Extremely high progesterone on embryo transfer day

[Summerishere83]

Hi all
I had a double embryo transfer yesterday and asked the clinic for a progesterone test for reassurance in case of too low levels. I have been taking progesterone pessaries 3 times a day since egg collection on the 23rd August 2023. I didn't expect result to come back 3 times the clinic's top normal range so 225nmol/l. Plenty of scientific articles I googled say that's detrimental to endometrial receptivity, implantation etc. The doctor yesterday said it was high but didn't recommend coming off the pessaries.
However, I'm really worried we've wasted 2 of the 3 embryos that we got over the last year of 4 attempts at egg collection.
Any advice and experience would be much appreciated! Xx

Hi,

Not sure how much help this is but I've done 4 transfers (2 fresh, 2 frozen), first resulting in a miscarriage, 4th resulting in a pregnancy (currently 9.5 weeks pregnant :)

Previous to this transfer I remained on the same level progesterone, I asked for them to increase this round which they did. I was paranoid that it would still be low so I paid for a private bloods test which showed a level of 132nmol/l (the nurse actually called me to confirm I was pregnant as her words were, 'your progesterone is through the roof'). Obviously that comment made me panic so after frantically googling I found there was no proven harm to you or the embryo for increased levels. My clinic has never tested my progesterone's levels even before starting the IVF and happily increased the dosage on my request. Surely if it was harmful they wouldn't do this without testing levels first.

Now pregnant, I'm adamant that the increased progesterone helped me implant (obviously ill never know this for certain but its my little theory lol). Good luck in your journey I hope all works out well for you :)

Hi @SH998 congratulations on the pregnancy, very good to hear! 🙂
Thanks for your words, it helps hearing it from someone else that it should be ok, just still my levels are really strikingly high I guess the next few days will be an agony and this will be a hard lesson learnt about things to watch out for next time.
All the best xx

Hi my lovelies
I want to know if anyone experienced period before confirmed pregnancy . Currently taking only cyclogest pessaries twice a day.
My fresh embryo transfer was on 21/08/2023 and today is day 9 . Yesterday I spotted and today its a full bleed 🩸. My test is tomorrow but clinic said if its full bleed we don't do bood test . I am so alone and not sure what to do
please any help or experience would be much appreciated
preet

Hi there @Preet89
Why don't you do a test? I'm sorry to hear about the full bleed, it's always a worry. When I had a positive and started to bleed I unfortunately miscarried early. But I've seen posts where it might be still alright, I'd do a test. Xx

@Preet89 sorry to hear about the bleed :(

The only experience I have with bleeding before test day was unfortunately not a good result. On 2 of my transfers I bleed within 7 days of my transfers, first one I was actually spotting on the day of the transfer and continued to spot with heavier bleeding within 5 days. The other transfer I started spotting then bleeding by day 7. Both results were negative. They say the pessaries are meant to stop bleeding but in my instance it was like my period was coming regardless of the medication.

Please don't think this is the case for you, I've seen many women on this forum who have bled leading up to test day and still had a positive outcome.

It can be such a lonely journey and no one can truly understand the effects on us unless they have experienced it first hand. Wishing you all the best :)

Thanks ladies but I definitely feel negative this time I have been testing from day 5 and until today it came as negative
I hve not seen positive results once
Good luck to you all!

@Preet89 I'm so sorry to hear that, its a long, brutal journey. How many transfers/collections have you had? Have you been diagnosed with a problem or unexplained? Mines unexplained which is a useless assumption to make as there is clearly an issue.

Don't give up, it can happen I'm living proof of that x

Hi there I still have 2 frozen, embryos which I'm not gonna sure when they gonna transfer I'm still bleeding and it's like my regular period and cramping. According to my app I was due yesterday on my period which I started but not sure if this happens in IVF as well because I never heard anyone got period within two weeks wait. I'm not giving up and praying for all the ladies out there those are struggling like me x

@Preet89 well 2 still frozen is great news, at least you wouldn't have to do the stims again. I'm not sure how common bleeding is in the 2 week wait but as I said I bleed both times within 7 days, I suppose it will vary person.

Take your time and don't go ahead until your mentally ready, its hard on the body and the mind.

The only thing that changed on my 4th transfer was they upped my progesterone. First 3 cycles I was on just 2 pessaries a day, on the fourth cycle I was on 2 pessaries a day, 4 estrogen and 1 Lubion injection. Who knows if this was the reason for a positive outcome or whether it was a better quality embryo.

