Progesterone – the key facts for IVF patients

27 Feb Progesterone – the key facts for IVF patients

Progesterone: IVF patients know it well. Why? Because progesterone support is essential for getting, and staying, pregnant after fertility treatment. But some progesterone products work better than others. Some have side effects. Others are fiddly. A few are expensive. So here’s the lowdown on the role of progesterone during IVF – and the best way to take it.

The reason IVF patients need extra progesterone is purely chemical. After natural ovulation, the follicle that contained your egg turns into the corpus luteum. This is the trigger for progesterone, which makes your womb lining super-ready for the fertilised embryo.

But IVF isn’t natural. Your FSH injections produce multiple follicles. More medication (e.g. Cetrotide) puts the brakes on ovulation. Your trigger shot (e.g. Ovitrelle) take those brakes off and your eggs are released and retrieved. In short, IVF disrupts your natural progesterone function. So you need lots more of it. Progesterone facilitates implantation and safeguards your ongoing pregnancy.

Progesterone supplements aren’t only for IVF with your own eggs. Donor-egg recipients need them too. In donor-egg treatment, your ovaries are down-regulated. (If you’ve got premature ovarian failure, they’ll have stopped of their own accord.) With your ovaries out of the picture, progesterone support is key. One or two missed dose could spell disaster in those early weeks.

Frozen embryo transfers (FETs) use progesterone too. FET patients won’t need a down-regulation injection, but the high dosage of estrogen still shuts off your ovarian function. Even in a natural-cycle FET (i.e. no estrogen support) your endometrium need some added progesterone. Your placenta then takes over the progesterone role from when you’re eight weeks’ pregnant.

Up until recently, you could take your progesterone three ways: orally, vaginally or intramuscularly. Now there’s a fourth way: subcutaneous application. Each has its pros and cons, but oral and vaginal use is the most common.

Oral pills (e.g. Utrogestan) are okay, but they can cause sedative and nauseous side effects. Most clinics warn against oral use. Best to take your Utrogestan vaginally. They’re less messy than gels and pessaries, and even if your product information is silent on vaginal application, you can still take them that way. Utrogestan is also the easiest form of progesterone to adjust dosage.

Vaginal progesterone, in the form of gel (Crinone) or pessaries (Cyclogest), is often considered more effective. Like the vaginal Utrogestan, they’re readily absorbed into the uterus, bypassing the liver, so you may feel more yourself. As a general rule, patients don’t really like vaginal insertion. But a 2019 study found that Crinone was more beneficial than intramuscular progesterone injections during FETs. This surprised us. A contrasting study in 2018 found injections were best.

We agree. Our favourite form of progesterone, taken by less than 10 per cent of fertility patients, is the intramuscular injection (e.g. Gestone, Prontogest, Agolutin). Absorbed slowly and evenly by the body, this oil-based product is still a safe bet. It can be good at limiting light spotting and bleeding in early pregnancy. One shot and you’re done for the day.

But what if your partner’s not at home to administer each one, daily, deep into your buttock? A daily trip to the local nurse is a bind. So is asking Noreen from next door. Despite its great credentials, intramuscular progesterone may not be everyone’s cup of tea. Also, using it as a supplement to vaginal progesterone after an FET does not improve ongoing pregnancy rates.

Last, but certainly not least, are subcutaneous progesterone injections (e.g .Prolutex and Lubion). They’re not intramuscular, so you can do it yourself. You might get fewer skin reactions. And a simple injection into your lower abdomen each day may be preferable to staying horizontal for 30 minutes after vaginal progesterone. But be warned: Lubion and Prolutex are quite expensive.

So that’s our summary of progesterone application during IVF. Whichever one you choose, don’t miss a single dose. Your baby needs progesterone more than you think.

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