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Progesterone: Shots, Rings and Gels

Supplementing the second part of the IVF or FET cycle (luteal phase) with progesterone is a universal and beneficial practice. The gold standard option, against which all other routes of administration are compared, is intramuscular progesterone in oil. Previously, the Center for Reproductive Medicine was one of eight centers that participated in a randomized, controlled trial of 800 patients comparing the efficacy and safety of aqueous subcutaneous progesterone with vaginal progesterone for luteal phase support of IVF, and the subcutaneous route was found to be similar to the vaginal, (Hum Reprod. 2014 Oct 10; 29(10): 2212–2220).

Presently, vaginal progesterone (Crinone™ and Endometrin™) is also a commonly employed route; however, the progesterone vaginal ring (Milprosa™) is a novel means for luteal support with advantages of controlled release with less frequent (weekly) dosing. The Center for Reproductive Medicine is one of fifteen centers participating in a phase III FDA clinical trial involving Milprosa. It is a prospective trial regarding the clinical safety of the progesterone vaginal ring in women undergoing IVF procedures and is sponsored by Ferring pharmaceuticals. The two inch in diameter silastic ring releases progesterone into the vaginal circulation and in previous studies has been proven to be a safe and effective alternative for luteal support in IVF. Among others, the end points of the current study include ongoing pregnancy rates, miscarriage rates, and vaginal bleeding.

It may be that in the not too distant future, the one and one-half inch long intramuscular progesterone injections could be a practice relegated to IVF lore. These daily injections into the gluteus muscles are given for up to eight weeks duration and are often considered by patients as the very worst part of the assisted reproductive technologies.

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