“Luteal phase” is the name for the time period following ovulation; in natural cycles, it is when a fertilized egg implants in the uterine lining (endometrium) to grow and develop. In IVF cycles, it is the time following ovulation and egg retrieval when the fertilized egg, or embryo, is transferred back into your uterus, also to implant.

Progesterone is a hormone that is considered key in making the endometrium receptive to implantation. During IVF, when your natural hormones are suppressed, your doctor will prescribe supplemental progesterone. It may also be given during natural cycles when the doctor suspects a “luteal phase defect” has been causing miscarriage.

Supplementing progesterone during IVF

Progesterone supplementation is usually begun on the evening of or the day following egg retrieval, to begin to prepare the uterine lining prior to embryo transfer.

Supplemental progesterone is initially prescribed until the first or second pregnancy test. Then, if you are pregnant, the prescription is refilled for about another 8 to 10 weeks, although this can vary from doctor to doctor. At the end of that time, the placenta will be more fully developed and produce its own supply of hormones to support the rest of the pregnancy.

Sometimes there is mild bleeding or spotting when using progesterone, so do not assume that you have miscarried. Continue taking your progesterone medication and consult with the doctor.

Questions & Answers

Q. I’ve heard there are different ways of taking progesterone. What are they?
A. There are a number of options available, and your doctor will decide which one best fits your individual needs. Here are the current methods from which your doctor may choose:

Injectable Progesterone – Suspended in oil and administered daily, or sometimes twice daily, progesterone is administered using a needle injected into a muscle (intramuscularly, or IM). PROS: Because doctors can measure your blood levels during treatment, they feel more secure prescribing it. CONS: Unfortunately, the needle gauge (thickness) has to be relatively large to accommodate the oil; this can cause great discomfort. It is also difficult to inject yourself, as the area of injection is small and hard to reach; a partner, nurse or friend must be available to help. What’s more, some women are allergic to the kind of oil (such as peanut oil) that is used to deliver the progesterone.

Oral Progesterone – This is progesterone available in capsule form. PROS: This form is easy to take.
CONS: Some women may experience sleepiness, dizziness, or lightheadedness. As the capsule uses a base of peanut oil, you cannot take it if you have a peanut allergy. Also, since doctors have a concern about how much progesterone gets through the digestive tract, it is not that popular a method.

Vaginal Progesterone – This form of progesterone is designed to deliver medication directly to the site by various methods:

Progesterone Inserts – ENDOMETRIN^®, newly approved by the FDA and shown to be highly effective in the largest IVF trial ever conducted in the United States¹, are specially formulated, 100-mg inserts of natural progesterone that are administered vaginally 2 or 3 times a day.
PROS: ENDOMETRIN^® inserts…

• Achieved excellent rates of pregnancy and live birth in the largest IVF clinical trial ever conducted in the United States
• Are easily administered using a specially designed disposable applicator
• Can be inserted while standing, sitting, or when lying on your back with your knees bent
• Dissolves rapidly to quickly achieve effective levels of medication²

Progesterone Suppositories – These are compounded by individual pharmacies on your doctor’s specifications, and inserted vaginally one or more times a day. They are compounded in fatty acid or polyethylene glycol (PEG), and melt on contact with your body to release the progesterone. PROS: It’s not a shot. Also, doctors sometimes prescribe progesterone suppositories to supplement a daily IM injection.
CONS: They can be messy. Also, some women may have a reaction to the compounding material. What’s more, the amount of medication you receive can vary from dose to dose.

Vaginal Progesterone Gel – This is progesterone in a gel base which you insert daily.
PROS: It is easy to dose using a single-use applicator.
CONS: Because the gel is made to adhere to the vaginal walls, buildup and blockage can be a problem; you or your doctor may need to clear it manually. Also, some women can have a reaction to or irritation from the gel itself.

At Ferring, we’re always looking for ways to make medications more comfortable and convenient and provide you with information that, along with your doctor’s advice, helps you explore treatment options that may be right for you. Keep checking this site for more new product news as it becomes available.

References: 1. Doody K, Shamma FN, Paulson RJ, et al. Endometrin^® for luteal phase support in a randomized, controlled, open-label, prospective IVF clinical trial using a combination of Menopur^® and Bravelle^®. Presented at: 55th Annual Meeting of the Pacific Coast Reproductive Society; April 18-22, 2007; Rancho Mirage, California.2. Blake EJ, Norris PM, Yankov VI. A randomized, open-label, single and multidose (single-day and multiple-day) pharmacokinetic study of a vaginal micronized progesterone tablet (Endometrin^®) compared to Crinone^® 8% vaginal gel in healthy reproductive-age female subjects. Presented at: 54th Annual Scientific Meeting of the Society for Gynecologic Investigation; March 16, 2007; Reno, Nevada.

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