# Is measuring progesterone level before embryo transfer usual practice?



## artistliz (Feb 24, 2020)

I would be grateful for people's insights on here regarding whether their clinics regularly test progesterone levels just before transfer or not? I have just had my 4th and last unsuccessful IVF. It was a FET with our only viable euploid 5 day embryo with my own eggs. I am 43 and very low AMH with now no realistic chance of further egg collection. I was told by the clinic which is formerly the Bridge in London Bridge,  now known as the London Women's clinic that the progesterone level didn't need to be tested. I would be grateful for people's feedback if possible please.
Thanks very much everyone


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## kittykat76 (Jan 17, 2016)

I replied to your comment on other thread also- personally think progesterone should be tested on day of transfer,my level wasnt checked until beta with my 1st fet and it was only 10 (clinic liked it to be over 30) and I was put on injectable progesterone,sadly I miscarried the next day and when I questioned the clinic manager she told me they don't know if prog is low due to pregnancy failing or if pregnancy failing due to low prog. My hcg was 409 so I think it was the latter. After that they started testing on transfer day


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## artistliz (Feb 24, 2020)

Thanks so much KittyKat for taking the time to reply to me again. I am very sorry to hear about your pregnancy loss and the circumstances.  In a way I wish there wasn't so much evidence based research out there which I've now come across showing that progesterone levels are key for implantation, as I could be at peace. But now it's completing tormenting me that the clinic said it wasn't necessary to measure. I am going to talk with the consultant next week and try and get some answers. Desperately need to be able to move on from this and not fixate. But very hard to understand how a clinic could make this decision when we only had one viable pgs tested embryo. I find it strange when clinics are obsessed with statistics...surely a clinic would try and do whatever is best practice to try and achieve a pregnancy?


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## Stacey10 (Jun 7, 2013)

I absolutely agree that it should be tested on transfer day also, and adjusted if necessary, you see so many ladies bleeding before test date etc and if their progesterone was high enough this wouldn’t happen. If your clinic doesn’t do this as routine, (many clinics don’t) I would ask to have it done for your own piece of mind.


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## artistliz (Feb 24, 2020)

Thankyou for sharing this Stacey. I would like women not to go through what we have. So we are hopefully going to get some answers from the clinic next week to try and understand their rationale as they refused to test my progesterone when I asked twice in the days leading up to my FET.  Sadly too late for us now as I am too old with too low AMH for any further IVF with my own eggs. But hopefully our experience can help change things for other people in the future.


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## missl73 (Mar 12, 2018)

With a medicated FET where you are not producing your own progesterone I think it should be tested the day before not the day of transfer, by transfer day if it’s low there isn’t enough time to correct it to stop it impacting implantation. I had a FET with a 5AA that failed to implant when my progesterone levels on day of transfer were very low (19) - they put me on prontogest but I think it was too late to help achieve implantation and it failed. I insisted that they test me before transfer for the next FET with a 5AB and I also started prontogest as well as pessaries 5 days prior to transfer, my levels were over 200 and it stuck I now am 28 weeks. Out of 3 transfers I’ve been pregnant twice (one resulted in a MMC at 11 weeks - all top quality blastocysts). I am absolutely certain the only thing that stopped my perfect-graded second embryo implanting was my low progesterone. 

Prontogest (intramuscular injections of progesterone in oil) are the gold standard for progesterone administration. Yes they’re unpleasant, it’s a very big needle and more expensive but it works and is absorbed much better than anything else. For a medicated FET I would always insist on it in the future.


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## artistliz (Feb 24, 2020)

Thankyou for replying Stacey and sharing your story. I'm sorry about your pregnancy loss. Wishing you all the best with your current pregnancy. Why wouldn't a clinic considering all the evidence test progesterone a day before transfer? Wouldn't they have their patients' best interests in their practice?


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## hannahdaisy (Oct 23, 2016)

We had our treatment at the Lister Hospital and they didn't test it as standard. My first cycle was medicated so that I could line up my cycle with my partner and the lady that would be receiving half of our eggs. They did during my practice run of drugs and it was slightly low, but didn't for the real thing. Luckily, a member on here suggested that I should ask to test it on transfer day, just in case. I did and it came back low. I was able to collect Prontogest the next day and start taking that. The pregnancy was successful and I now have a 2yr old from that cycle.

For our second cycle we did a natural FET and they said I wouldn't need to have it tested because my body would naturally be producing progesterone, but I said I wanted it anyway for peace of mind. They were right and it was high, but I still wanted to be sure!


