QuestionHello Dr. Ramirez,
I am writing you from the DC-area; I had contacted you some time ago and was very grateful for your helpful and quick reply then.
I am preparing my 8th transfer- doing ivf because of my age (51), since almost for years, unsuccessfully. Currently with a clinic abroad. This will be my 5th transfer with this clinic. First three transfers with them, progesterone was started the day of transfer. All chemical pregnancies. Did some research and found out that in my case - post-menopausal -progesterone supplementation needs to start days before transfer. Had two other transfers with progesterone starting at different times before transfer after pointing this out to the doctor. Like all the others before, this next one will be a 5-day blast. Question: when (how many days before transfer) would you think progesterone needs to start with a 5 day blast transfer ? Obviously,I have not much faith in my current fertility doctor anymore but of course, no way to go elsewhere since my embryos are stored with his clinic. I am here trying to manage things on my own.
Also: does it make sense to check progesterone levels in case of pregnancy, I mean, can P-levels be low despite supplementation ? The plan now is to supplement Utrogestan 200mg 3 times daily 6 days before transfer.
Thank you very much, Gina
AnswerHello Gina from the U.S. (Virginia),
First of all, you do have the option to transfer your embryos elsewhere. That service is easily available and there are several companies that can assist with that. They can be transferred internationally as well.
It is my sincere hope that these embryos are donor embryos, because that is what will give you the best chances of pregnancy. Otherwise, it is possible that the pregnancy losses were all due to an age factor and not hormonal.
I am very skeptical of clinics outside of the U.S. I get letters from all over the world and they have convinced me that there are a lot of unreliable and poor quality clinics and doctors out there. Of course, Americans do go elsewhere because the cost is cheaper, but as the saying goes "you get what you pay for."
So enough of the pontificating. Progesterone is usually started on the day of retrieval in a fresh cycle. In a frozen embryos transfer it depends on the age of the embryo. If it is a D#3 embryo, the progesterone is started three days prior so that it is progesterone day #4 on the day of transfer. If it is a blastocyst, then the progesterone is started five days before (so that the transfer is on D#6). This is basic IVF protocol and has been around for years, and any good IVF clinic should already know this.
It is not standard practice to test progesterone levels but I know that some practices do. The reason for not testing is because many studies have shown that the endometrial levels of progesterone do not correlate with the blood levels. Also, progesterone should be given via injection or vaginal route for the best absorption into the endometrium. If you use it orally, then studies have shown totally inadequate levels. If you consult my blog, I have written extensively regarding progesterone supplementation.
Good Luck,
Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf
