Progesterone in IVF
When a woman prepares for in vitro fertilization, one of the first tests she's prescribed is a progesterone blood test. Then, on forums, she sees that progesterone levels are causing a huge stir among everyone who's already enrolled in the protocol or is just planning to. Now she, too, needs to figure out why progesterone is needed.
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How does progesterone affect IVF implantation?
The chance of an embryo implanting depends on three main factors:
- Embryo quality
- Endometrial condition
- Uterine muscle tone
Embryo quality at this stage can no longer be changed, but progesterone influences the other two factors. It:
- Reduces excitability of the uterus and fallopian tubes
- Causes changes in the endometrium that will facilitate embryo implantation: it stops endometrial cell division and stimulates the production of a secretion, which will widen the lumen of the uterine cavity.
- Reduces uterine muscle tone and minimizes the possibility of individual contractions of its sections – so that the embryo can attach to the endometrium.
Furthermore, progesterone suppresses the immune system to prevent it from rejecting the embryo as a foreign body, and it inhibits subsequent ovulation. When its concentration decreases, the woman's body receives a signal that it is time to give birth.
Therefore, for the embryo to implant normally, the body must have sufficient levels of this important hormone. Therefore, before implantation, it is very important to determine the progesterone concentration and, if it is less than 8.7 nmol/L, do not proceed with the protocol, but freeze the embryos until the next cycle.
Progesterone levels after embryo transfer
Doctors recommend meticulously testing progesterone levels after embryo transfer, doing so on the day of transfer, then on days 3, 5, 7, 9, and 14. It's important to repeat the test multiple times, as even if the first 2-3 tests show a positive result, it doesn't mean implantation has occurred (this can occur up to and including day 10).
To obtain the most accurate results, blood should be donated in the morning, after 8-10 hours of fasting.
Progesterone levels should be maintained within normal limits, meaning no lower than 38.15 nmol/L (or 12 ng/ml in other units of measurement), but no higher than 57.8 nmol/L (or 18.2 ng/ml).
Low hormone levels are the most dangerous, as they increase the risk of miscarriage. This should be corrected immediately with progesterone supplements—in the form of injections, tablets, or vaginal gel.
Less dangerous, but not ideal, is elevated progesterone. It causes pathological changes in the endometrium, which also reduces the likelihood of implantation.
How do you know if your progesterone levels are low? These symptoms indicate this:
- Vaginal bleeding
- Decreased body temperature and basal body temperature
- Irritability
- Swelling
- Headaches
- Flatulence
Unfortunately, you can't diagnose yourself based on these symptoms alone: they can develop with other conditions. If you experience these symptoms, you should immediately call your doctor and possibly have a blood test to measure your progesterone levels.
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The hormone progesterone in women
Progesterone is a hormone produced by a special endocrine gland that lives for only about 14 days in a non-pregnant woman, and for another 12-16 weeks in a pregnant woman, after which it dies. This gland is called the corpus luteum. Its main function is to synthesize progesterone, and when it dies, it passes the baton of this hormone's production to the placenta. What does progesterone affect? Why is it so important?
This hormone prepares the body for pregnancy and tries to support it by acting on the tissues of the uterus and the immune system (more details in the next section). It promotes the development of glands within the mammary glands, but if a woman is breastfeeding, lactation is inhibited. The hormone stores subcutaneous fat and accumulates glycogen, a precursor to glucose, in the liver, thus preparing reserves in case conception does occur.