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Progesterone Levels rising @IVF Cycle


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#1 Stacy

Stacy
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  • My Clinic:Foothills,Conceptia,CcRM,Cali

Posted 31 January 2010 - 07:24 PM

I have a question for the RE's.

I have read a fair bit on progesterone levels during a fresh IVF cycle (mostly European articles)and I would like your take on the following questions.

1. I think most Clinics require progesterone levels at the baseline visit to be less than 4. Why is this ?
2. What would cause progesterone to rise during a fresh IVF cycle ?
3. At what point would you start to consider cancelling a fresh IVF cycle due to elevated progesterone levels and why ?
4. (Last one, I promise).... If you know your client's embryos will get to the Blast stage of development, is it still crucial to have a lower Progesterone level or does the progesterone level even matter at that point (being as how the blast would have caught up with the lining/progesterone levels).

Thank you very much. Your time you give us on this forum is so greatly appreciated.

Stacy

May '07 IVF #1 Foothills -BFP (twins)
Aug '07 M/C one -Vanishing twin
2008 one health baby :)
Jan '09 IVF #2 Conceptia -BFP (twins)
Apr '09 M/C - Twin Missed M/C
Sept'09 FET #1 Foohills -BFN
Nov.'09 FET #2 Conceptia -chemical M/C
Feb '10 IVF #3 Conceptia - BFP 1299 (twins)
Mar '10 M/C - lost One twin
Apr '10 M/C - lost Second twin
....next time, Immune treatment.
Oct '10 IVF#4 BFN
Jan '11 FET Blighted Ovum
Mar '11 FET Chemical
Apr '11 ODWU ccrm/ccs testing
Sept/11 IVF#5 CCRM
----------------------------------------------------------------------
(This was IVF#3 Feb2 Triggered.
Feb4 ER. Retrieved 11 eggs from 22 follicles. (Typical PCO Patient)
Feb5 10/11 fertilized. All 2 cell nuclei.
Feb7 All 10 Day 3 Embies doing well. 6 at top quality. Decided to do a Blast transfer
Feb9 Transferred 2 top quality blasts.
Feb16 bfp hpt (F.R.+ClearBlue) 7dp5dt
Feb21 BETA 1299 12dp5dt
Mar 10,2010 U/S 1 H/B ! (One vanished twin they were right !!)
Mar 23, 2010 US showed second twin Missed m/c, again.)

IVF#4. 150GonalF/75Luveris.am & 75GoanlF+75Luveris.pm
Baseline check. U/S Good. 10+follies each side.
CD4Sept24th. 10-12 follies each ovary less than 10. EL@550.
CD6Sept27th. L ovaary 11,12,11,and 10@10. R 11,10,12 &10@10.EL@2570
CD10. OCtober 3, TRIGGERED !13,000
E.R Oct5- retrived 24 eggs.
....Oct6- 17 fertilized at 2PN.
....Oct8- 17 Embryos. Going to Blasts.
....Oct10 ET 4AA and 3AA blasts
....7dp5dt AF arrived :(

FET # 3 estimated ET Jan12th. two top quality embies to thaw (O%frag) and if they (or one) doesn't make the thaw, thawing a 4BA Blast to go with it.
-bcp Nov.30 (21 days marvelon)
-suprefact Dec19 ((dDay21)
- No AF (Odd)
-Dec 29th, BW great, lining 3.3. Cleared to start FET. Began estrogel.
-Jan 7th U/S Lining 9.8 triple line 9.8. Start Prog
- Jan12th ET hatching blast, and another about to hatch (AH on both)
- BFP 7dp5dt FR+CB HPT's
- 12dp5dt beta 72. (U gotta be kidding me. Arg :0
- 15dp5dt hcg 120.4 (It's all pointing to a blighted ovum)
- 18dp5dt hcg 185.5 (G-r-o-a-n...., stop meds)
- 21dp5dt hcg 220.5
- 22dp5dt AF).
IVF#5 CCRM Sept'11 with CCS(CGH)
-11 blasts tested. the lowest grade is a 'normal'. Ladies thaT'S PROOF-..don't give up on your lowest graded ones!
IVF#6. CCRM Dec'12( 25 Blasts. Lots of High Quality but only 2 normal 4BB and a 6BB.
ET 2012 4BB 6BB homogeneous pattern...waiting..-Nope.
"sometimes when you hear hoof steps dont check for horses look for zebras."

