Maximum Dose of Oral Progynova for FET
The maximum dose of oral Progynova (estradiol valerate) for frozen embryo transfer is 6 mg daily, divided into three doses of 2 mg each, which is the standard upper limit used in artificial cycle endometrial preparation protocols.
Standard Dosing Protocol for FET
The typical approach for endometrial preparation in artificial FET cycles involves:
- Starting dose: 2 mg estradiol valerate three times daily (total 6 mg/day) beginning on cycle day 2-3 1, 2
- Duration: Continue for approximately 14 days until endometrial thickness reaches ≥7-8 mm 1
- Progesterone addition: Add progesterone supplementation once adequate endometrial development is confirmed, typically after 14 days of estrogen priming 1
Evidence Supporting 6 mg as Maximum Dose
Multiple studies consistently demonstrate that 6 mg daily of oral estradiol valerate is the standard maximum dose used in FET protocols:
- Research comparing different estrogen formulations used 6 mg daily as the equivalent dose across oral, transdermal patch, and gel preparations 3
- Clinical trials evaluating FET outcomes routinely employ 6 mg daily oral estradiol valerate without escalating beyond this dose 2, 4
- No evidence supports using doses higher than 6 mg daily, as this appears to be the established ceiling dose in reproductive medicine practice
Dose Equivalency Considerations
When comparing formulations, 6 mg oral estradiol valerate is approximately equivalent to:
- 100 mcg/day transdermal estradiol patches (changed twice weekly) 5, 4
- Transdermal gel delivering similar systemic estradiol levels 3
Critical Clinical Considerations
Do not exceed 6 mg daily as there is no evidence of improved endometrial receptivity or pregnancy outcomes with higher doses, and excessive estrogen may paradoxically impair implantation 2, 3.
Monitor endometrial thickness via ultrasound rather than arbitrarily increasing the dose—if adequate thickness is not achieved with 6 mg daily after 14 days, consider switching to transdermal delivery rather than escalating oral dose 4.
Always add progestogen for luteal support once endometrial preparation is complete, using either 40 mg/day oral dydrogesterone, 180 mg/day vaginal progesterone gel, or 100 mg/day intramuscular progesterone 6.
Common Pitfall to Avoid
The most critical error is attempting to escalate oral estradiol valerate beyond 6 mg daily when endometrial response is suboptimal. Instead, switch to transdermal delivery (100 mcg patches twice weekly), which may achieve better endometrial development in poor responders due to more stable serum levels and avoidance of hepatic first-pass metabolism 5, 4.