The Best Way To Wean Yourself Off IVF Meds

The IVF treatment worked. You’re pregnant. Wonderful news. But now you’re worrying – when should you stop your IVF medication? Your meds typically include progesterone and estrogen. But you may be taking additional meds too.

Don’t change or stop any IVF medication until your fertility clinic tells you to. You need precise instructions. There’s no standard approach, since when and how to wean differs from patient to patient. Your clinic must review what you’re taking – and why and when you’re taking it. How your pregnancy is progressing is also relevant. 

Your medication is supporting your pregnancy. Your natural hormones, in most cases, are bypassed in fertility treatment. So, read on for our best advice on tapering off your meds.

Why you need to take IVF medication after a positive pregnancy test

Progesterone prepares the womb lining for implantation. It’s very important in early pregnancy. In a fresh IVF cycle, your ovarian stimulation can disrupt your hormones during the luteal phase – the critical time after egg retrieval and embryo transfer and before your HCG pregnancy test.

You’ll probably be taking estrogen alongside progesterone if you’re transferring frozen embryos, having donor eggs or embryo adoption. In these treatments, ovulation is usually suppressed. You’re down regulated by the estrogen – and even more so with a depot shot. No corpus luteum activity means no post-ovulatory natural progesterone – the key pregnancy hormone.

A positive pregnancy test isn’t the moment to stop the synthetic hormones you’re taking. The developing placenta needs these man-made hormones for a few more weeks. Eventually, your body’s own hormones take over. But not yet.   

Let’s break down the different treatment types, the hormone support for each one, and how to wean off your meds in each case.    

Fresh IVF cycles – the standard weaning process

In a fresh IVF cycle, despite the strong stimulation injections and trigger shot, your corpus luteum still has some activity. But your natural reproductive system is still medically bewildered. A more stable progesterone flow is generally needed – hence the artificial progesterone you take from egg retrieval.  

That said, some studies show that progesterone may not need to be taken for as long once thought . A few years ago, the usual tapering-off point was around 12 weeks pregnant. These days, many clinics taper earlier – often around the 9-week mark.

A review of past studies into when to stop luteal-phase support in fresh IVF cycles found similar live-birth rates in earlier and later progesterone weaning, The key phrase? The luteo-placental shift – when the placenta takes over the critical hormone production started in the corpus luteum. That luteal shift happens between 7 and 9 weeks of pregnancy.

Fresh IVF protocols vary, as do patient cases. Current ESHRE guidance says, rather surprisingly, that progesterone should be continued until at least the date of the pregnancy test. In practice, most clinics start tapering progesterone no earlier than the luteo-placental shift – three or four weeks later. 

It’s quite common, in fresh IVF cycles, to start weaning off IVF medication around 8 weeks gestation. This means halving the daily progesterone dose at that point (and the estrogen, if you’re taking it) and stopping altogether at 9 weeks’ pregnant.

But it’s crucial to speak to your IVF clinic. Its medication-tapering approach for your case may be different.   

Natural or modified-natural FET cycles – tapering your medication

In a natural-cycle FET cycle, you ovulate as normal. Your corpus luteum plays its natural role. No synthetic estrogen is used at all, but progesterone supplementation is common. The progesterone daily dose here is typically lower than a medicated FET (100 mg to 200 mg daily is common).

So, your pregnancy after a natural-cycle FET is not as critically dependent on medication. Some studies even say luteal phase support isn’t needed at all.    

Your specific protocol and prognosis influence how and when you wean off this lower progesterone dose (if it’s prescribed). Once again, weaning off the medication around the luteo-placental shift is common practice.

This may mean reducing the medication by half, over a one-week period, and starting this reduction around 8 weeks’ pregnant. Reducing the full dose to one application every two days is another approach. Your clinic will tell you what to do.

Medicated FET cycles, donor-eggs and donor-embryos – the best way to wean

In FETs, donor-egg and donor-embryo cycles (fresh or frozen), careful weaning is important.     

Medicated FETs dispense with natural ovulation. As do fresh donor-egg and fresh donor-embryo cycles, where complete down regulation of the ovaries is standard. Estrogen and progesterone medication therefore provides vital hormonal support in early pregnancy.

Given the critical role the medication plays in these treatments, many clinics play it safe and continue the progesterone and estrogen until approximately 10 to 12 weeks gestation – later than the luteo-placental shift.