One low grade 2/3 normal cgh blast left to transfer. Given 20% chance of success.Winter2013 Pregnant !Low Grade normal Day6 & Lining -Excellent and trilaminar.

#2 Dr.S.P.Hudson

Dr.S.P.Hudson
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Posted 02 February 2010 - 09:43 AM

I have a question for the RE's.

I have read a fair bit on progesterone levels during a fresh IVF cycle (mostly European articles)and I would like your take on the following questions.

1. I think most Clinics require progesterone levels at the baseline visit to be less than 4. Why is this ?
2. What would cause progesterone to rise during a fresh IVF cycle ?
3. At what point would you start to consider cancelling a fresh IVF cycle due to elevated progesterone levels and why ?
4. (Last one, I promise).... If you know your client's embryos will get to the Blast stage of development, is it still crucial to have a lower Progesterone level or does the progesterone level even matter at that point (being as how the blast would have caught up with the lining/progesterone levels).

Thank you very much. Your time you give us on this forum is so greatly appreciated.

Stacy


Hi Stacy,

Those are very good questions. It is important that both your estradiol and progesterone levels are suppressed before you start stimulation. If your progesterone level is high at the beginning of the cycle it means that you still have a corpus luteum producing progesterone leftover from the previous month.
Progesterone levels will always rise during a cycle if you have a premature LH surge. In all IVF cycles either Lupron/Suprefact or an antagonist (such as Orgalutron or cetrotide) will be used to prevent that happening.
Even in the absence of a premature LH surge, progesterone levels may start rising towards the end of stimulation and before the egg retrieval. If the levels get too high too soon it can advance the development of the endometrium and create a less favorable environment for the embryo to implant.
It would seem that high progesterone levels may have less effect on blastocyst implantation than day 3 embryos - although this is also a little controversial.
If the progesterone level is above 9, either just before or at the time of hCG injection, it may have a negative impact on the chances of pregnancy.
However the progesterone level is just one colour in the picture. For instance if the progesterone level is going up and the estrogen level is declining that would be much more worrisome The appearance and thickness of the endometrium on ultrasound may also be important in the decision making.
I hope that this information is helpful to you.
Good luck with your next cycle

regards

Dr. Stephen Hudson
Victoria Fertility Center

#3 scout

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Posted 07 February 2010 - 12:26 AM

This was very interesting information. Thank you Stacy, for asking the question, and Dr. Hudson, for the thorough explanation.

Could you also let us know if Progesterone levels are as important to track in a FET? I have noticed that some clinics do test this for FET patients, yet others (including mine) do not. Can enough be gleaned from just measuring the lining a few days before the expected transfer date, or can FET patients Progesterone levels get too high as well?

Thank you very much!
me: 36
dh: 41

ttc#1: jan '05
BFP#1: june '05 (natural)
ds born: mar '06 (our miracle boy - we know how blessed and fortunate we are!!)

ttc#2: started sept '06 (lots of BFNs!)
fertility clinic: mar '07

fertility treatments:
IUIs = 7 x BFN
3 IUIs - clomid: BFN BFN BFN
2 month break (still trying on our own, of course!)
3 IUIs - double dose clomid: BFN BFN BFN
IVF wait list: nov '08
1 last IUI - no clomid: BFN

IVF#1: may '09 = BFN
20 eggs retrieved, 12 mature, 11 fertilized, 2 implanted (day 3), 7 frozen (day 3)

FET#1: sept '09 = BFP resulting in m/c at 9w6d
ET: sept 1 09 - 2 x 8-cell embryos
oct 5 09 viability u/s showed 1 beautiful baby!!
oct 17 09 (8w5d) = hb 168!
sadly, we lost our angel at 9w6d

FET#2: feb '10 = BFP resulting in non viable pregnancy
ET: feb 16 10 - 2 x embryos
march 3 10 - beta 13 = not viable

Taking a break and embracing the good fortune of having one beautiful 4 year old son who may be our only child. We really are okay with that now and love our life!