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## Northern (Sep 26, 2015)

This is a topic that's suddenly become very relevant to me too.  We've recently had treatment with the Lister doing egg share, after 5 unsuccessful rounds with Gennet in Prague.  Gennet never mentioned progesterone, never tested it, so it didn't even cross my mind to have it tested. 
With my fresh cycle egg share round in November, the Lister tested progesterone at each scan leading up to ec; 5 days before ec they said it was too high and they would recommend a freeze-all.  They tested again before ec and it was still too high so we froze everything from that cycle. 
We've just been back for FET and I asked about progesterone testing; they said they didn't test it as standard in a natural FET as your body will be producing it anyway, it's a different scenario to stims where your natural hormones are overtaken by all the drugs.  I did request it though based on what had happened in our fresh cycle; levels came back spot on at transfer and they were happy but I was glad we had checked. 

Unfortunately for some reason the cycle still failed.  This was our first with donor sperm; top quality blast, perfect lining, good progesterone levels.  The sad fact is that IVF still fails even in perfect conditions and doctors have no idea why. 

On the bright side it's helped me put a few issues to bed - when progesterone suddenly became an issue in our egg-share round it made me question everything that had gone before, and wonder if that had been the problem all along with our cycles at Gennet.  But if it still hasn't worked even when all that was checked and right for our FET then obviously there could be other things going on, or just 'bad luck' - which I've heard every time. 

Sorry to hear of everything you've been through - I hope you manage to process everything and find a way forward. x


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## artistliz (Feb 24, 2020)

Thankyou for sharing this Hannah. Congratulations on your child. It's really useful to be reading everyone's posts. It's also heartbreaking as well if I'm honest. I am blaming myself for not demanding the progesterone test before my transfer.  I asked them twice and they said not necessary. It's very difficult to cope with.


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## artistliz (Feb 24, 2020)

Thankyou Northern for taking the time to share this. What you have highlighted is completely the heart of the issue. As you say sometimes despite everything IVF doesn't work. We always accepted the uncertainty and genuinely felt we just wanted to try and would be at peace knowing we had tried and done our best. I could be at peace but not sure right now how to...as progesterone is clearly not insignificant and obviously good levels important for implantation. Just having peace of mind to check the levels would have been enough xx


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## artistliz (Feb 24, 2020)

Does anyone know out of interest why some clinics take progesterone very seriously and monitor it? And others don't? Bearing in mind the amount of clinical research out there showing the importance of not too high and not too low progesterone levels...


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## Stacey10 (Jun 7, 2013)

The clinic I went to in the Czech Republic routinely checks it on the day of transfer, it has to a minimum of 30, if it’s under that you risk bleeding before your test date, as progesterone not only changes your lining to receptive, it’s stops your lining from coming away. If it’s too high it can impede implantation as well, but once implantation has taken place there is no such thing as too high. Some ladies do not absorb progesterone very well and do better on injections, I’m not sure, maybe they’re not placing them in high enough etc, I’ve always been told that after popping them in you should be still for 20 min and the progesterone should be absorbed by then, and by be still I mean, not racing around, so if you have an office job etc go and sit at you desk for 20 min etc. Many ladies who have immune problems use a high dose of progesterone to start. All of this is for a medicated cycle, not a natural cycle. “I’m usually on 1000mg per day and my levels range between 60-80 from transfer and in early pregnancy.


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## artistliz (Feb 24, 2020)

Thankyou Stacey. It seems therefore it is totally pot luck really depending on the clinic and whether they do test. And if you aren't informed about all the issues yourself then its in the lap of the gods....


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## Northern (Sep 26, 2015)

> it is totally pot luck really depending on the clinic and whether they do test. And if you aren't informed about all the issues yourself then its in the lap of the gods


Completely agree with this artistliz - in hindsight I really wish I'd known more during my time with Gennet, if I'd known to ask then at least we could have ruled it in/out as a potential issue. 
It amazes me too how some clinics see it as a basic standard to test and others don't bother.

I'd really like to see some clear charts on what levels should be at certain points in cycle, and the variations in fresh/frozen/natural/medicated etc and what effect all this has.

It's also frustrating as it shows yet again that you really do need to be your own doctor in ivf - especially after repeated failures.


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## Stacey10 (Jun 7, 2013)

They should be concerned with the level, the cynic in me thinks it’s no skin of their noses as they get you to cycle again, then more money for them, the cynic in me also thinks it’s a fine line as to how many the clinics get pregnant vs how many times they can get you to cycle. As much as we like to think they have our best interests at heart, the bottom line is, it’s a business for them, and that business is making money.


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## artistliz (Feb 24, 2020)

Stacey and Northern you are both absolutely right. I have been totally naive about the whole process despite thinking I was pretty well informed. I always knew it was massive big business and a conveyor belt but foolishly thought the clinics had our best interests at heart. And yes I've learned too late to be my own ivf doctor


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## Pognut (Apr 8, 2012)

One counter-argument to that might be that the NHS don't measure it on transfer day as a matter of course, and they don't have a profit motive, it works better for them if it works first time! 

