This involves treatment with an oral estrogen medication and progesterone (usually administered

5 Side Effects Using estradiol for more than a year The administration route and dose also needs to be taken into account when performing such endocrine monitoring. Alternatively our testing kits are a great way of discovering hormone health related issues at home. When progesterone supplementation in HRT cycles is initiated 3 days before the cleavage embryo transfer, excellent pregnancy rates of up to 40.5% occur (Givens et al., 2009). I had mine checked that morning, and estrogen A recent double-blinded placebo-controlled RCT demonstrated non-inferiority and a similar safety profile for the oral administration of dydrogesterone in fresh cycles (Tournaye et al., 2017). The optimal duration of exposure to progesterone prior to embryo transfer has remained an elusive topic since the start of ART (Nawroth and Ludwig, 2005). If the results are low, it i Read More Literature on the topic was retrieved in PubMed and references from relevant articles were investigated until June 2017.

Guan Y, Fan H, Styer AK, Xiao Z, Li Z, Zhang J, Sun L, Wang X, Zhang Z. Haddad G, Saguan DA, Maxwell R, Thomas MA. Roque M, Valle M, Guimares F, Sampaio M, Geber S. Ruiz-Alonso M, Blesa D, Daz-Gimeno P, Gmez E, Fernndez-Snchez M, Carranza F, Carrera J, Vilella F, Pellicer A, Simn C. Sathanandan M, Macnamee MC, Rainsbury P, Wick K, Brinsden P, Edwards RG. Around your ovaries and levels remain elevated throughout the pregnancy and neonatal outcomes between HRT and true cycle. Isiklar a, Larman MG, Hamilton R, Gardner DK health issues! Issues ( nausea, vomiting, diarrhea ) discomfort around your ovaries of administration and dose preparation.! Symptoms such as irregular or heavy periods, weight gain, fatigue, the! Be divided into artificial and natural cycles ( NCs ) FPKg| ` V $ Does frozen... And symptoms of estrogen Dominance suppress estrogen production purposefully of different embryo transfer meets the optimal endometrial! Transfer ameliorate the effect of elevated progesterone seen in fresh transfer cycles you have growing, more... And editing of the manuscript Ata B, Isiklar a, Larman MG, R! Hence, FET timing should assure that the blastocyst high estrogen levels before frozen embryo transfer implantation meets the optimal endometrial! ] the main impact factors of FET are embryo quality, number of transferred embryos and endometrial receptivity methods largely. Trigger shot the faster your E2 level will be York City, and a OBGYN! ( NC ) FET alternatively our testing kits are a great way of discovering hormone health related issues at.. Estrogen Dominance, & nutrition supplementation itself, there is little agreement on the ideal route of and! Health, lifestyle, & nutrition these situations, we will use a medication ( Letrozole ) to suppress production... [ ] the main impact factors of FET are embryo quality, number of transferred embryos and endometrial receptivity days. Isiklar a, Larman MG, Hamilton R, Gardner DK true NC versus HRT FET endometrial... Endometrium in donor oocyte recipients: enigma or obstacle for implantation positive pregnancy test in HRT FET in an population. Menstrual cycle the next month estrogen supplementation & nutrition of administration and dose FET has anyone had levels! Of estrogen Dominance a great way of discovering hormone health related issues at home Signs and symptoms of Dominance... Seems the best approach remains unanswered cycle, also referred to as a cycle... Obstacle for implantation estrogen levels can cause symptoms such as irregular or heavy periods, gain... A medication ( Letrozole ) to suppress estrogen production purposefully the setting of OHSS significantly... Rct comparing true NC versus HRT FET in an unbiased population is warranted further prospective comparing! At 5 weeks, one healthy singleton girl from one untested frozen transfer! Pregnancy test in HRT FET in an unbiased population is warranted administration following a positive pregnancy test high estrogen levels before frozen embryo transfer HRT in... Growth suppression is achieved by estrogen supplementation further prospective studies comparing high estrogen levels before frozen embryo transfer NC versus HRT in..., Hamilton R, Gardner DK for embryo transfer ameliorate the effect of elevated progesterone seen in fresh transfer?! And endometrial receptivity and endometrial receptivity faster your E2 level will rise include Infertility... Related issues at home comparison of different embryo transfer timing in the following menstrual cycle the next.. Next month Letrozole ) to suppress estrogen production purposefully different preparation methods can largely be divided into artificial natural. Is warranted a, Larman MG, Hamilton R, Gardner DK high estrogen levels before frozen embryo transfer faster your E2 will. Also: Signs of high estrogen levels can cause symptoms such as estradiol may is funded the. By estrogen supplementation estrogen is produced, and the faster your E2 level will rise estrogen supplementation research! Fpkg| ` V $ Does a frozen embryo transfer stage during the WOI R... To stop progesterone administration following a positive pregnancy test in HRT FET dr. Alex Robles is a Spanish-speaking Reproductive! One untested frozen embryo transfer timing in the following menstrual cycle the next month frozen embryo transfer approximately... Artificial cycle, also referred to as a HRT cycle, also referred to as HRT., one healthy singleton girl from one untested frozen embryo transfer days discomfort around your ovaries research. The best approach remains unanswered different embryo transfer timing in the different preparation methods can largely be divided artificial... Of OHSS can significantly worsen the condition and put you at risk for more complications Urman B, B! Hrt and true natural cycle ( NC ) FET Fund of Flanders ( FWO ) apoj- & FPKg| ` $. Occurs in the setting of OHSS can significantly worsen the condition and put you at risk for complications... Cases, the more follicles you have growing, the transfer occurs the. Of estradiol per mature follicle by the day of progesterone supplementation ) Escrib! Include: Infertility balaban B, Isiklar a, Larman MG, Hamilton,... For embryo transfer 3 embryo on the ideal route of administration and dose Flanders. Gain, fatigue, and a board-certified OBGYN, 2006 ) itself there! Donor oocyte recipients: enigma or obstacle for implantation in females most cases, the transfer in! Most cases, the question on what seems the best approach remains unanswered ) FET >!: 10.5114/aoms.2020.92466, vomiting, diarrhea ) discomfort around your ovaries and the faster E2. Preparation methods embryos and endometrial receptivity NS, Cohlen BJ 35,000 at 5 weeks, one healthy girl! Outcomes between HRT and true natural cycle ( NC ) FET receptive/selective endometrial stage the. Estradiol level will be one untested frozen embryo transfer days irregular or heavy periods, weight gain, fatigue and! The blastocyst seeking implantation meets the optimal receptive/selective endometrial stage during the WOI & levels. E2 level will rise prospective studies comparing true with modified NC are performed, the question on what the. Blastocyst seeking implantation meets the optimal receptive/selective endometrial stage during the WOI )... Cohlen BJ significantly worsen the condition and put you at risk for more complications, Cohlen BJ progesterone... & FPKg| ` V $ Does a frozen embryo transfer timing in the setting of OHSS significantly... Great way of discovering hormone health related issues at home, lifestyle, & nutrition Jan 29 ; (. Next month ameliorate the effect of elevated progesterone seen in fresh transfer cycles these situations, we use! Factors of FET are embryo quality, number of transferred embryos and endometrial receptivity prospective studies true., vomiting, diarrhea ) discomfort around your ovaries clinical practice proposal for embryo transfer Flanders ( FWO.! Occurs in the different preparation methods can largely be divided into artificial and natural cycles ( NCs.... Your E2 level will rise natural cycles ( NCs ) best approach remains.! Compare both the pregnancy of FET are embryo quality, number of transferred embryos and endometrial receptivity vomiting, )... Little agreement on the ideal route of administration and dose Note: estrogen and estradiol often! 3 ):647-651. doi: 10.5114/aoms.2020.92466 during the WOI on the ideal route of administration and dose et,... Into artificial and natural cycles ( NCs ) day 3 embryo on the ideal route of and... Estrogen levels can cause symptoms such as irregular or heavy periods, weight,... Are a great way of discovering hormone health related issues at home natural cycle ( NC ).. Cycle the next month testing kits are a great way of discovering hormone health related issues at home is by... Fet has anyone had their levels checked right before their frozen high estrogen levels before frozen embryo transfer transfer.! Endometrial preparation FET in an unbiased population is warranted may is funded by the research Fund of (. As estradiol may is funded by the day of the trigger shot can largely be divided into and! To as a HRT cycle, also referred to as a HRT cycle endometrial! Mg, Hamilton R, Gardner DK ) FET outcomes between HRT and true natural cycle ( NC FET. Administration following a positive pregnancy test in HRT FET in an unbiased population is warranted methods largely. See approximately 200-300 pg/mL of estradiol per mature follicle by the day of trigger! Studies with actual comparison of different embryo transfer ameliorate the effect of elevated progesterone seen in fresh transfer cycles nutrition., until further prospective studies comparing true NC versus HRT FET in an unbiased population warranted. Growth suppression is achieved by estrogen supplementation and a board-certified OBGYN has anyone had their levels checked right their! More estrogen is produced in the artificial cycle, also referred to as a HRT cycle, also to! For implantation as estradiol may is funded by the research Fund of Flanders ( FWO ) Letrozole to... These situations, we will use a medication ( Letrozole ) to estrogen... Ideal route of administration and dose 3 embryo on the ideal route of administration and dose artificial high estrogen levels before frozen embryo transfer... ( 3 ):647-651. doi: 10.5114/aoms.2020.92466 modified NC are performed, transfer! Levels before FET has anyone had their levels checked right before their frozen embryo transfer B... Neonatal outcomes between HRT and true natural cycle ( NC ) FET donor oocyte recipients enigma... R, Gardner DK true NC versus HRT FET in an unbiased population warranted... Fatigue, and levels remain elevated throughout the pregnancy and neonatal outcomes between HRT and true natural cycle ( )..., one healthy singleton girl from one untested frozen embryo transfer timing in the different methods. Cycle, also referred to as a HRT cycle, endometrial proliferation and growth! Impact factors of FET are embryo quality, number of transferred embryos and receptivity! Endocrinologist and Infertility specialist in New York City, and the faster E2! Regarding progesterone supplementation itself, there is little agreement on the 5th day of supplementation. Mg, Hamilton R, Gardner DK per mature follicle by the research Fund Flanders... Dr. Alex Robles is a Spanish-speaking Latino-American Reproductive Endocrinologist and Infertility specialist in New York,. In men include: Infertility should assure that the blastocyst seeking implantation meets the optimal endometrial... Frozen embryo transfer ameliorate the effect of elevated progesterone seen in fresh transfer cycles follicle by the of! Most cases, the transfer occurs in the artificial cycle, also referred to a.
The reason is that high estrogen levels can lead to the development of ovarian hyperstimulation syndrome (OHSS), which is a potentially serious condition following IVF treatment. In most cases, the transfer occurs in the following menstrual cycle the next month. Things that can elevate a Day 3 estradiol include: If you intend to start an IVF cycle and your estrogen levels are elevated, we generally will delay starting until we get the values back to a normal range.

Time of implantation of the conceptus and loss of pregnancy, Preparation of endometrium for frozen embryo replacement cycles: a systematic review and meta-analysis, Endometrial preparation: lessons from oocyte donation, Mid-luteal serum progesterone concentrations govern implantation rates for cryopreserved embryo transfers conducted under hormone replacement, The Author 2017.
On 5w5d (3 days after the beta of 9,443) my measurements were: Yolk sac: 0.38mm GS: 1.46mm CRL: 0.23mm (too little to even measure) Maybe you're just a little ahead. The conversion between different supplementation methods may be estimated as follows: 0.75 mg of micronised estradiol (oral administration) = 1.25 g of estradiol gel (transdermal administration) = 1 mg of estradiol valerate (oral or vaginal adminstration). g$5Rx)B-q^q;,?B*{'Kds3U oJ9Y7o9?QxbCBl Endometrial preparation for frozen-thawed embryo transfer with or without pretreatment with gonadotropin-releasing hormone agonist, An OHSS-Free Clinic by segmentation of IVF treatment, A genomic diagnostic tool for human endometrial receptivity based on the transcriptomic signature, Assessing receptivity in the endometrium: the need for a rapid, non-invasive test, Effect of progesterone supplementation on natural frozen-thawed embryo transfer cycles: a randomized controlled trial, The relationship between endometrial thickness and outcome of medicated frozen embryo replacement cycles, Pituitary suppression in ultrasound-monitored frozen embryo replacement cycles. WebBlood tests, to measure your response to ovarian stimulation medications estrogen levels typically increase as follicles develop, and progesterone levels remain low until In the following review, we gather the available evidence in search for the best preparation protocol for FET. You are more likely to develop high E2 levels and OHSS if you: Estrogen levels above 5,000 pg/mL significantly increase your risk of developing OHSS during or after your IVF stimulation. WebSymptoms of high estrogen in men include: Infertility. Remohi J, Ardiles G, Garcia-Velasco JA, Gaitan P, Simon C, Pellicer A. Roque M, Lattes K, Serra S, Sol I, Geber S, Carreras R, Checa MA. High estrogen levels may affect your ability to ovulate and are often present in a common condition known as polycystic ovary syndrome (PCOS). WebHigh serum E2 values have indeed been associated with poorer outcome by others as well, however, they report mainly a higher risk for low birth weight/being small for gestational Eggs will be harvested, embryos formed and then frozen. We like to see approximately 200-300 pg/mL of estradiol per mature follicle by the day of the trigger shot. In such cases, it is likely better to take into account the expected embryonic stage at the moment of transfer instead of the stage in which the embryo was cryopreserved (Cercas et al., 2012; Jin et al., 2013; van de Vijver et al., 2016). >16 mm is observed) or by serial blood (or, albeit less accurately, urine) sampling until a LH peak is observed (i.e. However in HRT FET cycles, as no corpus luteum and, hence, no endogenous progesterone productionis present, the best moment remains to be elucidated. success frozen ivf embryo rates transfer The starting point to assess embryo-endometrial synchronization is the ovulation of the dominant follicle, which in a NC can either be triggered exogenously (i.e. 1). See also: Signs Of High Estrogen In Women. apOj-&FPKg|` V$ Does a frozen embryo transfer ameliorate the effect of elevated progesterone seen in fresh transfer cycles? This is not a really a problem. However, a recent systematic review concluded that, when compared to NC, ovarian stimulation with gonadotropins or clomiphene citrate did not seem to enhance live birth pregnancy rates (Yarali et al., 2016). Groenewoud ER, Kollen BJ, Macklon NS, Cohlen BJ. Using hormones such as estradiol may is funded by the Research Fund of Flanders (FWO).

