# Low Progesterone on day of transfer



## Claudia H (Oct 2, 2015)

Hi Everyone, 

I had an embryo transfer on Tuesday and a blood test confirmed my progesterone was only 36... isn’t this way to low to allow implantation? I thought it needed to be at least 80, if not 100? I’ve added daily IM (prontogest) shots now but isn’t it too late? The embryo was a hatching blast so if it can’t implant within 24/48 hrs it’s done for! 

Any thought? 

Thanks x 


Sent from my iPhone using Tapatalk


----------



## missl73 (Mar 12, 2018)

Hi Claudia

I had exactly the same situation with my most recent FET with a 5AA hatching and it failed BUT please don't be disheartened, my levels were much lower than yours at a measly 19.6. I did a lot of research because I was furious with my clinic (looking at your signature I think we are at the same one...) for not testing me earlier than transfer and then not putting me on the prontogest until 24 hours after that. Here are the two papers I found (links below) that suggest under 30 is when it becomes problematic and you are over that so I think with added injectable progesterone you should be ok.

(Note they use ng/ml not nmol/L but you can convert using google so you know the equivalent)

https://academic.oup.com/humrep/article/32/12/2437/4508784

https://www.tandfonline.com/doi/abs/10.1080/09513590.2018.1534952?journalCode=igye20

I am going to be complaining and asking my clinic to test at least the day before transfer in future and on my next cycle ask to start the prontogest sooner, it sounds like they are unusual in their approach when I asked on the boards most other clinics do not leave it this late. Good luck to you and I hope this is your lucky cycle. I should also add a lady in my cycle buddies group had a level of 20 similar to me and hers stuck so it's never a certainty there are always ladies that defy the odds xx


----------



## Claudia H (Oct 2, 2015)

Hi Missl73, 

Thanks for your reply! I have had failures with low progesterone before, once I had an FET with a PGS tested embryo but the clinic only tested progesterone on day of transfer and it was 6! They told me to rush home and object but really it was too late and needless to say it failed. 

With my current clinic I had success last time and they tested on day 3 of taking cyclogest. Low and behold my level was low so they started me on daily IM injections before transfer. I couldn’t understand why they didn’t want to do the same this cycle but they just said it was a new protocol and not to worry. Now of course I’m kicking myself I didn’t make more of a fuss. 

Thanks for the links. It’s interesting though that they seem to talk about OPR and LBR and misscarriage rather than implantation. I can’t find any info about low progesterone affecting implantation but I thought the level had to be 80 for a good chance? That’s what I’ve always heard from clinics but now I can’t seem to find any supporting evidence online. 

So does progesterone not affect implantation? Only OPR? I thought it was essential to prepare the lining in order to receive an embryo? I had an ERA done a few years ago and it was all about the exact 24/48 hour window when you lining would receive an embryo, and it was progesterone that was key in making that happen. Too much and your window of implantation would be too soon and too little and it would be too late. 

Sounds like we both need to talk to our clinics! 

Xx 


Sent from my iPhone using Tapatalk


----------



## Choupi15 (Oct 11, 2018)

Girls, 

NHS doesnt check your Progesteron at all before Transfer. I will request this, this time. 

Thanks for the Article i am reading it


----------



## missl73 (Mar 12, 2018)

I think the reason the papers refer to OPR is because it’s pretty much impossible to tell whether it was a failure to implant or a chemical I suspect that both happen. If there is no implantation then there is no OPR. The clinic said they wanted to see the level over 50. I can’t believe they switched from testing you after 3 days to day of transfer. I’m going to insist this time they test me 2 days before transfer and put me on prontogest earlier. When my level tested at 19 the clinic was already shut and they said they wouldn’t see me until the following afternoon because the clinic is really busy on Saturday mornings. Sounds like they put their own convenience before my embryo to me!!! 

I really hope that it works out ok for you this time, I’m still so angry myself as I only got my BFN 3 days ago and after I’d read the papers I sent you I was certain it was going to happen.


----------



## Claudia H (Oct 2, 2015)

I wonder though - OPR suggests pregnancy as opposed to a BFN. If progesterone is only responsible for OPR then it seems fine to test on day of transfer and just up it if you need to? 

I’m so confused! 


Sent from my iPhone using Tapatalk


----------



## Londonwriter (Mar 18, 2015)

If it helps any, I had a natural FET and my progesterone was less than 50. I had to go up to three cyclogest a day a week after the transfer to get it to 100. I got a BFP anyhow and was getting positive pregnancy tests in under a week, so it didn't seem to make any difference.

My progesterone was only about 80 when I was 6 weeks pregnant naturally with my DS (!). Again, once I discovered the pregnancy (I was about to have IVF), my clinic at the time tried boosting this level massively with cyclogest. 

Progesterone levels are way lower in natural than in medicated IVF pregnancies so I wouldn't worry too much. People get pregnant all the time with progesterone levels lower than what an IVF clinic is comfortable with - they're just concerned about people bleeding/losing the pregnancy.