Sorry to hear that you've been getting BFNs @Preet89 , we all know how this feels :( but it's good that you have 2 more embryos, it seems that every cycle is trial and error and like @SH998 says you should discuss upping progesterone next time or do something different. Either way, take your time to heal and take care of yourself xx

Hi @SH998
Something I meant to ask, why were you on estrogen injections too? I haven't heard that's needed in the luteal phase before.
I have sharp stabbing pains today which I absolutely always get on cd22-23, a week before my period. I was hoping if I didn't get them this time, transfer might have worked but I did :( and since I'm taking progesterone, the other reason for always having these pains must be dropping estrogen levels?
Thanks in advance xx

@Summerishere83 I'm not sure why they prescribed estrogen on top of the progesterone, I'm sure it does a similar job to the progesterone. I've just checked my notes and I've always taken them with transfers but only 2 previously, they upped it to 4 this time. The meds are called Progynova, worth a google I suppose.

It appears that different clinics have different processes.

Sorry to hear your having stabbing pains, could it possibly be implantation pains?

Thank you @SH998 !
I guess it could be implantation pains if I didn't have them regularly:( but there's always a chance it's a different reason this time, it's only 3dp5dt 🤞🤞🤞 just feeling very apprehensive now.
I've googled Progynova, looks like they're standard if you do a FET, mine was a fresh cycle transfer. Many things to look into and consider if we have to do a FET with the last embryo, perhaps it was a waste and very naive to go with 2 embryos at the first try :(

@Summerishere83 I had implantation pains the afternoon of day 2 and 3, quite sharp stabbing pains towards the lower left, not constant but a few at a time every few hours this time so you never know. They do also say that the progesterone can be similar to pregnancy symptoms. I personally have never experienced any such symptoms from the progesterone but everyone's different.

Its a massive learning curve and I leant something new on every transfer and I'm sure there's still a lot more to learn. Unfortunately everyone reacts differently so what's good for one is not always good for the other so its hard sometimes when asking for advice as it might not relate to you. I found these forums great as there are so many ladies with different views/experiences it really opens your eyes to the whole IVF process.

We put 2 embryos back in on one of our transfers, sadly that failed but hopefully that will not be the case for you. Do you know what grades your embryos were?

Hi @SH998
Yes, forums help a lot! It's unbelievable how many questions I have all the time and the amount of time I spend researching them.
We put in 3bb from the fresh cycle and thawed 5bb from the frozen embryos, against the doctor's recommendation not to transfer two but I'm 40 and have low AMH and AFC, 1 chemical and 1 early MC conceived naturally so I thought my main problem is the quality of the eggs. If they allowed, I'd have put in all 3, so no one else to blame really. The last embryo is 4cb.
How about you? What grades embryos did you have for your previous attempts as well as this lucky one? :)

One last question @SH998 if you don't mind, when did you do a test and when was it positive?
Thanks a lot xx

@Summerishere83 any questions, ask away, I'm happy to help if I can. My first pregnancy ended in miscarriage, that test showed positive on the morning of day 7, it was really faint so not sure if it would have shown any earlier had I tested sooner. This pregnancy showed positive on the evening of day 5, it wasn't super strong but it was clear there was a line. Day 6 showed a line immediately.

The fist transfer was a 5BB (ended in miscarriage), the second transfer was frozen from the first collection and I think was a 4BB, that failed to implant.

The third transfer was another fresh one and that's when we put 2 grade AA's back in, they failed to implant. I was absolutely gutted as supposedly top grades which failed. This transfer was a frozen and was a 5BB, I've had 2 scans and all is going well, hopefully it will continue, I have everything crossed ill make it to the finish line with a healthy baby. We are lucky enough to still have 2 frozen, grades are 3bb and 4bb should we decide to try again after this one. Try not to get caught up on the grading, a top grade embryo doesn't always work for whatever reason, I appear to be very lucky with 5BB's lol.

What I was told after the miscarriage which I did take some small comfort in is that I DID get pregnant which up until then I never had so it showed it was possible. This is also the case with you so its matter of 'when the time is right' and not an impossible task.

Also, don't get caught up in symptom checking, this time I've had barely any symptoms and the ones I do have come and go and were later along in the pregnancy. Some days I don't feel pregnant at all, other days I feel a little sick but nothing major.

