Early Spotting aftet ET although being on Progesterone

by Hamideh
(Iran)

Hi, I am 39, mother of a 4year-old child, with IVF(Fet),
and now an IVF patient(5th cycle for 2nd baby) on my 8days after ET. I started immediately after ET taking 2 progesterone shots each day(100mg), as I did during 4 previous cycles. unfortunately I started spotting on my 5th day so my health care provider changed my progestron level to 3 shot per day but I still I'm having frequent spotting. I informed again my health care provider to see if more progesterone needed or not but they said not more than 3 (150mg per day) is safe. Regarding my 4 privious unsuccessful IVF process ( ended each time by early spotting and bleeding after ET) would you please help me what to do now? what is your idea about using more than 3 progesterone shot per day? Is it likely to make any differance to stop my spotting, very soon gets to bleeding I think. I am mentally doing so much bad these days...

Comments for Early Spotting aftet ET although being on Progesterone

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Jul 26, 2013
Early Spotting aftet ET although being on Progesterone
by: Wray

Hi Hamideh I'm sorry you're going through so much trouble. I suspect your vitamin D level is very low, have they checked it? If you wear the typical full clothing as found in Iran, you will not be making any from the sun. Do you have a garden or balcony where you can sunbathe? Supplements are probably a better option. Please have a test done, as vitamin D is vital for the reproductive system. For more info on vitamin D levels, test kits etc see the following websites, Vitamin D Council, GrassrootsHealth and Birmingham Hospital. Blood levels should be 70-100ng/ml or 175-250nmol/L, and not the 30ng/ml or 75nmol/L most labs and doctors regard as adequate. The minimum daily dose should be 5000iu's per day, although the latest research indicates it should be 10,000iu's per day, see here. Two recent studies have found that increasing vitamin D levels have resulted in a greater success for IVF, see here and here. These are some papers on progesterone and IVF, see here, here, here, here, here, here, here, here, here, here, here and here. Continued below

Jul 26, 2013
Early Spotting aftet ET although being on Progesterone Part 2
by: Wray

Hi Hamideh And more here, here, here, here and here. Plus we have a page on Pregnancy you could look through, and another here. There are many papers on these pages too, you'll notice amounts between 200mg to 600mg per day are given to women with pregnancy problems. I would never recommend less than 200mg/day progesterone. We also have a page on Infertility too. I think you'll find if you get your vitamin D level up, and your progesterone, you won't feel so bad. Another page you could look through is the one on Anxiety. Amongst those papers I've given you above is one study that found progesterone cream is as well absorbed as the injections, and of course not painful. Another study found a low carb diet essential for successful implantation. The Ketogenic Diet is a good one to follow. Take care Wray

Jul 26, 2013
Thank you Wray...
by: Anonymous

Hi Wray. I really appreciate you... I appreciate your attention and sympathy as well as the time you spent replying me.
About my vitaminD level, actually I have no idea! I saw my blood test results,done during recent years, and looked for vitaminD level but couldn't find anything related to this matter. I've been never asked to do this test, I suppose. As you suspected, I think that I am deficient in vitaminD because I've been always careless about that. So, as you guided, I decided to do a vitaminD test -25(OH)D blood test. I am also going to use a topical vitaminD cream (just during my previous pregnancy I was using a kind of vitaminD jell -a canadian brand- prescribed by my gyno but unfortunately after labor I gave it up carelessly). I was going to prepare some vitaminD supplement but via your site I figured out that you are for transdermal cream more than oral supplement. So I decided to provide "sun shine in a tube" if it could be possible, otherwise I should get an alternative.
About the progesterone, I'm really wondering why there is such big difference in drug dosage prescribed here. I doubt perhaps there is a composition or qualitative difference between the progesterone available here and the one produced there!
Thanks God my spotting has been stopped since Wednesday night (a yellowish secretion instead since today: Friday) that is giving me a little hope although I am still worrying if it starts again! My Beta test will be on coming Thursday and I am doubtful whether I add one more shot till that day (to be taken totally 200mg progesterone per day) or beside daily 150mg injection I use the a cream too. Anyway I don't care the injection pain. It's funny but by taking injection, I just personally have a feeling of certainty that the material would be completely absorbed in where should be!
I am reading the useful links you kindly referred and thank you again for your helpful advices. I am happy there is an ear listening to me...thanks a lot Wray.




Jul 27, 2013
Thank you Wray...
by: Wray

Hi Hamideh Thanks for the kind words! It's typical not to test for vitamin D, particularly in a 'sunny' climate. But irrespective of our clothing habits, we spend up to 90% of our time indoors now, so get little to no sun. I'm delighted you've asked for the test and would really like to know your result. The cream won't be available just yet, as we are running a survey to see if anyone is interested in it. So far we've had a good response, but it's very early days yet. The survey only went up 2 weeks ago. So please take a supplement. The dose will be dependant on your blood levels, so when you get them I can advise how much. I like to recommend the vitamin D Dr Cannell formulated, see here. Part of the proceeds go towards his Vitamin D Council. Yes there is a big difference in the amounts of progesterone given, I think it's up the the doctor and the risk of his patient having problems. Particularly if someone has had recurrent miscarriages they use high amounts. In the case of IVF I wouldn't hesitate to use more than the minimum 200mg/day. I don't place much store by a hCG test. It's a hormone which stimulates the corpus luteum to produce more progesterone. It can be high, and progesterone low, because the corpus luteum cannot secrete more. I feel it's far more important to test for progesterone levels, after all without enough, the placenta will detach and a miscarriage will occur. You might like to add more progesterone via a cream, with the injection too, unless you're happy with the way things are going. Do keep in touch. Take care Wray

