Progesterone supplementation in IVF

April 13, 2012

After ovulation, the corpus luteum produces luteinizing hormone (progesterone). This is essential for the so-called „secretory transformation“ of the uterine lining. This only allows implantation and the early embryonic development.

It is generally customary to administer progesterone to female patients in the second half of the menstrual cycle, starting from the time of egg retrieval. The reason for this is the hypofunction of the ovaries, which occurs at least 7 days after the triggering of ovulation. The HCG in the „trigger injection“ stimulates the ovaries during this period after the final maturation of the eggs. Hypofunction of the ovaries occurs because the high concentrations of estrogen significantly restrict the secretion of LH from the pituitary gland (negative feedback). If implantation occurs, the „pregnancy HCG“ stimulates the ovaries. However, it is necessary to bridge the time between the fading stimulus from the ovulation injection and the endogenous HCG production by implantation.

Although there is worldwide agreement on the need for progesterone administration during IVF ICSI therapy, it has not been clear until now, or at least has been controversially discussed, how long this progesterone replacement should be continued without endangering the pregnancy.

In the study by D. Kyrou et al. (2011) received 600 mg of Utrogest daily for 100 female participants (in IVF therapy, pregnancy test positive, HCG doubling in the first few days) until the 7th week of pregnancy; the other 100 received the progesterone after the usual 14 days.

A comparison was made to see whether there were any differences in the rate of ongoing pregnancies.

Result: No significant difference could be found in either the frequency of vaginal bleeding or the rate of further pregnancies.

However, before generalizing this result, it must be noted that the 200 female participants were „ideal patients.“ All women were <39 years old and had normal baseline hormone profiles. Therefore, it is entirely possible that there are patient groups (older women, women with ovarian insufficiency, endometriosis) that could benefit from continuing therapy.

However, we can infer from this result that, at least for the majority of (rather ideal) female patients, progesterone replacement does not seem to be necessary beyond the usual 14 days.

Source:
D. Kyrou et al.: „Does cessation of progesterone supplementation in early pregnancy…“2011; Kolibianakis et al., 2003; Fatemi et al., 2007), G. Griesinger: „Is it time to abandon prog. supplementation of early pregnancy after IVF...?“ 2011