Progesterone is a naturally occurring hormone that plays a significant part in female reproductive health. It helps prepare the uterus for pregnancy and supports early pregnancy development. Progesterone supplementation is often used under medical guidance to assist with conception and maintain pregnancy.
Progesterone’s Essential Role in Fertility
Progesterone is primarily produced by the corpus luteum, which forms after ovulation. This hormone transforms the uterine lining, known as the endometrium, making it receptive to a fertilized egg. If conception occurs, progesterone maintains this thickened lining, essential for embryo implantation and early pregnancy progression. If pregnancy does not occur, progesterone levels decline, leading to the shedding of the uterine lining, resulting in menstruation.
Progesterone supplementation is often prescribed to support conception. One such condition is luteal phase defect (LPD), where the body does not produce sufficient progesterone after ovulation, potentially leading to an inadequately prepared uterine lining. Supplementation can overcome this deficiency and prevent early pregnancy loss. In assisted reproductive technologies (ART) like in vitro fertilization (IVF), exogenous progesterone is consistently administered because egg retrieval disrupts natural production. Progesterone support in IVF cycles is important for embryo implantation and maintaining pregnancy. Progesterone also has a potential role in some cases of recurrent pregnancy loss, particularly when associated with early pregnancy bleeding, by helping to strengthen the uterine lining and reduce contractions.
Administering Progesterone for Conception
Progesterone for fertility treatment is available in several forms. Oral pills, such as micronized progesterone, can be taken by mouth, though oral absorption can be inefficient due to liver metabolism. Vaginal options include suppositories, gels (e.g., Crinone), and inserts (e.g., Endometrin), which deliver progesterone directly to the uterus. Injectable solutions, typically progesterone in oil, are given as intramuscular injections. The specific form chosen is determined by a healthcare provider.
The timing of progesterone administration depends on the fertility context. In natural or medicated cycles, progesterone is typically started a few days after ovulation is confirmed (e.g., three days following ovulation or four days after detecting an LH surge). For IVF cycles, progesterone supplementation usually begins on the day of or the day after egg retrieval. If a frozen embryo transfer is planned, progesterone may be started a few days before the scheduled transfer to allow the uterine lining to adequately thicken.
Dosages for progesterone therapy vary and are determined by a healthcare provider. Common examples include:
Oral micronized progesterone: 200mg once or twice daily.
Compounded vaginal suppositories: 200mg once or twice daily.
Vaginal gels (e.g., Crinone): 90mg once daily.
Vaginal inserts (e.g., Endometrin): 100mg two to three times daily.
Intramuscular injections (progesterone in oil): 50mg per day.
Treatment duration often extends until a positive pregnancy test and then possibly through the first trimester (8 to 12 weeks of pregnancy), until the placenta develops sufficiently to take over natural progesterone production. Adhere strictly to the prescribed dosage and timing. If a dose is missed, individuals should contact their clinic for guidance.
Key Considerations for Progesterone Therapy
Individuals undergoing progesterone therapy may experience common side effects, which are usually mild and manageable. These can include bloating, breast tenderness, fatigue, and mood changes. Vaginal preparations might cause local irritation, itching, burning, or discharge. Injectable forms can lead to pain, swelling, or bruising at the injection site.
Progesterone should only be used under the supervision of a fertility specialist or doctor. Self-medication is not advised due to varying dosages, forms, and underlying causes of infertility that require medical assessment. A healthcare provider determines the appropriate treatment plan based on individual needs and medical history.
Monitoring and follow-up are important components of progesterone therapy. Blood tests, including progesterone levels, and ultrasounds may be conducted to assess the body’s response to treatment and the progression of pregnancy. These tests help clinicians tailor treatment plans and ensure optimal conditions for conception and early pregnancy.
Stopping progesterone should always be done under medical guidance. The decision on when to discontinue treatment is based on factors such as gestational age and the reason for supplementation. In many cases, progesterone is continued until the placenta is fully developed and producing sufficient hormones, typically between 10 and 12 weeks of pregnancy. Stopping too early without medical advice, especially after IVF or in high-risk pregnancies, could increase the risk of complications.