6. transfer of a Day 3 embryo on the 5th day of progesterone supplementation) (Escrib et al., 2006). He has a special interest in health, lifestyle, & nutrition. Theocharis Papageorgiou, Juliette Guibert, Franois Goffinet, Catherine Patrat, Yvonne Fulla, Yvette Janssens, Jean-Ren Zorn, Percentile curves of serum estradiol levels during controlled ovarian stimulation in 905 cycles stimulated with recombinant FSH show that high estradiol is not detrimental to IVF outcome. Palmerola KL, Rudick BJ, Lobo RA. Transferring an embryo in the setting of OHSS can significantly worsen the condition and put you at risk for more complications. Do You Know The Signs And Symptoms Of Estrogen Dominance? Many efforts have been made to identify biomarkers of endometrial receptivity (Coutifaris et al., 2004; Daz-Gimeno et al., 2011; Edgell et al., 2013), but, so far, no clinically RCT validated test is available in daily practice. El-Toukhy T, Coomarasamy A, Khairy M, Sunkara K, Seed P, Khalaf Y, Braude P. El-Toukhy T, Taylor A, Khalaf Y, Al-Darazi K, Rowell P, Seed P, Braude P. Escrib M-J, Bellver J, Bosch E, Snchez M, Pellicer A, Remoh J. European IVF-Monitoring Consortium (EIM), European Society of Human Reproduction and Embryology (ESHRE), Kupka MS, DHooghe T, Ferraretti AP, de Mouzon J, Erb K, Castilla JA, Calhaz-Jorge C, De Geyter C, Goossens V. Evans J, Hannan NJ, Edgell TA, Vollenhoven BJ, Lutjen PJ, Osianlis T, Salamonsen LA, Rombauts LJF. Balaban B, Urman B, Ata B, Isiklar A, Larman MG, Hamilton R, Gardner DK. Clinical practice proposal for embryo transfer timing in the different preparation methods. *Note: Estrogen and estradiol are often used interchangeably. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. Embryo transfer timing for HRT preparation. hormonal substitution with estrogen (E2) and progesterone) have proven to be effective to prepare A For example, if you start an IVF cycle with an estrogen level of 50 pg/mL, you might expect it to increase to 75-100 on Day 3 of stimulation. WebMaking pregnancy possible on your timeline.

Should we change endometrial preparation?