But protocols and clinics differ. Reducing the medication from 8 weeks pregnant and stopping it at 9 weeks pregnant can also be okay – as long as no bleeding happens beforehand. That’s what our Czech IVF  clinic does.

Let’s look at an example on how to reduce (not when).

You’re taking 6 mg of Progynova and 800 mg of Cyclogest daily. Reducing to 4 mg daily of Progynova and 400 mg daily of Cyclogest for one week is acceptable, after which the meds can stop.

But what If you’re taking more meds than normal? An example might be 6 mg or Progynova, 800 mg of Cyclogest plus an extra Lubion injection to boost your progesterone intake. Your clinic will advise, but tapering over two weeks may be better.

That could mean reducing the Progynova to 4 mg and stopping one of the Cyclogest doses in the first week – and spacing the Lubion and remaining Cyclogest 12 hours apart. The second week might see the Progynova reduced to 2 mg daily and perhaps just the Lubion injection continued. It’s a gentler weaning process, avoiding too big a hormonal drop.

Do all IVF medications need to be tapered?

Not every IVF drug has to be tapered. Progesterone and estrogen can sometimes be stopped dead on a specified date. Other clinics prefer a more staged reduction over a week or two. There’s no standard tapering approach – the timing, rather than the gradient, is more important.     

Don’t automatically halve your dose at 8 weeks’ pregnant. Ask your clinic three things:

• The exact date to reduce or stop each of your medications
• Instructions for missed or late doses
• If bleeding before or after the reduction affects anything

How to calculate how many weeks pregnant you are after IVF

IVF pregnancy dating can be confusing. An IVF due date calculator, and one that tells you how pregnant you are, may be helpful in identifying how and when to start the weaning process.   

Here’s a dating example. On the day of embryo transfer, you are, medically:

• 2 weeks and 3 days pregnant after a day-three embryo transfer
• 2 weeks and 5 days pregnant after a day-five blastocyst transfer

So, 8 weeks pregnant isn’t the same as 8 weeks post-embryo transfer. If you’re unclear, speak to your clinic. Your pregnancy is often more advanced than you think, but you must be sure what date to start the reduction process.     

How do you wean off aspirin, prednisolone and Clexane after IVF?

Stop dates for baby aspirin, Prednisolone and Clexane require more tailored advice. The key question is: why are you taking them?   

We know that clinics can include one or more in IVF protocols. Generally, none of them meaningfully improve live birth rates when routinely prescribed. They offer no clear benefits if given to every fertility patient. 

However, in some cases they’re needed. Baby aspirin and/or Clexane can help patients with antiphospholipid syndrome and certain thrombophilic or haematological conditions. The meds may be needed well beyond the first trimester and the normal weaning window.

If your protocol includes baby aspirin or Clexane as a precautionary   measure – with no clear medical reason to take them – weaning off the aspirin over a week or two, at the same time as your other meds, may be recommended. In the case of Clexane, stopping the medication dead at the end of the first trimester is a common approach.

Prednisolone needs careful handling. Routine use in IVF, as a so-called reproductive-immunology treatment, is questionable. But if there’s a compelling immunological reason to take it, ask your clinic how long you should take it for.    

Otherwise, tapering a small dose – say, 5 mg daily – over one week may be okay. This could mean reducing to one pill every other day over that period. For higher doses, a longer weaning process may be needed. But tapering is always sensible with Prednisolone; stopping it dead is generally not advised. Discuss with your doctor or clinic.

Weaning off IVF medication – in summary 

Before starting your medication reduction, follow our five-point plan:

1. Be clear what treatment you had: fresh IVF, fresh donor eggs, fresh donor embryos, a medicated FET or a natural-cycle FET.
2. Male a list of the meds you’re taking. It will usually include progesterone and estrogen – and might also include baby aspirin, Prednisolone, Clexane, and other products.
3. Ask your clinic why each medicine was prescribed.
4. Request instructions in writing from your clinic on how and when to wean off each medication.   
5. Run the instructions by your local doctor or any medical specialists you also see.

Stopping IVF medication can be an anxious moment. But with the right medical advice, personalised to you, it’s a process with few problems. As your body takes over the support of your pregnancy, the weaning transition should go smoothly.