please check