Progesterone: before and after the transfer

All women who want to become pregnant need progesterone, a hormone that helps the fertilized egg to implant well in the uterus.

Progesterone therefore plays an important role in the treatment of infertility.

What is progesterone and what is it used for? 2.

When to measure progesterone levels? 3.

Progesterone: how does it affect the stimulation and transfer process? 3.2.

Why is it important to measure progesterone level? What is progesterone and what is it used for? Progesterone is an essential hormone for women, it is produced by the ovarian follicle after ovulation when it becomes the corpus luteum and mainly serves to make the endometrium receptive to the embryo that is to be implanted there and to maintain it so to subsequently support the pregnancy.

The absence or deficiency of progesterone does not allow the implantation of the embryo.

Insufficient levels of this hormone can cause miscarriage.

If fertilization does not occur, the hormone level decreases and another menstrual cycle begins.

If conception occurs, the ovary continues to produce progesterone to prevent embryo loss and around 8-10 weeks, the placenta begins to produce it throughout the remainder of the pregnancy.

When to measure progesterone levels? About seven days after ovulation, the measurement of progesterone in the blood can tell us that ovulation has occurred and whether the corpus luteum is producing enough of it.

Normally the blood values ​​in this phase are approximately between 10 and 20 ng/ml but during pregnancy they reach higher levels.

Before ovulation they must be < 1 ng/ml.

When the levels in the menstrual cycle are too low, we must first understand the reason through the medical history and a series of other tests such as ultrasound and the measurement of other hormones.

Only then will it be possible to imagine adequate therapies which can be of various types and not just the administration of progesterone in various forms.

Progesterone and PMA Progesterone is also used in assisted procreation to promote the development of the embryo and prevent spontaneous abortions.

In PMA, progesterone continues to be very important but takes on different values ​​and meanings compared to what we see in the natural cycle.

First of all because generally there are more than one follicles and corpora lutea that form.

Furthermore, it is important to distinguish between the ovarian stimulation phase preceding the pick up and that following the transfer.

We must not confuse these two phases because in the first it must not exceed certain levels and in the second it must not be too low.

Progesterone: how does it affect the stimulation and transfer process? During stimulation, it is necessary to measure progesterone several times to know if it tends to increase and to avoid finding oneself with a level that is too high.

This measurement must be carried out every day if necessary, even on Saturdays and Sundays, as it allows us to better personalize the therapy and possibly anticipate the pick up.

In fact, we cannot ask ourselves why there was a failure if all the factors that could have caused it were not first evaluated.

Sometimes it is preferable to cryopreserve the embryos that are formed in that cycle and the transfer is done in another cycle without stimulation.

Unfortunately, numerous studies have shown that too high progesterone during stimulation can also reduce the quality of the oocytes and embryos that are formed.

Therefore those cryopreserved that transfer later may have reduced potential because they derive from the previous stimulation cycle in which progesterone was too high.

Why is it important to measure progesterone level? Once again, observations are published regarding the importance of evaluating progesterone levels before pick up.

These data come from many studies already before 2010 and in particular from a Chinese study on 42,468 PMA cycles! The negative role played by an early increase in progesterone on the oocytes is also highlighted, which reduced oocyte maturity, the percentage of fertilization, the number of embryos formed and then reached blastocysts, their quality, the percentage of pregnancies, implantation and births.

There are now many scientific articles on the subject that confirm these conclusions, but what is impressive is the number of cycles that made up this study.

To be clear: the one who first noticed the damage of too high progesterone on the endometrium had taken into consideration about 4,000 cycles, which is a high number.

This work is certainly the most numerous because it concerns in particular oocytes and embryos, but also in some way the endometrium as the percentage of implantation is evaluated.

These results are important in practice because they also tell us that if progesterone is too high (>1.5ng/ml) it may be useless to cryopreserve the oocytes or embryos from that cycle.

Of course, these observations do not mean that there would be no pregnancies but that the rates could be significantly reduced.

Therefore, the researchers conclude, it is a good idea to measure progesterone during stimulation and especially on the day of HCG (Gonasi or Ovitrelle) and do everything possible to avoid increasing this hormone too much.

Personalization of therapies There are various methods that can be used to prevent progesterone from growing too much and at Biofertility they are all implemented.

We have thus seen that in our series the cycles in which an excessive increase in progesterone occurs are really rare and in that case we suspend the stimulation to resume it in another cycle with a different protocol.

When couples with one or more failures behind them come to our observation, we cannot properly answer the right question about the causes of the failures if in previous attempts all the factors that could have caused it, including the levels of progesterone in the blood, had not been measured and evaluated.

Another important evaluation of progesterone is done after the transfer by measuring its levels to check that they are not too low.

We do this several times because it is possible that the administered progesterone arrives in low quantities in the blood, perhaps because it is poorly absorbed.

In these cases it is best to administer more.

It is not possible at the moment to give certainties on the minimum levels necessary also because they vary from case to case.

When carrying out a transfer from cryopreserved embryos, some scientific works report a minimum value of 9 ng/ml. Everything we have written is an excellent example of personalization of therapies that a quality center should always ensure to obtain good results precisely because not all couples are the same.