Posts Tagged ‘progesterone’

Maybe a silly question, but here goes: Why do we need to use injectable or vaginal progesterone in the 2WW? Why can’t one use oral progesterone? (I assume it must be absorbed from gastrointestinal tract as progesterone is in birth control pills.)

Monday, May 4th, 2009

This is due to the “1st 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 -

My GP (I live in a small town far away from Fertility Clinics have PCOS & Hypothyroidism) prescribed clomid from CD5 to CD9, and then Primolut -N for CD19 to CD26 (3 times a day), I have however read that Primolut -N is contra indicated during pregnancy or if you plan on becoming pregnant. What is your opinion of this or should I request something else?

Friday, January 30th, 2009

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 -

f you have a high progesterone count like mine was (67.5) does that also give you an indication of when I might have ovulated? I tested on CD25.

Friday, January 30th, 2009

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 -

I’m a little confused on the uptake of progesterone during the 2ww. In a previous question, your feedback: “There are different ways of administering the progesterone and this is mostly industry and market driven, as numerous randomised trials have shown all to be of equal efficacy with the exception of oral administration which has been shown to be not sufficient.” A friend just had a failed IVF and it was suggested that she should use POI shots instead of peccaries next time round with her FET. Why isn’t POI’s prescribed in the first place? Why risk the possibility of under absorption if it can be prevented with PIOs? It seems common sense that intra muscular uptake would be better than transvaginal.

Friday, June 13th, 2008

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 -

Please can you ask Dr V if they test for progesterone levels in one’s blood following a BFP after IVF to ensure that the extra progesterone one is taking is enough? Also, why do people take such different types and different amounts of progesterone after IVF and what do they do with their IVF patients following ET with regards to progesterone. Another thing I’ve noticed is that quite a few people are on Intragram / Intagram injections once a week following ET and continue in the first trimester. Why is this and should everyone be put on it following IVF?

Sunday, June 1st, 2008

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 -

A few weeks ago you answered the question on what level progesterone confirms ovulation. I quote: “It is suppose to confirm ovulation at a level of 10ng/ml or more”. Most of our test results are expressed in nmol/L, what would the confirmation level be in this unit?

Thursday, May 8th, 2008

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 -

Some women have complained that cyclogest leads to discomfort due to constipation. Is there a laxative safe for use in the two week wait, or should one simply live with the temporary discomfort?

Thursday, May 8th, 2008

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 -

If IVF is successful should progesterone testing be done along with beta’s? Is it safe to assume that progesterone supplements prescribed (e.g. Cyclogest)is sufficient? Shouldn’t it also be checked continually incase body doesn’t respond to Cyclogest and if that’s the case, what can be done?

Wednesday, March 26th, 2008

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 -

When monitoring progesterone post ovulation, what are you looking for? What types of counts on what days? And does progesterone levels indicate possible pregnancy at these early stages?

Wednesday, March 26th, 2008

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 -

How is ovulation determined with the use of a progesterone blood test? What is the count suppose to be post ovulation, what day is it tested? When does it confirm ovulation?

Wednesday, March 26th, 2008

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 -


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