What can be done to induce a period in a patient with irregular menstrual cycles, who is 2 weeks late, has a negative pregnancy test, and is preparing for embryo transfer?

Inducing Menstruation for Embryo Transfer Preparation

For a patient with irregular periods who is preparing for embryo transfer, progesterone 400 mg daily at bedtime for 10 days is recommended to induce menstruation. 1

Understanding the Situation

• The patient has irregular periods, is 2 weeks late, has a negative pregnancy test, and is preparing for embryo transfer 1
• Before proceeding with any treatment, it's important to be reasonably certain the patient is not pregnant, which is confirmed by her negative pregnancy test 2
• Inducing menstruation can help establish a predictable cycle for timing the embryo transfer 1

Recommended Treatment

First-line Option: Oral Progesterone

• Progesterone Capsules 400 mg daily at bedtime for 10 days is the FDA-approved regimen for secondary amenorrhea 1
• This regimen results in approximately 80% of women experiencing withdrawal bleeding within 7 days of the last dose 1
• Taking progesterone at bedtime is specifically recommended as some women experience drowsiness or dizziness after administration 1

Expected Outcomes

• Withdrawal bleeding typically occurs within 7 days after completing the 10-day course of progesterone 1
• This controlled bleeding allows for predictable timing of the subsequent cycle, which is crucial for embryo transfer preparation 3
• The induced menstruation helps reset the endometrial lining, preparing it for the controlled hormonal environment needed for embryo transfer 3

Timing Considerations for Embryo Transfer

• After menstruation occurs, the patient can begin preparation for embryo transfer according to her clinic's protocol 4
• For natural cycle frozen-thawed embryo transfers, proper timing relative to ovulation is critical 5
• The implantation window typically occurs between days 3-5 after progesterone exposure in the luteal phase 3
• Studies show that natural cycle protocols may have higher live birth rates compared to hormone replacement protocols in women with regular cycles 5

Important Considerations

• Progesterone should not be used if there is any suspicion of pregnancy despite the negative test 1
• The patient should be informed that drowsiness is a common side effect of progesterone, which is why bedtime administration is recommended 1
• If the patient has a history of liver problems, allergies to peanuts (as some progesterone capsules contain peanut oil), or unusual vaginal bleeding, progesterone may be contraindicated 1

Follow-up Plan

• The patient should contact her provider if withdrawal bleeding does not occur within 7 days after completing the progesterone course 1
• After menstruation occurs, the patient should follow up with her fertility specialist to begin the embryo transfer protocol 4
• Depending on the type of embryo transfer planned (fresh vs. frozen, natural vs. hormone-replacement cycle), different preparation protocols may be needed 4, 5

By following this approach, the patient can establish a predictable cycle that will facilitate optimal timing for embryo transfer, potentially improving chances of successful implantation.