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      • My IVF Cycle Failed – What Went Wrong? Question #14: Could it Have Been Due to Inadequate Hormonal Support After the Egg Retrieval & Embryo Transfer?

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      This is the 14th in a series of answers to common questions about failed IVF.

      In vitro fertilization establishes an abnormal hormonal environment in the uterus.In some cases (especially older women and those with a diminished ovarian reserve), high ovarian testosterone production impacts the uterus lining, reducing endometrial proliferation (thickening) in response to estrogen.Also, because follicles are aspirated (thereby removing much of the inner lining of the follicles which ultimately must produce both estrogen and progesterone), it is not uncommon for women undergoing IVF to develop hormonal insufficiency in the post-egg-retrieval (luteal) phase of the cycle.When this happens, hormonal support for the implanting embryo and the early conceptus is often deficient.For this reason, hormonal supplementation post egg retrieval has become relatively routine in the IVF setting.

      Some advocate the administration of progesterone either by daily injection of an oil suspension of the hormone (PIO) alone or in combination with vaginal estrogen administration.Others prefer to use daily vaginal progesterone applications in the form of suppositories (e.g., Endometrin), or in the form of a cream (e.g., Crinone 8%) in combination with vaginal estradiol suppositories or cream.At SIRM, we advocate the administration of PIO (50 mg daily) from the day of egg retrieval until the 10th week of pregnancy, in cases involving ovarian stimulation.In embryo recipient cycles (egg donation, gestational surrogacy, frozen embryo transfers, embryo donation) the dosage of progesterone is doubled.In most cases, we combine the progestagen therapy with estradiol valerate 1-2 mg daily.

      Some have advocated supplanting progesterone administration following the positive pregnancy test with intramuscular hCG 5000 units three times weekly in the hope that this will promote more physiological ovarian production of estrogen and progesterone.

      In truth, with the exception of cycles with down-regulation using an agonist (e.g., Lupron), or LH suppression with an antagonist (e.g., Ganirelix), there is little concrete evidence to confirm a benefit for the use of estrogen/progesterone supplementation in gonadotropin stimulation cycles.However, few are willing to take the risk of withholding such treatment, subscribing to the adage “if it ain’t broke, don’t fix it.”

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      6 Responses to “My IVF Cycle Failed – What Went Wrong? Question #14: Could it Have Been Due to Inadequate Hormonal Support After the Egg Retrieval & Embryo Transfer?”

      1. Krystyn says:
        August 10, 2011 at 12:22 pm

        Dr. Sher,
        I am a big fan of your blog and have been following it for quite some time. I am currently doing the A/ACP+E2V protocol and I am on Day 7 of stims (600 Follistim and 125 Ganirelix which was launched off of BCP/Lupron overlap.) I added in the 37.5 of Menopur on Day 5 of stims and when I went in today for baselines my lining had decreased from 5.77 to 4.56. My estrogen is currently at 638 (313 on Day 5 of stims) (last E2V given Day 5 of stims due for next tomorrow) and my LH is only 0.39. I am a bit concerned that my LH is so low. My follicles are continuing to grow and are currently between 11mm and 12mm in size with a total of approx 12 or so follicles. Should I be concerned with my LH level? Is it normal for my lining to have decreased? It was remeasured about 5 times and the measurements remained consistent. I am also currently on 25mg Viagra suppositories 4xday along with Terbutaline 5mg TID. Any suggestions?
        Thanks so much,
        Krystyn

        Reply
      2. Geoffrey Sher, MD says:
        August 11, 2011 at 10:15 am

        Hi Krystyn,

        Thanks for your question. Dr. Sher is out of the country until 8/21 and probably won't have access to his blog until he returns, so his response may be delayed.

        Admin

        Reply
      3. Geoffrey Sher, MD says:
        August 16, 2011 at 6:23 am

        I would not be concerned about a low LH. Also this protocol often takes longer, so wait and allow the follicles to grow and (hopefully) the lining thicken too.

        Good luck!

        Geoff Sher

        P.S. Thanks for your kind sentiments.

        Reply
      4. Salina says:
        July 21, 2012 at 11:34 am

        Hi! I been taking the progesterone oil shot (2ml) every other day since my egg retrieval on 7/19/11. I just had my day 5 transfer on 7/19/12 & still on the progesterone oil shot & my dr added the endometrin viginal supposotrial tablets (taking 2x a day). My question is, why is my body discharging the endometrin suppositorial tablets? Is this normal or am I inserting not deep enough? Please help. Thx!

        Reply
      5. Salina says:
        July 21, 2012 at 11:38 am

        Just adding that this is my first IVF w/ CGH &. PGD testing. I had 4 normal pregnancies on my own & I am 36 years old. I don’t smoke or drink at all.

        Reply

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