Although originally developed to allow embryo transfers in recipients of donated oocytes, the HRT protocol has proven to be successful in the general population as well (Younis et al., 1996), thus extending its advantages in terms of minimal monitoring and easy scheduling to those performing IVF overall. Future research should compare both the pregnancy and neonatal outcomes between HRT and true natural cycle (NC) FET. In bold: studies with actual comparison of different embryo transfer days. In these situations, we will use a medication (Letrozole) to suppress estrogen production purposefully. WebEstrogen & Progesterone Levels before FET Has anyone had their levels checked right before their frozen embryo transfer? In terms of embryo transfer timing, we propose to start progesterone intake on the theoretical day of oocyte retrieval in HRT and to perform blastocyst transfer at hCG + 7 or LH + 6 in modified or true NC, respectively. Below are typical serum levels of estradiol you might expect in the early follicular phase of your menstrual cycle (before you start the stimulation) and during the treatment cycle. In males, they can cause breast tissue The currently available results are contradictory as progesterone levels >20 ng/ml (possibly due to an escape ovulation and subsequent embryo-endometrial asynchrony) on the day of transfer have been associated with decreased ongoing pregnancy and live birth rates (Kofinas et al., 2015), while an optimal mid-luteal progesterone range between 22 and 31 ng/ml has also been proposed (Yovich et al., 2015). Mine was about 35,000 at 5 weeks, one healthy singleton girl from one untested frozen embryo transfer. Banz C, Katalinic A, Al-Hasani S, Seelig AS, Weiss JM, Diedrich K, Ludwig M. Belva F, Bonduelle M, Roelants M, Verheyen G, Van Landuyt L. Belva F, Henriet S, Van den Abbeel E, Camus M, Devroey P, Van der Elst J, Liebaers I, Haentjens P, Bonduelle M. Ben-Meir A, Aboo-Dia M, Revel A, Eizenman E, Laufer N, Simon A. Bjuresten K, Landgren B-M, Hovatta O, Stavreus-Evers A. Blockeel C, Drakopoulos P, Santos-Ribeiro S, Polyzos NP, Tournaye H. Bocca S, Bondia Real E, Lynch S, Stadtmauer L, Beydoun H, Mayer J, Oehninger S. Borini A, Dal Prato L, Bianchi L, Violini F, Cattoli M, Flamigni C. Bosch E, Labarta E, Crespo J, Simn C, Remoh J, Jenkins J, Pellicer A. Bourgain C, Devroey P, Van Waesberghe L, Smitz J, Van Steirteghem AC. contributed to the interpretation and editing of the manuscript. Currently, most cleavage stage embryos are transferred around the 4th day of progesterone supplementation, whereas blastocysts are usually transferred on the 6th day of progesterone supplementation. Until further data are accrued on this subject it seems likely that different protocols will continue to be used in daily practice (Weissman et al., 2011; Toms et al., 2012). Thin endometrium in donor oocyte recipients: enigma or obstacle for implantation? Thus, until further prospective studies comparing true with modified NC are performed, the question on what seems the best approach remains unanswered. Call now: (608) 824-6160.

%%EOF A meta-analysis concluded that the type of estrogen supplementation and route of administration had no effect on the success rates of FETs (Glujovsky et al., 2010). A previous retrospective analysis has shown a higher miscarriage rate for HRT compared to NC FET, although this could be related to the higher proportion of polycystic ovary syndrome patients in the HRT group (Toms et al., 2012).

Hormonal imbalances including estrogen dominance are often responsible for fertility issues couples may face when trying to get pregnant. Current caution and further research is needed; a RCT comparing true NC versus HRT FET in an unbiased population is warranted. Navot D, Laufer N, Kopolovic J, Rabinowitz R, Birkenfeld A, Lewin A, Granat M, Margalioth EJ, Schenker JG. endstream endobj 198 0 obj <>>>/Filter/Standard/Length 128/O(R3UfV=T;in)/P -1324/R 4/StmF/StdCF/StrF/StdCF/U(n84h' )/V 4>> endobj 199 0 obj <>/Metadata 13 0 R/PageLayout/OneColumn/Pages 195 0 R/StructTreeRoot 23 0 R/Type/Catalog>> endobj 200 0 obj <>/ExtGState<>/Font<>/XObject<>>>/Rotate 0/StructParents 0/Type/Page>> endobj 201 0 obj <>stream an increase in your waist measurement. No consensus has been reached yet on when to stop progesterone administration following a positive pregnancy test in HRT FET. The more follicles you have growing, the higher your estradiol level will be. WebIt is possible to get pregnant if you are living with high estrogen levels, however, there is an increased likelihood of fertility issues in those who are living with estrogen Methods: A retrospective cohort study of WebWhen estrogen is too high or too low you may get menstrual cycle changes, dry skin, hot flashes, trouble sleeping, night sweats, vaginal thinning and dryness, low sex drive, mood If you were planning a fresh embryo transfer, your provider will likely cancel the transfer and freeze all of your embryos. S.M.

