Can I Use Vaginal Progesterone During IVF?

Progesterone Is Called "The Pregnancy Hormone"


From a reader: I’m a 35-year old woman and I recently started in vitro fertilization treatment for infertility. My physician said that I will need shots of progesterone. Can you tell me what the progesterone is for? I read that I also can use a progesterone gel in my vagina. I would appreciate your thoughts.

Progesterone is often called “the pregnancy hormone.” It is necessary in preparation for implantation of a fertilized egg (embryo) and for the changes that take place in your uterus at the site where the embryo implants itself.

Progesterone is produced by your ovaries during ovulation (the release of a mature egg from an ovary). Specifically, progesterone is produced by cells of the ovarian follicles, which are cysts that contained the eggs prior to ovulation. After 8 weeks of gestation, the placenta makes progesterone.

Progesterone prepares the lining of your uterus (endometrium) for implantation of a fertilized egg. If the fertilized egg does not implant itself into the uterus, your levels of progesterone drop and menstruation begins. If implantation is successful and pregnancy occurs, about 10 weeks into your pregnancy, your placenta takes over and produces high levels of progesterone and continues until your baby is born.

Do I Need Progesterone to Treat Infertility?

Taking progesterone is an essential part of fertility treatment. During IVF, your normal production of progesterone may be lowered for several reasons:

  • Medications used to slow down premature ovulation (such as Lupron, Antagon or Cetrotide) may reduce the production of progesterone following collection of your eggs.
  • At the time of follicle aspiration to obtain your mature eggs, many progesterone-producing cells may also be removed due to the mechanics of the procedure itself.

    To assure that the lining of the uterus is prepared for implantation of the fertilized egg, most women undergoing IVF will be given progesterone after the retrieval of her eggs.

    How Is Progesterone Given?

    If you are undergoing IVF, you may begin using progesterone starting at the time between egg retrieval and embryo transfer. Once a positive pregnancy test is confirmed progesterone treatment will continue for a total duration of up to 10 to 12 weeks (first trimester). You can take progesterone orally (by mouth), by injection, or vaginally.

    Progesterone taken by mouth is not reliable because it is metabolized in your liver after it is absorbed which can reduce its effectiveness and cause adverse effects.

    Although progesterone injections are effective, this method is the most uncomfortable form for you to take.

    The use of vaginal progesterone avoids the problems of both oral and injectable progesterone.

    Are There Different Types of Vaginal Progesterone?

    There are three types of available progesterone preparations that can be used vaginally:

    • Progesterone suppositories are made-to-order by a pharmacist based on the dose of progesterone and frequency of use as prescribed by your IVF specialist.
    • Progesterone gel is placed in your vagina once a day for progesterone supplementation or twice a day for progesterone replacement using a special applicator.
    • Vaginal tablets are placed in the vagina once or twice a day using a special applicator. Note that vaginal capsules are not approved by the FDA and are made to be given orally, not vaginally.

    What Are Some Brand Name Vaginal Progesterones?

    Brand name vaginal progesterones are Crinone, Endometrin, and Prometrium.

    If you are using vaginal progesterone you should not use any other vaginal medications for the duration of treatment unless instructed by your physician. Adverse effects may vary by type and brand of vaginal progesterone and you should make sure to discuss potential adverse effects with your doctor.

    Edited by Naveed Saleh, MD, MS, on 1/26/2016

    Selected Sources

    Molina PE. Chapter 9. Female Reproductive System. In: Molina PE. eds. Endocrine Physiology, 4e. New York, NY: McGraw-Hill; 2013. Accessed January 26, 2016.

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