Progesterone and Pregnancy: A Vital Connection

The role of progesterone in overall fertility health, is that it helps prepare the uterus for pregnancy. After ovulation occurs, the ovaries start to produce progesterone needed by the uterus. Progesterone causes the uterine lining or endometrium to thicken. The overall goal is to have a thick lining which will helps create an ideal supportive environment in your uterus for a fertilized egg/embryo.

Progesterone balance in a pregnancy is essential. A consistent supply of progesterone to the endometrium continues helps nurture the developing fetus throughout the pregnancy. Following a successful implantation, progesterone also helps maintain a supportive environment for the developing fetus. After 8 to 10 weeks of pregnancy, the placenta takes over progesterone production from the ovaries and substantially increases progesterone production.

Not all forms of progesterone are created equal. There are several types of progesterone are available, including vaginal products that deliver progesterone directly to the uterus.

The different forms include the following:

Vaginal gel:

• Used once a day for progesterone supplementation
• Unique — the only once-daily FDA-approved progesterone for ART for up to 12 weeks of pregnancy
• The only FDA-approved progesterone for replacement for donor egg recipients and frozen embryo transfers
• Over a decade of experience and over 40 million doses prescribed
  In studies where patient preference was measured, a majority of women preferred the gel for comfort and convenience over other progesterone formulations
• Some discharge reported during use

Vaginal suppositories:

• Compounded at specialty pharmacists
• Wax-based
• Widely used but not FDA-approved
• Used 2 to 3 times a day
• Leakage can be messy

Vaginal inserts:

• Designed for vaginal use
• FDA-approved for progesterone supplementation but not for progesterone replacement
• Effective in women under 35 years; no established results in women over 35 years
  Used 2 to 3 times a day

Progesterone oral capsules, used vaginally:

• Not formulated or FDA-approved for vaginal use
• Fewer side effects when capsules are used vaginally instead of orally
• Used up to 3 times a day

Injections:

• An oil-based solution (sometimes called progesterone in oil)
• Widely used; the oldest, most established method of progesterone delivery
• Injected into the buttocks once a day
• Require long, thick needle to penetrate layers of skin and fat
• Difficult to administer by yourself
• Injections may be painful
• Skin reactions are common

This is a decision that you and your health care provider can make together. Progesterone is an important part of infertility treatment because it supports implantation and pregnancy. Health care providers often have a preference for which form of progesterone they prescribe for infertility treatment. Their preference is generally based on their experience with the various methods. But patient convenience and request are also important considerations.

Most women prefer a progesterone formulation that is easy, convenient, and comfortable. So, be sure to discuss your options with your health care provider.