Aug 10, 2013
Vitamin D3 low levels and early pregnancy
by: Hamideh

Hi Wray, hope you are doing well and thanks in advance for your advice.
I got my vitamin D test result - 25(OH)D test. The result showed drastic low levels of vitamin D3 : 9.0 ng/ml
Please guid me about the dose of supplement I should take daily. Also as supplement brand, you suggested Dr Cannell formulated one, is this the same one under brand name of D3Plus?
Beside this bad news I have a good news too that I would like to share. My IVF process appeared successful firstly by a positive beta test. You can imagine how much I am happy although a little worried at the same time (had an ultrasound at 5weeks,2days showing G sac, yolk sac as well as fetal pole BUT no heartbeat.) Now I am at week 5 day 6, continuously on progesterone shots(150mg per day) and Heparin.(Because of repeatedly spotting, my care provider cut off baby aspirin pills but added no more progesterone)
I would be grateful if you give me any advice helping with my situation.

Aug 11, 2013
Vitamin D3 low levels and early pregnancy
by: Wray

Hi Hamideh Oh dear, it's as I suspected, your level is dangerously low! How they expected you to conceive or carry a child I have no idea. I'm delighted and amazed the IVF has succeeded. Don't be too concerned about the heart beat, it can take longer to show up. This is an excellent site which leads you through all the steps of pregnancy, see here. I'm surprised you were given aspirin and heparin, both thin blood. But so too do progesterone and vitamin D. Such a pity they are not giving you more progesterone than the 150mg/day you now getting. You do need to increase your vitamin D levels very quickly. You are correct, it is the D3Plus. They have two versions, one contains 5000iu per capsule, plus all the co-factors. The other contains 50,000iu per capsule without the co-factors. I can't tell you what to do, only what I would do in the same circumstances. I would take one capsule of each per day, getting 55,000iu vitamin D plus the co-factors. I would then have another test done a month later to check my levels. And I'd continue taking the combo until my level had reached the 90-100ng/ml mark. You might like to speak to your doctor about this, although they will probably throw up their hands in horror at the amount! But 5000iu is only a maintenance dose, and does not raise levels quickly if at all. Thank you so much for listening to me about the vitamin D and having the test done. I wouldn't be surprised to learn that this is the only thing preventing you from conceiving normally. Please let me know how you get on. Take care Wray

Aug 14, 2013
choosing prenatal supplement including vitamin D3
by: Hamideh

Hi Wray,
I am going to provide D3 Plus as you recommended: D3-5 5000 IU as well as D3-50 50,000 IU by BIO TECH to take a total dosage of 55000 iu per day but now I am on a dilemma, would like to know your opinion. As you know I must use prenatal vitamins at least for 8 coming months (I've just being taken Folic Asid so far). So I searched for a good complete supplement and came up with D3 Natal prenatal multivitamins by the same Pharmaceutical company,that includes essential vitamins and minerals such as Vitamin D dosage of 5000 iu. Now I am doubtful whether order this product in addition to D3-50 50000 iu or just consider a simple multivitamins not vitamin D included as well as having separately my 55000 iu per day.
Here I should add something in brackets that because of Iran medicine sanctions, The BIO TECH or other similar products enjoying a good quality are not available on our market. So, I have to ask one of our friends in US. to buy and send them to me. Because of this difficulty of providing medication here, I want to make a right decision about choosing the best prenatal vitamins beside D3 Plus. please tell me what you would do if were in my place. I am curious to hear any other suggestions as prenatal supplement.
Thank you so much in advance.

Aug 15, 2013
§choosing prenatal supplement including vitamin D3
by: Wray

Hi Hamideh I didn't realise they also did a prenatal vitamin complex, that's excellent. I suggest taking that, plus the 50,000iu D3. That will also give you the 55,000iu. Please, you must have a test done after 1 month, taking that much should raise the level quickly. Keep having a monthly test until your level has reached the 70-100ng/ml level. Then you can stop the 50,000iu, but continue to take 10,000iu/day. Or take 1 x 50,000iu every 10 days, which will give you the equivalent of 5000iu/day, plus the 5000iu in the complex. How shocking you can't get proper prenatal nutrition, so sad. One other nutrient you should consider is taurine, about 1000-2000mg/day. It's never added to prenatals, and yet it's often to short in pregnant women. It's vital for the growth of the foetus, even more so after birth, see here, here, here, here, here and here. Although it's a non essential amino acid for adults, it's an essential amino for newborns. They cannot convert it from cysteine, they don't have the right enzymes, these only develop later in childhood. So high levels need to be kept up in the mother while pregnant, and after birth when the newborn gets it from the milk. Maybe you can get some in Iran, otherwise the States? It's not found in any vegetables, seeds or nuts, only animal protein. Fish has the highest level. Let me know how you get on. Take care Wray

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