A successful fertilisation during the IVF treatment is only the beginning. It is just as important that the fertilised egg can successfully implant itself into your endometrium and develop into a healthy baby. An important hormone responsible for a successful implantation is progesterone – the same one that your fertility specialist would advise you to take after your IVF treatment.
Because of its important role, let us take a closer look at this hormone.
Progesterone and pregnancy
Dr Wong Pak Seng explains that progesterone is a hormone that is ordinarily released by a structure called the corpus luteum in the ovaries after the egg is released during ovulation. Anticipating a fertilisation and subsequent pregnancy, progesterone proceeds to help bring about changes in the uterus lining (endometrium) in order to allow implantation of the fertilised egg.
If there is no fertilisation, the progesterone level is decreased as you do not need it anymore, and your period arrives. If fertilisation takes place, your ovaries secrete more progesterone until about the 8th week of pregnancy, after which the placenta takes over from the ovaries in continuing to produce and secrete this hormone. During this phase, progesterone helps your body to maintain your pregnancy all the way to the time of delivery.
As you can see, progesterone is a very essential hormone when it comes to ensuring a successful implantation and the subsequent development of the foetus into a baby. This is why you would be given progesterone during in-vitro fertilisation (IVF).
The purpose of progesterone
Dr Wong stresses that progesterone supplementation is needed because, during IVF, your normal menstrual cycle is suppressed using hormone injections to prevent premature ovulation. As a result, the usual schedule of your ovaries is thrown off balance, and they would not produce enough progesterone on their own to facilitate the implantation of your fertilised eggs. To improve your chances of success, your fertility specialist will attempt to make up for the low levels of progesterone by prescribing progesterone supplements.
Progesterone in many forms
Dr Wong mentions that there are different types of progesterone supplements available, but he recommends pessaries which are inserted into the vagina.
There are oral progesterone supplements, but they have to take the long way round – through the stomach, later the liver – before reaching your uterus, and some people may experience side effects such as nausea. Progesterone pessaries deliver progesterone via the more direct route and the hormone is more readily absorbed by the uterus.
Using a progesterone pessary
These are some general guidelines on how to use a progesterone pessary. However, these are just general tips, and should not replace your fertility specialist’s instructions.
- Wash your hands.
- Gently insert into your vagina once a day (for 200mg dosage) or twice a day (for 400mg dosage) by placing the pessary between the lips of your vagina, and then push it upwards and backwards until it is fully inserted. You may find it easier to do this in a squatting or lying down position.
- If you have a vaginal infection, you can insert the pessary into your rectum. Gently push it in. Your muscles will be able to hold it in once it is deep enough. Clench your buttocks for a few seconds.
- If you forget to insert a pessary, do so as soon as you remember. However, do not use two doses at the same time. If you have troubles remembering, consider installing a reminder app on your mobile phone.
- Diarrhoea, rectal soreness and flatulence are some possible side effects. Consult your fertility specialist if you experience persistent side effects.
Progesterone injections are also available. Oil-based injections have to be injected deep into your buttock, and usually, someone else has to do it for you. This can be inconvenient if your partner is not around and you are self-conscious about asking someone else to help you. Water-based injections can be injected through the skin, and can be administered on your own.
Sometimes, when you bleed at any point after a positive pregnancy test, your fertility specialist may prescribe a combination of various forms of progesterone, such as pills alongside pessaries or injections, to boost progesterone levels in your body.
Whichever forms of progesterone you are on, it is very important that you follow the instructions and do not miss a single dose.
Another Day, Another Sunrise
“Most of the important things in the world have been accomplished by people who have kept on trying when there seemed to be no hope at all.” – Dale Carnegie
We hope this Special Report has been invaluable in giving you a good insight into fertility treatments, especially IVF. When it comes to creating life out of love, unfortunately technology is not enough. There is no guarantee that your first, second or subsequent attempts may be successful.
An unsuccessful IVF is always devastating news, but do not blame yourself. Do not dwell on the possibility that something you had done could have caused the failure of the treatment. There is actually very little you could have done to improve the outcome of the IVF. Instead, find solace in the fact that you are doing the best you can possibly do to have a child. Keep on thinking positively, and calmly decide with your partner what you want to do next.
There are many ways you can find emotional support to help you through the ups and downs on the road from infertility to parenthood. You can talk to a counsellor or join a support group either, in real life or on Facebook. Some find comfort in keeping a journal. You do not have to be alone in your emotional distress, there are people who care and are there to support you.
Remember, there is always a new dawn waiting to break over the horizon. So best of luck to you on your journey!
RESOLVE: The National Infertility Association. Progesterone and pregnancy: a vital connection. Retrieved at April 5, 2015, from http://www.resolve.org/about-infertility/understanding-my-body/progesterone-and-pregnancy-a-vital-connection.html.
 Retrieved from the Cyclogest product leaflet; will not be quoted in final article - http://www.drugs.com/uk/progesterone-400mg-pessaries-leaflet.html