# Timing of progesterone support



## Mogwai34 (Jul 25, 2015)

Hi,

I'm hoping someone will be able to shed some light on what the normal protocol is for progesterone support in a frozen cycle.  

I started downregulation on day 21, then proceeded onto progynova to build the lining and will be on this for 14 days. My question is how many days of progesterone support is given before transferring a five day blastocyst? My clinic start cyclogest the evening after what would be egg collection day on a fresh cycle, so day 1. They then say cyclogest is taken 2x daily and a blastocyst is transferred on the 5th day of progesterone (so progesterone started on Saturday evening and blastocyst thawed and transferred on Wednesday.)

However, I know many clinics start progesterone the evening of day 0 (egg collection/ovulation day) and transfer the blast on the 6th day of transfer. So this is confusing and worrying me a little. My clinic said they used to do the latter but didn't see so many bfp's so switched to starting progesterone a day later. 

I know one day difference may not matter but I have previously bled before test day so I am worried that incorrect luteal support may be detrimental. My only successful cycle was when I transferred the blast on the 6th day of progesterone, however that was a fresh cycle so I'm not sure if the protocol for preparing the uterus on a fresh cycle differs from frozen. 

Id be interested to hear what others are doing or if anyone has any knowledge around the rationale behind the different options. 

Thanks xx


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## Stacey10 (Jun 7, 2013)

I’ve always had transfer on the morning of the 6th day of progesterone, for both fresh and frozen, if I was to be given your protocol I’d start in the morning not night, so you would have the full day of progesterone. There are plenty of studies that show good pregnancy rates for a full 5 days or on day 6 of progesterone.


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## missl73 (Mar 12, 2018)

My FET mirrored a fresh cycle, so started progesterone the day after what would have been egg collection and then transfer was on day 5 and I got my BFP. I did have trouble with low progesterone on FETs in the past though so I insisted on having my levels tested before transfer and this time I was on intramuscular injections as well as cyclogest and for me that made the difference between my BFN (progesterone level was only 19 on day of transfer) and BFP (progesterone level was >200 on day of transfer) xx


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## Mogwai34 (Jul 25, 2015)

Thank you so much for your replies!

Its confusing as on my fresh cycle my embryos were transferred on day 6 of progesterone and that worked. I was unsure if a frozen embryo takes longer to implant, hence the later onset of progesterone.

Stacey10 its interesting that you had the same timing for both fet and fresh and it worked both times. So I guess your endometrium must have been receptive with that amount of progesterone. I'm thinking of just repeating exactly what worked on my successful cycle for no regrets. I'm the same as you- I have twins and we are trying for another with our fet. 

Thanks for both replies x


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## FranWillow (Nov 15, 2019)

Hi Mogwai34,

The amount of progesterone you take and how many days you take it for determines your implantation window - so it's crucial to get this right.

I had an ERA test (endo lining biopsy to detect when the optimal implantation window is) and it showed that it was only after 6 days of progesterone + 12 hours. I did a FET on day 7 (morning) and I got BFP and live birth. I went back for a sibling and after a failed FET it looks a if the second attempt worked; after POAS 14 days after my transfer it's a positive (waiting for the blood results to be shared with me sometime today before I can celebrate!!). A transfer on day 7 is non-standard but I think it applies to a lot of women.

Here is a clinical trial about it:

https://www.fertstert.org/article/S0015-0282(17)31569-8/pdf

Have you done FETs only - or also some fresh cycles?

Wishing you all the best!!


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## Stacey10 (Jun 7, 2013)

I would definitely stick to what worked for you with your twin bfp


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## Mogwai34 (Jul 25, 2015)

Hi FranWillow,

Thanks for your reply. Congratulations on your bfp!! I really hope you had good news today with your blood test results 

Thanks for the info about your ERA test. Yes, I was aware of this study and have been madly googling about progesterone and receptivity. It annoys me that my clinic say that it doesn't matter which day I start when clearly this is a key factor. I have never had the ERA test. I had 1 failed fresh (6th day progesterone transfer), 1 failed FET (5th day of progesterone transfer.) I then went on to have a successful fresh when doing 1x prontogest and 1x cyclogest daily transferring on 6th day of progesterone. It worked and I had a bfp. However, I did add a lot of immune treatment to that cycle which I hadn't previously.

As my last cycle worked with a transfer on the 6th day of progesterone, we know that I was receptive with that level and duration of progesterone so I am thinking that I should keep this the same . However, I don't know if receptivity can change over time. More specifically, I wonder whether a receptive endometrium on day 6 of progesterone in a fresh cycle, would also mean the same for a FET. Particularly as progesterone levels already start to rise in a fresh cycle after the trigger shot which doesn't happen in a frozen. So perhaps I would need longer exposure for a frozen...?

But do frozen embryos take longer to implant than fresh? ("There are unconfirmed reports from animal studies about a 12 h delayed reactivation of thawed embryos in relation to its morphological stage and endometrial phase. This could justify a shorter progesterone pretreatment.") Also read this and I'm so confused: "Lelaidier et al. (1995) have shown high pregnancy rates after transferring blastocysts on the fifth day of progesterone administration and concluded that the implantation window was brought forward in time in the case of blastocysts."

https://academic.oup.com/humrep/article/20/5/1127/2356723

Argghhhh Im going around in circles with this decision.

FranWillow- After your ERA, was your protocol for a transfer on day 7 of progesterone regardless whether it would have been a fresh or frozen?

My clinic are only suggesting a transfer on 5th or 6th day of progesterone, so the 7th day isn't an option, especially given that I haven't had an ERA to indicate I am pre-receptive. If I was pre-receptive then I guess at least transferring on the 6th day would give me a greater chance than on day 5 at least perhaps?

I guess no-one really knows unless you do the ERA. That's why I am veering towards repeating what I did in my fresh and hope my endometrium responds in a similar way. Thanks Stacey for this advice.

So, I'm very confused. Does any of this make sense FranWillow or have I totally rambled and got confused....? xx


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## FranWillow (Nov 15, 2019)

Hi Mogwai34,

I can confirm that I'm pregnant - so exciting and nerve wrecking times!

Sorry to hear that you've been met with so little understanding by your clinic.

Just to be clear, when you speak about a fresh cycle, do you mean a cycle in which they harvested your eggs and they did a transfer immediately without freezing? If yes, I think this is different from a FET and that the lining possibly will reach the implantation window on a different day from when you do a transfer in a cycle where no eggs have been harvested; I believe it can take longer (as in more days with progesterone) to reach the implantation window in a FET cycle. But again, that was my experience - backed up by the ERA test. I'm post-menopausal and much older than you and your factors may lead to a different result. You have been pregnant once, which is excellent news. And perhaps it's worth looking into immune issues as well as having an ERA test done?

To answer your question: _After your ERA, was your protocol for a transfer on day 7 of progesterone regardless whether it would have been a fresh or frozen?_

My ERA test was a preparation for a frozen transfer only. It's my understanding that ERA results do not apply to a fresh (egg harvesting) cycle.

Would you consider changing clinic? If they don't seem to take your concerns and valid questions seriously perhaps you would like to look into which other options you have?


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