When do you plan to test?

Hi @SH998 thanks a lot for all the details and advice!
Yes, I wish you all the best and a happy and healthy pregnancy! ❤️ It does sound like you had good quality embryos, just perhaps timing or something else wasn't exactly right.
I'm ok with the grades, I think if they were good enough to freeze and survived thawing, they must be good enough at this stage, plenty of success stories with lower grade embryos around.
I have been testing since the day after the transfer to see if hcg from the trigger is still there. Yesterday and today's tests are entirely blank. Planning to test every morning because it will be important to know even if it's a chemical only.
Will be looking forward to testing on Sunday when my day 6 will be 🤞🤞🤞

@Summerishere83 thank you for your kind words :)

I honestly think in my case my body just wasn't ready for them, mainly due to progesterone (I'm the only one who thinks this, no one has said anything more on it lol).
Your right wit the embryos if they are good enough to freeze and are successfully thawed then your already onto a good thing. That's how naïve I was first transfer, I didn't even know about the trigger shot, therefore didn't test it out.

Good luck with your testing, so far you haven't said anything negative about the transfer/after affects so hopefully you will see those 2 little lines in a few days :) xx

I can't thank you enough @SH998 !
Your comments have really put my mind at ease so perhaps I will stop obsessing and relax a bit.
I hope you also had great support during everything you've been through, it's amazing how women here find a way to just keep going and hoping, despite the odds. Maybe it was the progesterone that made the difference :) which sounds logical after all, in fact the clinic should have suggested this instead of repeating the same thing after multiple failures and losses.
Perhaps having too much progesterone isn't a problem, either after all. We'll see xx

Hi @Summerishere83 just to reassure you about the progesterone, there are a number of studies which tried to find an optimum level of progesterone, these worried me too, but it's important to note the very specialists clinics and reproductive immunologists in London that have a high success rate aim for progesterone levels over 100, I am currently 20 weeks after several years of Ivf and you can see from the image attached how high my progesterone was. The level where it had dropped is after I came off supplements in the second trimester and I was worried by this so went back on. Many people have success with levels including over 300.

Hi @Gardenlady543 thank you so much for this graph! It is very interesting and reassuring, I sent it to my husband too as he was very disheartened too. I guess I was worried because of this window of implantation talk that is governed by progesterone levels. I came across a clinic in the US explaining on their site that based on those findings about high progesterone on day of trigger negatively affecting implantation they test it and would cancel a transfer if too high. But all is done now and Create Wimbledon with which I am told me if I don't get pregnant it's unlikely it would be because of the high progesterone. They're not worried therefore not testing it I suppose.

Congratulations on your pregnancy! Very happy to hear you've been successful and everything is going well, all the best ❤️

I'll be keeping my fingers crossed that our 2 embryos were not wasted and have a chance 🤞🤞🤞thank you all for your comments ❤️

@Summerishere83 I really don't get these articles and this opinion as in very complicated patients like me, the specialists want progesterone as high as possible. And the issue is having a low level at the time of transfer, although it's been shown that increasing up dosage at the point of transfer leads to the same success levels as those who already had a good level. The issue with the implantation window is the time since the progesterone was started rather than the actual level. So in a fresh cycle some clinics do a blood test before starting and if it's raised then the window would be displaced and they would do a freeze all. Most clinics don't test for this though. For what it's worth the window of implantation is pretty poorly understood and the ERA test which looks at RNA in an endometrial biopsy and then adjusts the timing of a transfer based on this, is having numerous studies coming out showing it makes no difference.

Hi @Gardenlady543 yes I have looked into ERA and it's not something I'd pay for at this point because of conflicting reports but the window of implantation must be a real thing and my clinic should have known better...
I do appreciate the positive messages here though and I'm more relaxed now so will just have to wait and see.

All the best ❤️

@Summerishere83 please don't worry about progesterone levels. Your level at trigger will be very different to your level at transfer. The studies are talking about levels at transfer. The most successful clinics tend to go for super high levels and most women there have levels over 200 or higher on transfer day. There is no negative impact from high levels other than potential side effects for you.

Yes as others have said oestrogen is prescribed in medicated cycles because the body's natural hormone balance has been switched off. I also had it prescribed in a natural cycle in which I triggered with burserelin due to risk of OHSS because burserelin also switched off natural hormones.

Have everything crossed for you and hope it works out xxx