This is due to the “1^st pass” phenomenon. Oral absorption is not nearly sufficient enough to obtain and maintain adequate levels in the uterus.

- Answers kindly provided by Dr. Stephan Volschenk -

Supplementation of the luteal phase, if and when required, should preferably be using natural progesterones and therefore Primulut N is not really indicated. One would be more inclined to use Cyclogest or Utrogestan or Crinone Gel.

- Bi-Week 30 answers kindly provided by Dr. Stephan Volschenk -

The progesterone level does not give you an indication as to when ovulation might have taken place. It just confirms ovulation. Therefore one can only really work out when ovulation had taken place once you start your period by subtracting 14 days.

- Bi- Week 30 answers kindly provided by Dr. Stephan Volschenk -

The meaning of a randomised controlled trial is that during the trial, 2 subjects are run head to head and the results analysed as to which is the best. There is no difference in the absorption between intra muscular and vaginal progesterone at all – this has been proven numerous times. So therefore, common sense does not prevail in this instance. It is up to the attending physician in consultation with the patient to decide which form of progesterone supplementation will be used to support the luteal phase. Most people would prefer not to have a painful injection, one that is not without side effects I might add, if there is a less invasive and proven equally effective method such as vaginal pessaries in the correct dose.

With regards to your friend as mentioned in the question: We have a very similar case in the clinic at the moment and the only reason why we have decided to change to the injectable progesterone is because the discharge that follows the insertion of the pessary is socially not acceptable to her.

- Week 16 answers kindly provided by Dr. Stephan Volschenk -

It is important to understand the so called “first pass” effect in the uterus during exogenous progesterone. This means that the levels of the progesterone in and around the uterus is not the same as that in the peripheral blood – hence the inability to measure the progesterone in the blood and extrapolating what the level is in the uterus. So the answer is no – it can not and should not be measured as it will give a false value. Through many randomised controlled trials we know today that 400-600 mg of supplemented progesterone is sufficient to support the endometruim and pregnancy. There are different ways of administering the progesterone and this is mostly industry and market driven, as numerous randomised trial have shown all to be of equal efficacy with the exception of oral administration which has been shown to be not sufficient.

There are currently no studies to support the use of intra muscular gamma globulin in a reproductive setting and are not without any side effects.

- Week 15 answers kindly provided by Dr. Stephan Volschenk -

You multiply by 3.18

10ng/ml x 3.18 = 31.8, a count of at least 30 nmol/L would therefore confirm ovulation

- Week 13 answers kindly provided by Dr. Stephan Volschenk -

Cyclogest is progesterone and progesterone is a natural smooth muscle relaxant. Due to the fact that the whole digestive tract consist of smooth muscle, constipation is therefore a “side effect”. Fortunately there are many stool softeners on the market that is quite safe during pregnancy and the time leading up to a pregnancy. These are substances that do not get absorbed by the body, but rather stays in the digestive system. Examples of these are Duphalac, Fybogel Orange etc.

- Week 13 answers kindly provided by Dr. Stephan Volschenk -

After completion of an IVF cycle, it is of no value to monitor progesterone levels in the bloodstream. This is due to the so called “first pass effect” which essentially means that the progesterone levels in the area of the uterus is always higher than in the bloodstream and therefore not representative of whatever is measured in the bloodstream There are more than enough evidence stating that if the vaginal preparation is used properly, the absorption is sufficient ,hence no need for injectable progesterone preparations.

- Week 7 answers kindly provided by Dr. Stephan Volschenk -

The best way to monitor progesterone is to do serial levels at specific intervals. This is to diagnose possible luteal phase defects, meaning not enough progesterone production to support and stabilize the endometrium and a possible pregnancy. We look for the trend of the levels rather than specific values. Should the trend be upwards over an extended period of time, it usually is indicative of a pregnancy.

- Week 7 answers kindly provided by Dr. Stephan Volschenk -

Progesterone levels are usually done by gynaecologists to confirm ovulation. This is usually done half way between the midfollicular and luteal phase, usually on day 21. It is suppose to confirm ovulation at a level of 10ng/ml or more.

- Week 7 answers kindly provided by Dr. Stephan Volschenk -