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Progesterone: shots vs suppositories

Posted Sep 25 2009 3:34pm

I really think that most doctors are actually afraid of shots. I remember as a Duke medical student the scene during my first year when we were all lined up to get our hepatitis vaccines….what a bunch of weenies. Boy, we were shaking in our boots over a stupid little shot. Of course, now I am on the other side of the needle.

So why do we use the barbaric progesterone in oil shots after IVF or for an FET or donor egg cycle? Honestly, there is no really satisfactory answer. We know that progesterone suppositories work as well and yet we have a hard time using them as first line progesterone replacement. I am as guilty as the next RE in this behavior. However, I have no problem using non-injectible forms of progesterone if needed.

Fortunately, hope may be on the horizon. Ferring has a new FDA approved vaginal progesterone tablet called Endometrin. Preliminary data looks good and patient acceptance is high. On the other hand, we thought that Crinone Progesterone Gel would be the answer to the prayers of thousands of IVF patients and that did not work out so well as some patients ended up having this lump of gel extrude from their vagina after a couple of doses. Needless to say, patient compliance suffered.

So here is today’s Question of the Day (which has ended up becoming more like the Question of the Week…but hey, it’s free).

65. I had an allergic reaction to the progesterone in oil shots. Does this mean that I cannot do IVF?

Following follicle aspiration, most clinics place patients on progesterone supplementation. The rationale behind the supplemental progesterone is that following egg collection, ovarian hormone production may be impaired because many of the hormone-producing cells are removed at the time of follicle aspiration. In addition, the use of GnRH agonists such as Lupron may diminish ovarian steroid production following egg collection. Progesterone supplementation has evolved over the years to include patients undergoing both stimulated IUI cycles and IVF. Although most clinics tend to use progesterone-in-oil injections, excellent pregnancy rates have been reported in patients who used vaginal progesterone supplementation. Because the progesterone shots are either sesame or peanut oil based, allergic reactions are not infrequent; switching patients to vaginal progesterone preparations usually resolves the problem. Another strategy to maintain progesterone production after IUI or egg collection involves the use of HCG booster shots to enhance steroid production from the patient’s ovaries rather than relying on an outside source. Unfortunately, the use of HCG boosters may also increase the woman’s risk of ovarian hyperstimulation syndrome.

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