Is progesterone needed in IVF?

Progesterone is the hormone produced in large amounts in the ovary after ovulation. Specifically progesterone is produced from the cells of the follicle cyst that contained the egg prior to ovulation. The time period after ovulation when progesterone  is being produced is called the luteal phase.  

During IVF  cycles, the production of progesterone can be compromised for several reasons :

• Medications that suppress ovulation such as Lupron , Ganarelix or Cetrotide .
• Aspirating the follicles reduces the number of cells available to make progesterone.

Natural Progesterone Supplementation

Natural progesterone supplementation is used in the majority of in vitro fertilization cycles to overcome the progesterone deficiency. It may be administered orally, by intramuscular injection, or by placement in the vagina. However, natural progesterone given orally tends to be unreliable because of the extensive breakdown of natural progesterone by the stomach and liver after absorption. Several studies suggest that intramuscular progesterone injections are effective but this is the most uncomfortable form for the patient to take.  The vaginal route is an attractive option because it avoids the problems of oral injectable progesterone. In addition, there is evidence that points to the fact that vaginally administered natural progesterone may result in higher uterine concentrations of progesterone compared to other methods.  

There are three widely available natural progesterone preparations that can be administered vaginally:

• Crinone 8% Vaginal Gel
• Prometrium capsules
• Progesterone suppositories
• Endometrin

Progesterone in IVF study

In a recent IVF study, women were randomly assigned to receive either Prometrium capsules three times a day or Crinone twice daily. The results of this study indicated that the chances for embryo implantation were no different between the groups. Likewise, the pregnancy rate and miscarriage rate were no different between the two groups. It would seem, therefore, that doctors or patients may choose to use either one of these types of natural progesterone during IVF.