Progesterone deficiency despite vaginal and subcutaneous substitution

    • New

    Dear team, I apologize for writing again. We received confirmation today that our 3rd and last blastocyst transfer also failed to implant.

    I am now having a hysteroscopy to get the diagnosis going and then my husband and I will decide how and where we want to proceed!

    The blood test today showed that despite taking cyclogest 400mg vaginally 3 times a day and 25mg s.c. once a day, my progesterone was still below 10ng... This was the case in all my attempts that I could never keep the levels above 10ng despite substitution, whether cryo or fresh transfer. During my pregnancy in the 1st cryotransfer 2 years ago, my levels were always sufficiently high at around 20ng with 2x daily cyclogest...

    Do you have any ideas as to why this could be or whether I could have further diagnostics before we start trying again or do you have any ideas as to how this progesterone deficiency could be managed in the future or is another pregnancy not possible for me under these conditions?

    A natural cycle is not feasible as I suffer from decades of amenorroeh despite being of normal weight and my husband suffers from cryotozoospermia.


    Thank you very much for taking care of my worries and thoughts!!!

    • New

    Dear BergBambi,

    we know that there are several factors that can influence the absorption of progesterone. These include, for example, the condition of the uterus and the endometrial flora.

    An examination of the uterus must be carried out by means of hysteroscopy and endometrial biopsies to rule out the presence of chronic endometritis or dysbiosis. In such cases, treatment with antibiotics and probiotics may be necessary. I do not know your BMI, but it has been observed that women with a high BMI have difficulty achieving adequate progesterone levels.

    It should not be forgotten that the standard time for determining the progesterone level is 4 hours after the last dose. It is not always possible to do the test at this time, but in your case this would be advisable in order to obtain a more realistic value.

    And in your case, I would also recommend examining the implantation window during the same biopsy that is done to examine the endometrium - even if you already have a child, the implantation window may be displaced.

    So a hysteroscopy is a good next step, but please also have the endometrial flora examined by biopsy. Unfortunately, this cannot be done at the same time as you need a thin mucosa for the hysteroscopy and a thick mucosa ready for transfer for the biopsy.

    Yours sincerely,

    Dr. E. Rodriguez

    Ihr Vida Fertility Team <3

    • New

    Thank you very much for your detailed reply! I feel better advised and taken more seriously here than in my clinic where you do not want any diagnostics! Endometritis was already suspected and I took doxycycline for 2 weeks, now I had a uterine endoscopy at my own request and polyps were removed from around my caesarean section scar and my isthmocele was smoothed out.

    A biopsy was also taken, but only to detect the plasma cells again, which are still elevated.

    Now I don't know how to proceed as doxycycline hasn't helped but the doctor said that correcting the niche alone would not resolve the inflammation. My clinic doesn't believe in plasma and killer cells and advises me to have another Icsi and try again as they think it's due to my husband's cryptozoospermia...

    I would now like to try another AB and continue with the probiotics to support my flora. do you have any tips in this regard that I could proactively bring up with my doctor?

    Do you know how soon after the removal of the polyps I should even attempt the next transfer?

    Edited once, last by BergBambi (April 10, 2026 at 9:49 AM).

    • New

    At Jena University Hospital, which also offers plasma and killer cell analysis, the combination of amoxycillin clavulan and metronidazole was often recommended as the second antibiotic after doxycycline. Nowadays, however, they usually recommend a bacterial culture to determine the specifically effective antibiotic.

    So far, I have had doxycycline once, the specifically determined cefpodoxime once and then, as the plasma cells were still elevated, the combination mentioned. However, I don't yet know whether it has had any effect, the result is still pending.

    - 08/2019 -05/2021: 1. EZS in der Aagaard Klinik in DK, lange Wartezeit, 1. Transfer erfolgreich -> wunderbare Tochter :) <3

    - 07/2023: Start in Runde 2 mit der 2. Blastocyste der gleichen Spenderin - leider negativ ;(

    - 10-12/2023: Eine neue Spenderin gefunden! Leider nur 3 Eizellen, 1 befruchtet, 1 Blasto, Transfer negativ ;(

    - 03-07/2025: Endlich eine neue Spenderin! 16 Eizellen, 7 befruchtet, nur 2 Blastos. 1. Transfer negativ ;(

    - 09/2025: 2. Transfer negativ ;(

    - 11/2025: Klinikwechsel geplant...

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