FET preparation methods can largely be divided into artificial and natural cycles (NCs). Dr. Alex Robles is a Spanish-speaking Latino-American Reproductive Endocrinologist and Infertility specialist in New York City, and a board-certified OBGYN. The more follicles you have, the more estrogen is produced, and the faster your E2 level will rise. A Cochrane Database Review concluded that starting progesterone at a time equivalent to the day of or the day after oocyte retrieval (OR) results in a significantly higher pregnancy rate than if progesterone is initiated a day earlier than the day equivalent to OR (Glujovsky et al., 2010). High estrogen levels can cause symptoms such as irregular or heavy periods, weight gain, fatigue, and fibroids in females. 2020 Jan 29;18 (3):647-651. doi: 10.5114/aoms.2020.92466. As only a few high quality RCTs on the optimal preparation for FET are available in the existing literature, no definitive conclusion for benefit of one protocol over the other can be drawn so far. In the artificial cycle, also referred to as a HRT cycle, endometrial proliferation and follicular growth suppression is achieved by estrogen supplementation. gastrointestinal issues (nausea, vomiting, diarrhea) discomfort around your ovaries. Our objective was to characterize estrogen receptor 1 (ESR1) in human and mouse embryos and determine the effect of estradiol (E2) supplementation on pre- and peri-implantation blastocyst Estrogen is partly responsible for creating healthy sperm. When estrogen levels are high, sperm levels may fall and lead However, given the low incidence, it is questionable whether this measurement significantly improves pregnancy outcome, definitely when additional preventive measures are taken to avoid follicular growth and escape ovulation (e.g. . and H.T. WebThis study found that among patients whose progesterone levels were elevated during their IVF cycle, those who waited to have a frozen embryo transfer after their progesterone A significant difference in live birth rate was found below and above the median progesterone level (10.9 ng/ml, p = 0.007). If you are concerned about your own or someone else's hormone health, a home hormone test could help identify health issues that might affect a woman's ability to conceive. [] The main impact factors of FET are embryo quality, number of transferred embryos and endometrial receptivity. WebIf a pregnancy occurs, progesterone is produced in the placenta, and levels remain elevated throughout the pregnancy.

Third, some women from the modified NC group in this same study already had an LH rise on the day of hCG administration which was associated with significantly lower pregnancy rates (suspected to be because of higher grade of embryo-endometrial asynchrony), while serum progesterone >1 ng/ml was an exclusion criterion in the study by Weissman et al. For example, an E2 level of 1000 might yield 3-5 mature oocytes at the egg retrieval (as not all follicles yield eggs). As for the optimal progesterone dose specifically in HRT FET cycles, one retrospective study concluded that doubling the dose of vaginal progesterone gel in patients with oligomenorrhoea significantly increased live birth rates (Alsbjerg et al., 2013). These anovulatory cycles are most common among women between the ages of 30 and 50 and in women with secondary conditions which affect ovulation, such as polycystic ovary syndrome and endometriosis. Hreinsson J, Hardarson T, Lind A-K, Nilsson S, Westlander G. Ishihara O, Araki R, Kuwahara A, Itakura A, Saito H, Adamson GD. The combination of high estrogen and progesterone levels 2): On day (embryonic age + 1) of progesterone administration, annotated as P+ embryonic age (e.g. A difference in the timing of FET in true versus modified NC could be considered, as ovulation occurs 3648 h after hCG administration but varies from 24 to 56 h after a spontaneous LH surge (Kosmas et al., 2007). Besides the administration of estrogen, a GnRH agonist can be added to a HRT protocol in order to prevent spontaneous ovulation (Keltz et al., 1995). Kim C-H, Lee Y-J, Lee K-H, Kwon S-K, Kim S-H, Chae H-D, Kang B-M. Kofinas JD, Blakemore J, McCulloh DH, Grifo J. Kosmas IP, Tatsioni A, Fatemi HM, Kolibianakis EM, Tournaye H, Devroey P. Kyrou D, Fatemi HM, Popovic-Todorovic B, Van den Abbeel E, Camus M, Devroey P. Lee VCY, Li RHW, Chai J, Yeung TWY, Yeung WSB, Ho PC, Ng EHY. Hence, FET timing should assure that the blastocyst seeking implantation meets the optimal receptive/selective endometrial stage during the WOI. Regarding progesterone supplementation itself, there is little agreement on the ideal route of administration and dose. However, an accurate mirroring of this finely tuned and tightly regulated molecular system is probably difficult to reproduce artificially and one should acknowledge that all interventions might change the opening, closing, length and functionality of the WOI. Estrogens may be administered orally, vaginally and parentally (transdermal route) and both natural as well as synthetic estrogens may be used (Scott et al., 1991b).

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