Micronized Progesterone May Be as Effective as Intramuscular Progesterone for IVF Patients

By Arushi Sinha

docguide.com

SAN FRANCISCO — November 13, 2008 — Luteal support with a vaginal progesterone formulation has comparable clinical outcomes to an intramuscular (IM) delivery method, researchers reported here at the American Society for Reproductive Medicine (ASRM) 64th Annual Meeting.

Currently, patients undergoing fertility therapy have many formulation options for their medications. Research presented here examined the effectiveness of a vaginal formulation of progesterone when compared with the more traditional IM dosing.

Mohamed Mitwally, MD, Reproductive Medicine and Fertility Center, Colorado Springs, Colorado, presented the study findings on November 11 on behalf of the research team.

Dr. Mitwally and colleagues enrolled 544 women who were undergoing treatment for in vitro fertilisation and embryo transfer (IVF-ET). Study participants were divided into 2 groups: 145 women received vaginal micronised progesterone and 399 women received standard IM progesterone. They received a gonadotropin-releasing hormone for pituitary down-regulation as part of what is known as the long protocol for IVF-ET.

Embryo transfers were performed during either the cleavage or the blastocyst developmental stages.

Women in the study were aged 33 years on average in the treatment cohort and 34 years in the control cohort.

Results demonstrated that pregnancy outcomes were similar for the 2 groups, with clinical pregnancies in 49% and 53% of women, respectively. The groups also experienced similar rates of miscarriage (8% vs 10%). No statistically appreciable differences were observed in the number of oocytes retrieved (13 vs 14) and in the mean number of embryo transfers (2.4 vs 2.6). All these differences were statistically nonsignificant.

Based on these findings, the authors concluded that luteal support with vaginal progesterone has comparable clinical outcomes to IM delivery.

"The 2 formulations have similar clinical outcomes, but obviously, the vaginal administration may be more convenient," summarised Dr. Mitwally. "Why use an injection form if the vaginal approach can provide the same outcomes?"

Funding for this research was provided by Ferring Pharmaceuticals, Inc.

Fertility Expert:

In our practice, we always "double up". For patients who have more body fat, intramuscular injection of progesterone ends up in the fat layer and absorbs poorly into the bloodstream" : vaginal inserts are better. On the other hand, vaginal inserts must be "inserted" deeply near the cervix to have highest absorption. The outer 2/3 of the vagina is not designed for medicine absorption while the inner 1/3 vaginal lining is just like any lining of the intestinal tract.

So, we instruct patients to administer IM progesterone 3 times a week, plus vaginal insert nightly at bedtime, and the results are quite satisfactory.

Read more at home page XPert Fertility Care.

Tags: ivf, Progesterone