Having said that, I had private treatment after NHS cycles, and when my private clinic did test me before transfer they found my levels were a bit low and upped my dose (it didn't make any difference, no luck at all so far). But my private and NHS clinic's success rates were pretty similar, so who knows...


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## AmberJ (Sep 25, 2016)

Pognut, as an ex employee of the NHS I suspect they do the absolute minimum in terms of testing because it increases the cost to them. This can be very short sighted since it may mean that if the woman has a mc she may be able to have another free round on the NHS. Unfortunately, I see it in so many areas of NHS healthcare. Crisis management as opposed to preventative management is the norm.


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## missl73 (Mar 12, 2018)

My clinic do test as routine despite the director of the clinic really not believing in it! He thinks it is not proven and doesn't think the evidence supports it but presumably other doctors at the clinic do and they hedge their bets and do it just in case as it's not harmful to do so? I think there is some evidence that testing progesterone levels in blood isn't always accurate as a measure of the level of progesterone in your uterus. However, personally from my own experience where I have always fallen pregnant on every cycle (all with very high grade blastos) except for the one where my progesterone was very low, totally believe it's necessary particularly for medicated FETs where your body is not producing it's own. Different forms of progesterone administration are more/less effective and in my case, pessaries were not enough the best thing was intramuscular injections of progesterone in oil (e.g. prontogest) which is more expensive and much more unpleasant but works extremely well. I would always ask for protogest as my progesterone support for any future FET cycle.


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## kittykat76 (Jan 17, 2016)

I would speak to the clinic and say you want to complain about it as you asked twice and they still refused,they could/should have done it for your peace of mind. My clinic asked if I wanted to move back to pessaries as they now test on transfer day but I refused and stuck with the prontogest as I knew that worked for me and I wouldn't forgive self if changed it and it went wrong. Prog is important,I was annoyed when I was told they weren't sure if it was as felt I was being fobbed off. Unfortunately in this journey you often only find the strength to be assertive as you get further along and do more cycles and sometimes its too late by then if you are have no more embies or cant afford to keep going. I think they not knowing is the hardest part as you just torture yourself over it all. I agree with other ladies that levels should always be tested in a medicated fet as you aren't producing it yourself


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## artistliz (Feb 24, 2020)

Thankyou everyone for sharing all the feedback and your experiences. Kittykat thankyou, yes we are going to talk with the consultant next week to hopefully get some answers. And also the counsellor. I actually wrote it all down today for the consultant, nurse team and counsellor as it was all spinning around in my head and found writing it down very helpful and hopefully can act as a discussion starting point. 

In my case it was difficult as I was told when I was due to start taking them the consultant's protocol is prontogest injections every day but i had to check with my NHS haematologist due to my antiphospholipid syndrome as I've three blood clots in my leg and on blood thinners and aspirin. My haematologist said I shouldnt be on prontogest as bleeding risk was too high. So i asked to speak to discuss with my ivf consultant and was told he was too busy and could only speak 10 days later which was 5 days after embryo transfer!! 

So I got an email from the ivf nurse saying how about prontogest every 3 days and 3 pessaries a day on top. So I discussed with my haematologist who despite massive workload is always readily available to talk!!! She said ok do that but make sure the injections are done properly and lots of pressure afterwards to avoid bleeding risk. So that's what was decided but as I've said before despite asking twice for my progesterone to be tested the ivf nurse said my consultant said not necessary. Obviously I realise the progesterone level was probably fine. But who knows!!!! 

My ivf clinic clearly now I see is unable to do tailored individualised treatment plans and is unable to communicate effectively and with care and empathy...


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## artistliz (Feb 24, 2020)

So having no individualised treatment plan when you spend 20k on ivf seems kind of crazy!!!!


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## taraeob (Jul 7, 2015)

your question is very interesting.  I have just had failed FET and I suggested to doctor that I would get my tsh checked and he also asked me to get progesterone checked- at start of cycle and again before transfer.  Hopefully this will show whether the cyclogest is enough or not.


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## artistliz (Feb 24, 2020)

So what was your dose of cyclogest on your last FET? Did your doctor say your progesterone levels were high enough?


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## brooky (Feb 17, 2016)

Hi guys, just thought I would add that my clinic don't test progesterone, however they have put me on 3 lots of progesterone a day , suppository morning and night and pessary midday. I wonder why they don't do it as standard? I mean.... it does seem really weird.. I might ask if they can do, but I feel like they will say no.


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## artistliz (Feb 24, 2020)

It's too late for us now. But if we were to do ivf again from this terrible experience i would never ever take no for an answer. Its completely the case that you shouldnt have to be your own IVF doctor but after what we have been through i would just never ever trust a clinic or a so called ivf specialist.


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