PROGESTERONE AND PREGNANCY

Progesterone is an important part of infertility treatment, and fertility specialists often prescribe progesterone supplements to help improve pregnancy rates during IVF. So why is progesterone supplementation used, and could it also help natural conception rates?

What is progesterone?

Progesterone is a hormone produced by the ovaries. It first appears in the middle of the menstrual cycle, when an egg is released (ovulation). One of the most important functions of progesterone is to prepare the lining of the uterus (endometrium) so that a fertilised egg (embryo) can implant. If no pregnancy occurs, progesterone levels fall and a period follows. If an embryo implants in the lining of the uterus, the resulting pregnancy produces the hormone human chorionic gonadotropin (hCG), which in turn directs the ovaries to produce progesterone until eight weeks of pregnancy. After that, progesterone is produced by the placenta for the rest of the pregnancy.

Do I need progesterone if I am trying to conceive naturally?

There is no evidence that giving progesterone supplements to otherwise healthy women in early pregnancy has additional benefits or reduces the risk of spontaneous miscarriage. A recent randomised trial also found no benefit from progesterone supplements in a group of women with recurrent miscarriage. Nevertheless, there may still be some benefit from this approach in individual cases, always after discussion with your doctor in the light of your own particular circumstances.

Why is progesterone prescribed during IVF treatment?

During an IVF cycle, medicines are usually used to prevent an egg from being released too early (premature ovulation). These medicines affect progesterone levels. The fertility specialist may therefore prescribe a progesterone supplement to make up for this reduction in the ovaries' ability to produce progesterone. In this way, an embryo can implant and develop in the uterus. Many scientific studies have looked at pregnancy rates in IVF cycles using progesterone. These studies have shown that the rates are much higher than in cycles where progesterone was not used.

When and how should I take progesterone?

Fertility specialists usually prescribe a progesterone supplement a few days after egg retrieval. Progesterone supplements generally come as vaginal pessaries or intramuscular injections. Although pessaries and injections appear to be equally effective, most women and fertility specialists prefer the vaginal preparations. Alternatively, luteal phase support with intermittent or multiple hCG injections can be used to stimulate the ovaries to produce progesterone. This is not recommended if more than ten follicles are seen on ultrasound, as it can cause an ovarian cyst or ovarian hyperstimulation (OHSS). For women undergoing IVF, progesterone supplements can be safely stopped at the time of a positive pregnancy test (hCG), as the body regains its ability to secrete progesterone at this stage.

Are there any risks in taking progesterone?

Many studies have been carried out on the use of natural progesterone during IVF treatment. These studies have shown that progesterone poses no risk to you or your baby. For some women, however, vaginal preparations can cause discharge and local irritation. If you have any questions about taking progesterone and the options available, contact the Reproductive Medicine and Fetal Medicine Centre - Dr. Alexandros Traianos for a consultation. For information, call ☎️(+30) 2310 277 032 or send a message to 📧email alexandrostraianos@gmail.com.