Tuesday, July 13, 2010

Prometrium Vs. Endometrim For Luteal Phase Support In IVF


Question:

Dear Dr. Ramirez,

I've written to you before about luteal phase bleeding. We've tried 3 IUI's, but my husband's morphology has been consistently 0%, so we are moving on to IVF with ICSI.

My RE has me on a long protocol (BCP, Synarel, Puregon, Repronex). My main concern is luteal phase support. My RE plans to have me on 200mg of Prometrium PV TID starting the evening of retrieval... During my last natural cycle I tried this dose of Prometrium and I still had some breakthrough bleeding (but not everyday). Do you think that this is sufficient luteal phase support for someone with a history of luteal bleeding? My RE is doing a hysteroscopy next week to rule out other causes.

Thank-you for your time, L. from Canada
29yo, secondary infertility

Answer:

Hello L. from Canada,

The dosage of prometrium that your doctor has prescribed is certainly adequate for luteal phase support but is not the mainstay with IVF treatments. The gold standard is injectable progesterone 50 mg per day starting on the day of the retrieval. The alternatives that have been studied with IVF are Endometrin 100 mg vaginally three times per day or Crinone 8%/Prochieve 8% vaginally each morning. I double up and use the progesterone injection and the Endometrin or Crinone together to make sure that I have adequate progesterone coverage. So, prometrium can be used but is not the medication of choice with IVF. It is the cheapest alternative however.

Good Luck,

Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
Monterey, California, U.S.A.

Comment: Thank-you Dr. Ramirez! My RE has given me the option of using Endometrin (just recently approved in Canada) so I will use your advice.

6 comments:

  1. Hi Dr. Ramirez,
    What about Progesterone suppositories? How do these compare to what you have mentioned?
    Thanks,
    Maddy

    ReplyDelete
  2. There are no pharmaceutical grade progesterone suppositories, however, many clinics will have a local pharmacist formulate them. They seem to work just fine, and since they are used vaginally, have a good delivery of progesterone to the endometrial lining. The biggest drawback is that the vehicle the pharmacists use to make the suppositories (wax) usually will dissolve and run out of the vagina causing a mess, but most vaginal formulations cause some type of vaginal discharge but the discharge is less. The only other complaint or worry that I have is that since the pharmacist is making the suppository, there is no guaratnee of a uniform delivery of the hormone i.e. the amount of progesterone delivered could be variable. Other than these two things, they are just fine.

    ReplyDelete
  3. Hello Dr Ramirez
    Is Endometrin derived from a plant, or is it synthetic, does it pose any risk of birth defect when taking during early pregnancy? I understand that Prometrium on the other hand is naturally derived and hence poses no risk during pregnancy.
    Thanks much in advanced for your insights

    ReplyDelete
  4. Hello,

    Endometrin is a natural progesterone and is the only progesterone that has been approved by the FDA specifically for the use in infertility. There is no risk to your pregnancy from this medication.

    ReplyDelete
  5. Thanks so much for responding to my question about the effects of Endometrin during pregnancy. I have also been prescribed to take generic Estrace orally twice daily (1mg tablet) for 30 days starting the day after embryo transfer. Does Estrace (Estradiol) poses any risk of birth defects when taken during the first month of pregnancy?

    ReplyDelete
  6. No. There are theoretical risks, such as those stated in the information given by the pharmacy, but this is very commonly used with infertility treatments and there is not a preponderance of female babies (which is the theoretical risk from excess estrogen).

    ReplyDelete

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