Progesterone: Answers to the most frequently asked questions and concerns

CNY Fertility Center, founded and directed by Dr. Robert J. Kiltz, with offices in Albany, Latham, Syracuse and Rochester, NY offers several different protocols for the treatment of infertility.  All treatments include the administration of a vaginal progesterone for luteal phase support.  Progesterone is necessary to prepare the uterus for implantation of an embryo.  Progesterone is produced by the cells in a follicle after ovulation.  If the embryo does not implant into the uterus, your level of progesterone drops and menstruation begins.  If implantation is successful and pregnancy occurs, about 10-12 weeks into your pregnancy, your placenta takes over and produces high levels of progesterone and continues until your baby is born.  There are many reasons why a client may not produce enough progesterone to support a pregnancy.  Certain medications as well as the aspiration of follicles minimizes the number of progesterone-producing cells, therefore, the supplementation of progesterone is indicated in all types of protocols when assisting reproduction.
At CNY Fertility Center, we use three different types of vaginal progesterone, all which provide support to the endometrial lining and a pregnancy.  Crinone Gel, Endometrin and Prometrium are the commonly used progesterones.  All offer common levels of support and have similar side effects.  Shortly after ovulation/egg retrieval, progesterone support is initiated.  The vaginal progesterones cause very similar side effects and are similar to the effects of premenstrual syndrome (PMS).  Breast tenderness, bloating, nausea, occasional vomiting, mood swings, depressive feelings, and cramping are common side effects.  Many of our clients will look for signs and symptoms of an impending positive pregnancy test and the progesterone support often gives the same symptoms of an early pregnancy.  Vaginal progesterone can also irritate the vagina, much like a yeast infection.  Clients may complain of vaginal itching and discharge.  These are very common side effects and does not necessarily indicate infection.  Some clients may also experience bleeding prior to their pregnancy test.  It is IMPERITIVE that our clients remain on their progesterone support until their pregnancy test.  Often a client who is pregnant may have bleeding early on in pregnancy so it is very important to remain on progesterone support until a blood pregnancy test confirms the outcome.
Once a pregnancy is established, many clients experience cervical irritation from the vaginal progesterone and thus experience bleeding.  This bleeding typically presents as a “gush” of watery blood which, over a period of a few hours to one day, tapers off to a brown spotting.  We encourage our clients to call the office with any bleeding and we will evaluate you in the office, however, be reassured, that in most cases, this is cervical irritation and has no affect on your baby growing in your uterus.  Oral progesterones are available, however, at CNY Fertility Center, we have found that the vaginal route is more effective.  Vaginal progesterone support is a very important step in reaching the goal of a successful pregnancy.
Justine Taylor, RN, BSN
Nurse Manager and IVF Coordinator