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Should
I take progesterone supplementation during treatment?
Some RE's put patients on progesterone during the luteal phase automatically. The underlying concept is that if you
wait and find out if the progesterone is low, even at seven days past ovulation (7 dpo), it can be too late because the lining
may not be receptive to implantation. Low progesterone can cause implantation failure, because its role is to vascularize
and maintain the uterine lining, which is where implantation takes place. Sometimes women require more progesterone support
in the luteal phase on injectables, even if they have a good progesterone level. This may have to do with the high levels
of estrogen that occur during injectable cycles. There are four different common methods of progesterone supplementation:
progesterone in oil shots (PIO), progesterone suppositories or vaginal capsules, Crinone (progesterone) vaginal gel, and oral
progesterone. Also, hCG "boosters" given five days or so after the first dose, are commonly used to cause the Corpus Luteum
to produce more progesterone. Progesterone, even in the form of over-the-counter creams, should not be taken before ovulation
because it can block ovulation and make the cervical mucus hard for the sperm to penetrate. Crinone and suppositories deliver
progesterone in a more effective manner than oral supplementation. Oral progesterone is not used by some RE's due to ineffective
absorption. Crinone is quite expensive and progesterone suppositories can be messy. Vaginal capsules (identical in appearance
to a capsule used for oral medication, but inserted into the vagina) may be a little hard to place, but are quite inexpensive
and available in a variety of doses in the same manner as suppositories. PIO shots can be uncomfortable, but they are effective.
Discuss the best medication method and dosage with your doctor.
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FAQ ON PROGESTERONE TESTING/LEVELS/ETC.
A progesterone test
is done to confirm ovulation. (www.fertilityplus.org/faq...esterone). Serum progesterone rises with ovulation, peaks 5-9
days following ovulation, and declines as the menstrual period approaches. (www.medhelp.or/forums/mat...3130.html) . Pregnancy
rescues the corpus luteum and the progesterone level does not fall. Ibid. Progesterone is best tested 6, 7, or 8 days following
ovulation. Ibid. Testing on day 21 presumes ovulation occurred on day 14. Ibid. Many doctors routinely test on day 21 or day
23.
A level over 5 probably indicates some form of ovulation, but most doctors want to see a level over 10 on a natural
cycle, and level over 15 on a medicated cycle. (www.fertilityplus.org/faq...esterone). Some people say that a level of 3-6
on a natural cycle indicates some form of ovulation. There is no mid-luteal level that predicts pregnancy. (www.fertilityplus.org/faq...esterone).
Some say the test may be more accurate if done first thing in the morning after fasting. Ibid.
In early pregnancy,
progesterone is largely produced by the corpus luteum (the ruptured spot on the ovary where the egg erupted) until about 10
weeks of gestation. (www.parentsplace.com/expe...,00.html). A woman needs approximately 10 ng/mL of circulating progesterone
per day to maintain the pregnancy. Ibid. But pregnancies survive with much lower and much higher levels, so the predictive
value of progesterone levels is limited. Ibid. The average progesterone level at 4 weeks LMP is about 20 ng/mL, and at 14
weeks LMP it’s about 40 ng/mL. (www.fertilityplus.or/faq/...esterone).
After 10 weeks, the placenta takes over
the progesterone production, and the levels gradually rise to 100 to 200 ng/mL by term. (www.parentsplace.com/expe...,00.html).
Production of progesterone is independent of fetal well-being, or even the presence of a fetus. Ibid. This is because the
fetus contributes no precursor to progesterone formation. Ibid. The majority of placental progesterone is derived from maternal
cholesterol. Ibid. However, some say that higher progesterone levels do correspond to higher pregnancy success rates, although
they caution that outcome cannot be predicted by progesterone levels. (www.fertilityplus.or/faq/...esterone).
Also,
the same source indicates that progesterone supplementation is unlikely to help if started after a positive pregnancy test.
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