Pick one, any one…progesterone

So many doctors have differing opinions about which type of progesterone is best for your IVF cycle.  Each doctor seems to have their favorites or the ones they use for their practice.  But have you ever asked your doctor why they prefer one over the other?  Some may give you a choice of options – so how do you choose?

Many US doctors are strong proponents of the PIO (progesterone in oils) shots.  These are the intramuscular shots that hurt like heck!  But, the benefit of them is that the progesterone can be measured in your blood stream.  And with a little preparation (ice/heat/massage), for many patients, it isn’t nearly as bad as the initial anticipation of the shots. 

An alternate source of progesterone that is gaining some popularity with US and European doctors is Crinone 8% gel.  Inserted vaginally once (or sometimes twice) daily, most studies have shown it to be as effective if not more effective than the PIO shots or other vaginal forms of progesterone (measured in studies based on numbers of patients getting pregnant- aka implantation rates, and staying pregnant- aka loss rates).  If you like reading all of the details, here’s a link to two of the more recent studies:

• http://findarticles.com/p/articles/mi_m0EIN/is_2007_June_25/ai_n19313115/ 
• http://www.crinoneusa.com/professionals/donor_egg_berger.html (this one is specific to donor egg IVF) 

A third common type of progesterone prescribed is the oral or vaginal capsules such as Prometrium, Endometrin, Utrogestan, etc.  These are widely used in Europe, and are also used by many reproductive practices in the US.   They tend to require more daily applications (sometimes up to 4 or 6 doses per day) than the PIO or Crinone 8% gel, so for some patients – this may have more of a nuisance factor.   Some doctors recommend use of the oral capsules vaginally – to essentially get the progesterone directly where it needs to go without having to be processed by your liver, and to minimize some of the side effects that are more prevalent when the medications are administered orally (such as sleepiness).  On the other hand, if your IVF medications (and stress) are causing insomnia, perhaps an evening oral dose of progesterone making you sleepy would be a welcome side effect.  

In the case of both Crinone and the Prometrium/Endometrin types of progesterone, you can expect to see a lower level in blood tests than you would with PIO, and that level may vary at different times during the day. So if you have a local doctor doing your monitoring for your cycle abroad, make sure they are aware of the type of progesterone you are using so they can advise you accordingly.

Also, if you are doing IVF abroad (aka an IVF vacation) remember that taking your progesterone on a consistent time schedule is important – so keep that in mind while you are traveling.  You may need to plan ahead, or slowly adjust the timing of your progesterone dose as you travel through many time zones.  Discuss this with your doctor and have a plan for making sure you get the progesterone you need when you need it. 

Also, if you are traveling with your medications, you need to do a little advance planning.  Make sure you have them with you in your carry on,  so that lost luggage doesn’t interrupt your medication administration and create a panic of trying to replace the medication while traveling.  You may also want to carry a letter from your doctor or pharmacy in case TSA or airport screening questions the needles, vials, or gel applicators you will have in your carry on luggage. 

The bottom line is that there are several very good options for progesterone support – and it is best to discuss the options with your doctor to decide which is the best choice for your case.