Progesterone supplementation

Progesterone is made from the ovaries after ovulation. During IVF cycles, progesterone is produced after the hCG trigger injection is taken. Using medications to prevent premature ovulation and performing an egg retrieval may cause the progesterone production to be inadequate. For this reason, we will supplement progesterone. The most reliable way to get progesterone to the uterus is to administer it vaginally. Several studies have been performed comparing vaginal progesterone to intra-muscular injections. Some studies show that vaginal is best, some show intra-muscular is best and others show no difference between the two. Until the issue is resolved satisfactorily, we have decided to use both types.

We like to use vaginal progesterone in the evening (either a natural progesterone cream called Crinone or natural progesterone suppositories or a new type of vaginal progesterone called Endometrin ). Crinone comes in an applicator like medications that are used to treat yeast infections. One applicator of Crinone or one natural progesterone suppository is given each night starting on the night of the egg retrieval. The intra-muscular progesterone starts the next morning and continues every morning.

Many couples worry whether treatment with progesterone is safe for the baby. The short answer is yes. 

 

Progesterone supplements come in different varieties. Only a few of these types are safe to use in pregnancy. Progesterone that is chemically identical to the "natural" progesterone made in the ovaries is safe to use in pregnancy. In fact, two brands, Crinone and Endometrin, are natural progesterones that are approved by the U.S. FDA for use in fertility treatments. Some pharmacies can also make natural progesterone vaginal suppositories. Progesterone intramuscular injections also contain natural progesterone and may be used during pregnancy.

 

There are progesterone supplements that are synthetically derived and not chemically identical to the progesterone made in the ovaries. For example, the progesterones that are contained in birth control pills like norethindrone, drospirenone (and others) should not be used in pregnancy. A very commonly used type of synthetic progesterone called Provera should also not be used in pregnant women.