* Author Topic: Is measuring progesterone level before embryo transfer usual practice?  (Read 994 times)

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Offline artistliz

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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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    Offline kittykat76

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    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

    Offline artistliz

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    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?

    Online Stacey10

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    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 wouldnít happen. If your clinic doesnít do this as routine, (many clinics donít) I would ask to have it done for your own piece of mind.

    Offline artistliz

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    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.

    Offline missl73

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    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 itís low there isnít 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 Iíve 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 theyíre unpleasant, itís 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.

    Offline artistliz

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    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?

    Offline hannahdaisy

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    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!

    Offline Northern

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    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

    Offline artistliz

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    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.