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Progesterone Supplementation - IVF Guide

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What is progesterone and what does it do?
It gives support for the lining of the uterus and is needed to maintain an early pregnancy. There may not be enough progesterone made by the ovary during an IVF cycle, and so more progesterone is routinely given. Crinone vaginal gel, intramuscular progesterone, and Prometrium capsules are natural progesterone preparations which are safe to use during pregnancy. You will be given instructions as to which medication to use.

When do I start progesterone?
We will give you a prescription for progesterone (Crinone vaginal gel, intramuscular progesterone, or Prometrium capsules) when you start your IVF cycle. If you are using Crinone or Prometrium, begin the medication when you wake up in the morning starting the day after your egg retrieval. If you are using intramuscular progesterone, begin it either in the morning or the evening of your egg retrieval.

Is there anything else I need to know if I am taking Crinone?

  • When using Crinone, it is generally recommended that you take it when you first wake up.

  • When your cervix is cleaned off at the time of the embryo transfer, some of your morning dose may be washed out. Because of this, we want you to take a second dose when you get back home that day.

  • The day after your transfer, go back to taking it once a day again.

Is there anything else I need to know if I am using Prometrium?

  • When using Prometrium, the dose is usually one 200 mg. capsule three times a day.

  • Insert a capsule with your finger into your vagina about one half the distance towards your cervix. The exact distance that you place the capsule does not matter as long as it is fully inserted.

  • The first capsule should be inserted when you wake up, the second about mid-day, and the third at bedtime.

  • After your embryo transfer, you may just take your mid-day dose at the usual time without inserting any extra capsules.

Is there anything I need to know if I am using intramuscular (IM) progesterone?

  • Intramuscular (IM) means the shot goes deep in the muscle.
  • When using IM progesterone, the dose is 1 cc (1 ml), which is 50 mg IM once a day.

  • This shot is different from the subcutaneous (sq. or under the skin) shots used with your other medications. You will need specific instructions on how to give yourself this shot.

  • The progesterone can be used right from its container.

  • It does not matter if you take this in the morning or evening, as long as you give yourself the shot at about the same time each day (within one hour of the time of the shot the day before).

  • The progesterone is mixed with sesame oil which makes it very thick and can be hard to inject. Because you use the same vial many times, it can become contaminated. Be very careful to clean the top before each shot.

  • If the place where you give yourself the shot becomes warm, itchy, red, or inflamed, call the office. You should then get a new vial of progesterone in case the one you are using has become contaminated and is causing this reaction.

  • Putting cold on the injection site will decrease the itching. Warm moist soaks to the area can decrease the discomfort if you have pain, redness, or swelling. If you develop itching or a rash that is more generalized to your body, report this to our office before taking another shot.

Helpful Hints:

  • Please be aware of how much progesterone you have left so you can get more from your pharmacy before you run out. Your pharmacy may not keep this in stock and may need a day or two to get it in.

  • If you forget to take a dose of your progesterone, you do not need to call the office or the doctor on call to report this. Take your missed dose as soon as you remember it and then start your regular progesterone dosing schedule.

  • If you are pregnant, you will need to keep taking your progesterone supplement until about eight to nine weeks from your embryo transfer. Call our office if your “send-off” visit with your doctor is going to be later than this and we will plan the “weaning” schedule for you. Otherwise, this schedule can be made at the time of your “send-off” visit with your doctor. Little by little you will decrease your use of progesterone during the ninth week of pregnancy.

Side Effects of Progesterone
What are the side effects of taking progesterone?

  • Natural progesterone does not have any known side effects on a pregnancy. This includes the progesterone in Crinone gel suppositories, Prometrium capsules, and the progesterone in oil for injection.

  • The synthetic forms of progesterone - such as Medroxyprogesterone Acetate (Provera, Cycrin, Curretab) or Norethindrone Acetate (Norlutate) – should not be taken during your pregnancy. The progesterone that is in the birth control pill or Provera is man-made and may be related to bad side effects when taken during a pregnancy. These forms of progesterone should never be used whenever a woman may be pregnant.

Does the FDA having any warnings for Progesterone?
Yes. The FDA requires that all forms of progesterone have a warning label on them. Even though it has this warning label, natural progesterone does not increase the chance of birth defects or congenital anomalies. It is not linked with the risks of synthetic (man-made) progesterone used in pregnancy. Natural progesterone is safe no matter which form (shots or gel/suppositories/capsules) you use. Your pharmacist can easily check to see if the form of progesterone that you get is a natural one.

What effect will the progesterone have on me?
The progesterone supplement you are taking may give you symptoms of pregnancy (such as feeling full in the breast or bloating). This can happen even if you are not actually be pregnant. You may bleed during this time even if you are pregnant. Please be patient and stay on your progesterone until you know the results of your pregnancy test. Please call our office with any questions or concerns.

Are there any other side effects I should be aware of?

  • Crinone and Prometrium coat the vaginal mucosa. You may have what looks like small white “clumps” that come as a discharge. This can happen even after you have used it for several days. It can easily be confused with the discharge from a yeast infection. It may also become discolored and look like coffee grounds. If you notice a discharge and are concerned, please call our office.

  • The capsule that contains the Prometrium may fall out after you place it. As long as it is in your vagina for 20 minutes, you will have received the dose you need. No additional dose is needed. If the capsule falls out before 20 minutes, you may re-insert it or put in a new capsule.
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