----------



## missl73 (Mar 12, 2018)

I can’t say for certain Claudia but my parents are both medical doctors and they both agreed with my interpretation of the papers so I trust their judgement. I’ll have to wait and see what the consultant says. 

Londonwriter I suspect you are right that clinics like to err on the side of caution, however my levels were so low that in a normal cycle if they’d been the results of a Day 21 blood test to check for ovulation they’d have been below the cut off levels even for that!!


----------



## Choupi15 (Oct 11, 2018)

what about the Proluton injection does this not help with Progesterone ?


----------



## Claudia H (Oct 2, 2015)

Hi Choupi, 

There are lots of things that can help supplement progesterone - but the problem is when it’s administered. 




Sent from my iPhone using Tapatalk


----------



## katkat2014 (Nov 28, 2014)

Help Claudia, I hope you don't mind me asking about your natural FET as I just had 2 failed cycles and wonder if a contributing factor was my P levels. Mine were ok on transfer day but dropped after I am certain. Did you take a trigger shot as I was told that this is also already some kind to luteal phase support? How much progesterone did you take and when did you start it?

Claudia. I hope your levels went back up. Will you retest them?

Afm can you have levels that are too high on ET day? And does anyone know what levels are deemed ideal? I'd assume it depends on if you did a natural or medicated FET but I may can't find any P info about a natural FET anywhere. Once mine were about 130nmol and once 63 nmol. My issue is that they seem to drop afterwards :/


----------



## Claudia H (Oct 2, 2015)

I think I'm Beginning to agree with Londonwriter. After a lot more googling around it seems that low progesterone on day of transfer may not affect implantation rates and really it's the high level of progesterone needed AFTER transfer that maintains the pregnancy and helps OPR.

Have a look at this link - I know it's not a study itself but it does refer to several which I've had a glance at and the seem to concur.

https://pregnancy.lovetoknow.com/infertility/low-progesterone-infertility

Also this study talks about the dangers of progesterone being too high on day of transfer! 
https://www.ncbi.nlm.nih.gov/m/pubmed/21540246/

Missl73 - I'm beginning to think the studies you found were indeed about OPR and not implantation. So it makes sense to test on day of transfer and supplement then if it's low - but not before...

Katkat - I had a medicated I'm afraid so can't advise on natural but if you look at the link to the study above it does suggest P levels that are too high may affect implantation. Maybe something to discuss with you clinic?

X

Sent from my iPhone using Tapatalk


----------



## Pognut (Apr 8, 2012)

The clinic I was at wanted your progesterone to be about 100 around transfer (after more than before, I think) - I was told by someone else that that's massively over-cautious and it doesn't need to be anything like that high. Does anyone know what the recommended levels before and after transfer actually are?


----------



## missl73 (Mar 12, 2018)

Progesterone is important in the preparation of the uterine lining though, the tricky thing with the article you posted is it's not really about IVF it's talking about normal pregnancy. Also the first study it quotes was on 20 women (a tiny sample size not usually considered reliable in scientific papers) and is from 1991 so is almost 30 years old. In a medicated HRT FET cycle your body isn't producing any of its own progesterone because there was no follicle and therefore no corpus luteum so you need the supplemental progesterone to be enough to prepare the lining. If you read what they say about luteal phase deficiency it says a) the tests aren't reliable b) a lot of the causes of low progesterone are reasons women like us are needing IVF.

The second study you post is related to fresh cycles only and refers to the progesterone level after stims but before trigger administration. This is before the follicles have had the eggs collected. Interesting but I think different to what we've been talking about.

Ideally you want to find studies specifically relevant to the treatment option you are having. For example this one: https://www.rbmojournal.com/article/S1472-6483(15)00243-6/pdf is directly relevant to me it's about HRT FET, it's recent (last 5 years) and had a larger sample size >500 patients and gave an optimum progesterone level for implantation (over 50 and under 99). There is so much out there it's hard to read it all. I met with my consultant since I last posted and I'm on a different progesterone protocol for this cycle.


----------



## Choupi15 (Oct 11, 2018)

Thanks missl73 

Do you get your progersterone level check before ET , thats a good info you provided. NHS doesnt do any check , i will ask my private consultant to check them for me or mention about progresterone


----------



## missl73 (Mar 12, 2018)

Hey Choupi, yes, I’m going to be tested the day before transfer this time. However mine is a FET, from memory you’re having a fresh stims cycle this time right? You shouldn’t have any trouble with progesterone levels as all the follicles you produce will release their own progesterone after egg collection. It’s a more common problem in a frozen transfer cycle where you don’t have any naturally occurring. After egg collection your clinic will give you some level of progesterone support (usually pessaries) as standard.


----------



## Choupi15 (Oct 11, 2018)

hi missl73 

Yes i am having a fresh cycle, thank you for the info. its very helpful and kind of you for sharing.  

When i had a FET in my last cycle they never tested me very annoyed , anyways i will ask them to test mine before  hehe to be on the safe side. 

Thanks


----------

