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Progesterone support after embryo transfer
Progesterone is the hormone that keeps the womb lining ready for an embryo to implant and grow. After an embryo transfer, extra progesterone is given because the body's own supply may not be enough. It is usually continued until the pregnancy test, and if the test is positive, for some weeks into the pregnancy.
What progesterone does in a natural cycle
In a natural cycle, after an egg is released, the empty follicle in the ovary becomes the corpus luteum, which makes progesterone for about two weeks. Progesterone changes the womb lining so that an embryo can attach to it. If a pregnancy starts, the pregnancy hormone hCG keeps the corpus luteum working until the placenta can make enough progesterone on its own. If there is no pregnancy, progesterone falls and the period comes.
Why progesterone is needed after a transfer
- After a fresh IVF cycle: the stimulation injections and the egg collection lower the body's own progesterone in the days after, so support is added.
- In a frozen embryo transfer prepared with estrogen: there is no ovulation, so the body makes almost no progesterone of its own, and the support given is what holds the lining.
- In a natural-cycle frozen transfer: the body makes its own progesterone, and extra support is often still added.
This support is also called luteal phase support.
Forms of progesterone
- Vaginal pessaries, capsules or gel, used once or more each day.
- Injections, into the muscle or under the skin.
- Tablets, such as dydrogesterone, sometimes used alone or with another form.
Each of these forms is effective when used as prescribed, and the choice depends on the type of cycle, your own comfort and your doctor's plan. Please follow the exact plan you are given.
Tips for vaginal progesterone
- Use it at the times you are given, and wash your hands before and after.
- Lying down for a few minutes afterwards can reduce leaking.
- A white or creamy discharge is common; a panty liner helps.
- Tell your clinic if you have burning, itching or a bad-smelling discharge.
Tips for progesterone injections
- Injections are given by a nurse or by you or your partner after being taught how.
- Change the injection site each time.
- A warm pad and gentle movement can ease soreness.
- Tell the clinic if an injection site becomes red, hot, very painful, or forms a hard lump that does not settle.
- Tell the clinic at once about a rash, swelling of the face or breathing trouble.
Are blood levels checked?
The progesterone level is sometimes checked around the time of a frozen transfer, and the support is adjusted if it is low. In other plans a fixed schedule is followed without blood tests. Both ways are used; ask your doctor which one your plan follows.
How long is progesterone continued?
It is continued until the beta hCG blood test, usually about 10 to 14 days after the transfer, on the date your clinic gives you. If the test is positive, progesterone is usually continued until somewhere between about 8 and 12 weeks of pregnancy, when the placenta makes enough of its own. If the test is negative, your doctor will tell you when to stop.
Side effects
Breast tenderness, bloating, tiredness and mood changes are common and can feel like early pregnancy. Pessaries can cause a discharge, and injections can leave the area sore. These are expected and usually settle.
Progesterone in early pregnancy
Once the pregnancy test is positive, you will usually continue the same progesterone plan until your doctor reduces or stops it. An early scan, usually a few weeks after the positive test, checks that the pregnancy is in the womb and that the heartbeat can be seen. Progesterone is sometimes also advised in pregnancies that were not from IVF, for example for women with bleeding in early pregnancy who have had a miscarriage before; see recurrent miscarriage.
When to contact the clinic at once
- Heavy bleeding, or bleeding with cramps.
- Severe pain in the abdomen, one-sided pain, pain in the shoulder tip, or feeling faint or dizzy.
- Fever, or signs of an allergic reaction.
- Swelling of the abdomen, sudden weight gain, breathlessness, passing very little urine, or vomiting that does not stop, after a fresh IVF cycle.
Do not stop on your own
Stopping progesterone early can lower the chance of the pregnancy continuing. If you have spotting or bleeding, keep taking it and contact your clinic at once. If you miss a dose, call your clinic the same day to ask what to do, and never take a double dose. Keep taking your next doses at their usual times while you wait to hear from the clinic. Missed doses matter most in a frozen transfer prepared with estrogen, where your own body makes little progesterone. See also frozen embryo transfer.
Questions about progesterone after embryo transfer
Why is progesterone given after embryo transfer?
It keeps the womb lining ready for the embryo to implant and grow, because the body's own progesterone may not be enough after IVF.
How long do I take progesterone after embryo transfer?
Until the pregnancy test, and if it is positive, usually until somewhere between about 8 and 12 weeks of pregnancy. Your doctor tells you the exact day to stop.
Are progesterone injections better than pessaries?
Each of these forms is effective when used as prescribed. The choice depends on the type of cycle and your doctor's plan, and some women use more than one form.
I have spotting on progesterone. Should I stop it?
No. Keep taking it and contact your clinic at once, so they can advise you.
Do progesterone side effects mean I am pregnant?
Not always. Breast tenderness and bloating are common with progesterone itself, so only the blood test can tell.
Is a white discharge normal with progesterone pessaries?
Yes, a white or creamy discharge is common. Tell your clinic if it itches, burns or smells bad.
Will my progesterone level be checked?
Sometimes. It may be checked around a frozen transfer and the support adjusted; in other plans a fixed schedule is used. Ask your doctor which one your plan follows.
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What you read here explains fertility care in general terms and cannot replace a consultation. Decisions about your own care should be made with a doctor who knows your history and has seen you. We do not carry out or offer sex determination of any kind, which is prohibited by law in India under the PCPNDT Act.