It is always advisable to follow the indication of the centre in which you have done the treatment and usually you have to take progesterone and continue taking it till the pregnancy test. If it is negative, you should stop with the medication but if it is positive, you should maintain all the medication and remain in contact with your centre. Usually, we recommend using progesterone and all the medication that you are taking during the first trimester but usually, we start to decrease the dose more or less from week 10, but the protocol is not the same for every woman so we will personalize every protocol.
This again is controversial and progesterone is the hormone that normally the ovary produces after it’s released an egg. Now, with an IVF cycle, the natural cycle has been altered, so with a fresh cycle of IVF where you’ve had an egg collection, your ovaries are still much bigger than normal and will be producing some progesterone to some extent, however it’s thought that that progesterone may be a bit insufficient and therefore, it’s encouraged to take extra supplementation. In our clinic, we normally would do that for about two weeks or up until the pregnancy test.
Now, with a frozen cycle of IVF treatment it’s a little bit different because there’s lots of different ways you can do it: you can do it in a natural cycle, a medicated cycle and different clinics will have different ways of going about that but in some medicated cycles, it suppresses the ovary from producing any progesterone at all. So absolutely vital to take progesterone supplementation and in those circumstances, I prescribe it for up to 12 weeks pregnancy up until that initial scan. So, that’s the reason why you take progesterone because the body’s not producing any in a fresh cycle it’s probably a bit less important than in a frozen cycle and the lengths vary and different clinics have slightly different protocols as well. It’s always worth discussing with your own doctor.
Progesterone is what we call the hormone of the pregnancy so it will prepare the endometrium for the embryo for the implantation. That’s the importance of progesterone: checking progesterone and the supplementation of progesterone during the cycle.
For how long should be the progesterone taken is still a controversial issue. In the majority of the treatment cycles, it is recommended to continue it until the patient is 8 weeks pregnant. It is not very uncommon to continue the progesterone until the pregnancy reaches the 12th week because it is when the placenta takes over the ovaries and then it will completely safe to stop it.
However, there are clinics that advise stopping the progesterone intake as soon as the patient is pregnant because they consider that the ovaries can produce enough progesterone to support the pregnancy. However, this is a not very common stand and, as I’ve said in the beginning, in the majority of the cases it is recommended to continue at least until the patient is 8 weeks pregnant.
Progesterone is a very important hormone in IVF. In a spontaneous conception after the fertilization and after implantation of a follicle, a cyst is created after the ovulation called the corpus luteum produces progesterone.
In IVF though, at the time of egg collection, all the follicles are sucked so that we can get the eggs, there is nothing to support the pregnancy. This is why we need to give additional external progesterone.
Progesterone can be given in many ways, orally, vaginally, subcutaneously, intramuscularly. A woman definitely needs to take progesterone in big doses for about 12 days – until the time that she does a pregnancy test to find out if she is pregnant or not. After that, if the woman is pregnant, we need to carry on with progesterone during pregnancy. The doses can gradually be reduced but not abruptly, and the duration of progesterone supplementation may take up to 12 weeks.
When we’re talking about medication after the embryo transfer for better response, we usually use progesterone. We have several types of progesterone, such as an intramuscular injection, oral, or vaginal option. For better comfort for patients, usually, here in Latvia, we use more vaginal progesterone. This support is necessary during the luteal phase in the ART procedure. We don’t have as much progesterone from the corpus luteum as in a natural menstrual cycle.
