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Don’t Let Me Be Misunderstood!

What do cheese-filled pizza crusts, The Mona Lisa, Valentine’s Day and being your high school’s “most likely to succeed” all have in common? They are all highly valued by some people and deemed overrated by others. This is not much unlike our friend Progesterone, or P4, if you prefer a chemically accurate rap name. P4, or Prog, as it is sometimes called, is one of the most measured and misunderstood, over and underestimated hormones that ever came into world of medicine. While it is true that progesterone is important (indeed essential) to maintain a pregnancy, what is not commonly known is how little progesterone is actually required. In our experience, too much emphasis is placed on progesterone.

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 Progesterone and Pregnancy

Progesterone is an important part of infertility treatment, with fertility specialists often prescribing progesterone supplements to help improve pregnancy rates from IVF. So why is progesterone supplementation used and can it help with natural conception rates as well? While both the suppository and injection methods appear to be equally effective, vaginal preparations are preferred by most patients and fertility specialists alike. Alternatively, luteal phase support with intermittent or several hCG injections can be used to stimulate the ovaries to produce progesterone.

 PROMISE: first-trimester progesterone therapy in women with a history of unexplained recurrent miscarriages

The study found no evidence that first-trimester progesterone therapy improves outcomes in women with a history of unexplained recurrent miscarriages.

Articles of Interest

Does taking progesterone increase the chances of pregnancy?

Can progesterone help you get pregnant? Progesterone for conception has been a very controversial topic and there is still a lot of conflicting research out about progesterone supplementation and pregnancy.

IVF and Progesterone Shots: Why Progesterone Is Essential for IVF Success

During IVF, eggs are retrieved from the follicles using a fine needle. This process removes the very cells that would typically produce progesterone, resulting in a luteal phase deficiency. To make up for this deficit, progesterone supplementation after IVF is necessary. Without it, the uterine lining may not be receptive enough for implantation.

IVF and Progesterone Shots: Why Progesterone Is Essential for IVF Success

During IVF, eggs are retrieved from the follicles using a fine needle. This process removes the very cells that would typically produce progesterone, resulting in a luteal phase deficiency. To make up for this deficit, progesterone supplementation after IVF is necessary. Without it, the uterine lining may not be receptive enough for implantation.

IVF and Progesterone Shots: Why Progesterone Is Essential for IVF Success

During IVF, eggs are retrieved from the follicles using a fine needle. This process removes the very cells that would typically produce progesterone, resulting in a luteal phase deficiency. To make up for this deficit, progesterone supplementation after IVF is necessary. Without it, the uterine lining may not be receptive enough for implantation.

Miscarriages May Be Prevented With Progesterone

Progesterone has been shown to help stabilize the inner lining of the uterus called the endometrium, an important factor for healthy embryo development. Progesterone supplements (also known as micronized progesterone) have been recommended for more than 50 years for women struggling with infertility, but there’s been less research on how it might benefit women who get pregnant but then miscarry.

Progesterone 101

For treatment, progesterone usage falls into two broad groups, progesterone supplementation, where progesterone is produced in the ovary and supplemented with medication, and progesterone replacement, where there is no natural progesterone production. Progesterone replacement would be used in an oocyte donation recipient. Since ovulation occurs in the donor, and there is no natural progesterone in the recipient, all progesterone must be administered. Progesterone replacement is also common for cryopreserved embryo transfers, though natural cycles can also be used in many women with regular menstrual cycles.

Progesterone and IVF: So why do I need this?

Progesterone helps support implantation and the IVF process blunts your body’s natural ability to make progesterone. When one undergoes a fresh IVF cycle for example, all of those follicles that are aspirated at the time of egg retrieval made progesterone but the hormone signals from the brain that KEEP those follicles making progesterone is blunted by the IVF medications that are responsible for prevented ovulation. As a result, progesterone supplementation is required in IVF.

Progesterone May Not Help Women With History of Miscarriages, Study Finds

Giving progesterone to women who have had three or more miscarriages does not improve their chances of carrying a pregnancy to term, according to a study published on Wednesday. Researchers had hoped that pregnant women who were given supplemental progesterone early in their first trimester would be less likely to miscarry than women who did not have it. Previous studies suggested that progesterone could lower the risk among women with a history of recurrent miscarriages. But the results of the new trial, published in The New England Journal of Medicine, show that 65.8 percent of the women given progesterone gave birth to a baby, compared with 63.3 percent of the control group — not a significant difference.

Progesterone supplementation during IVF

Progesterone supplementation is usually started on the day of egg retrieval. If a pregnancy takes place, supplementation may continue throughout the first trimester. Progesterone may be taken as an intramuscular injection or given through the vagina as a suppository, gel, or tablet. There appears to be no difference in the chance of becoming pregnant or continuing a pregnancy based on how the progesterone is given.

Progesterone Supplements 101: Everything You Need to Know

The most effective progesterone supplements for fertility are injectable and vaginal forms of progesterone. It’s no contest when you compare these forms to oral progesterone. They easily win the fight!

Progesterone treatment in early pregnancy

Studies have shown that women, who are bleeding and have had more than one miscarriage may benefit from taking progesterone. PROMISE study: studied 836 women with unexplained recurrent miscarriages at 45 hospitals in the UK and the Netherlands and found a 3% higher live birth rate with progesterone. PRISM studied 4,153 women with early pregnancy bleeding at 48 hospitals in the UK and found there was a 5% increase in the number of babies born to those who were given progesterone who had previously had one or more miscarriages, compared to those given a placebo.

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.

Taking progesterone in early pregnancy

If you are under the care of a recurrent miscarriage clinic, your doctor may offer progesterone supplements from day 21 of your menstrual cycle. They will only do this if tests show that your ovaries are not releasing enough progesterone (also called luteal phase hormonal insufficiency). If your pregnancy test is positive during that cycle, the progesterone supplements will be continued until 12 weeks. Progesterone is also used in fertility treatment and for women and birthing people at risk of preterm labour.