In a normal fertility cycle, following ovulation, the body will produce the hormone progesterone, which serves to thicken the uterine lining and help an egg to implant and grow, thus maintaining an early pregnancy. In an IVF cycle, progesterone is taken most commonly by intra-vaginal insertion of micronized progesterone. Less commonly, women can take the progesterone by intra-muscular injection. Progesterone is continued for two weeks, when the patient receives a pregnancy test and continued when pregnant for an additional 3 weeks after the positive test.
When women take the IVF stimulation medications, her estrogen levels will be very high at the end of the stimulation phase. They will tend to fall after the egg retrieval. In order to avoid a precipitous fall and risk early uterine bleeding, we usually prescribe Vivelle estrogen patches to keep a nice even level during the luteal phase. This estrogen is stopped at the first pregnancy test, regardless of the result.
It is very common to have light bleeding during the luteal phase. It is also common to have sensation of 'heaviness' or cramping in your pelvic area up to 10 days after egg retrieval. The ovaries frequently enlarge at this time.
Call our clinic anytime if there are any concerns, and contact us immediately if any of the following symptoms occur:
- Intense cramping
- Bleeding that is more than spotting
- Weight gain of more than 10 pounds in 3 days
- Fever of above 100 degrees
- Shortness of breath
Two weeks after the egg retrieval procedure, the woman will obtain a blood pregnancy test, sometimes called a beta or beta-hCG level, to see if she is pregnant. If the test is positive she will be asked to receive a second blood test two days later. A pregnancy at this early stage is referred to as a chemical pregnancy.
Two weeks and again four weeks after the first blood pregnancy test, an ultrasound is given to confirm a clinical pregnancy, which is the presence of a gestational sac in the uterine cavity (the gestational sac can be seen before the embryo is visible).
If she is pregnant, she may be continued on progesterone. If there is no pregnancy, she will be asked to stop the progesterone and her period will begin in 2 to 5 days. If she does not had a menstrual period within 5 days of discontinuing the medication, call the clinic.