How should I manage the luteal phase support?

Dear Colleagues,

I would like to ask for your advice regarding the use of progesterone for luteal support. I am getting confused when I search the literature and when I ask my colleagues about their practice. There are several available products like: The progesterone vaginal gel, progesterone vaginal suppositories, the new vaginal ring presented by Teva, progesterone IM, the new progesterone SC coming out by IBSA and the oral formulation by Abbott.
Apart from the new and untested progesterones like the ring, SC and the oral progesterone all the rest giving same clinical results.

Is this correct, what should we use if they all, including the oral would give same good results in pregnancy rates and outcome?

View Answers

New Answer | All Questions | More in this subject | Add new Question

Answer by Dom de Ziegler

Hi there

In essence, all progesterone preparations available for IM or vaginal use are equivalent as far as efficacy is concerned. Side effects vary of course.
Oral progesterone is not effective in infertility due to the high hepatic metabolism. Is effective in menopause though.Synthetic molecules are better not used. SC progesterone by IBSA is being launched at ESHRE in Europe. Teva's ring I don't know. Both are equally effective, but again with different side effects.

Hope this is helpful

Dom de Ziegler, MD
Professor and Head, Div. Reprod. Endocr. and Infertility
Université Paris Descartes - Hôp. Cochin, Paris, France

Answer by Georg Griesinger

Hi there

Regarding the oral route of administration, it is important to distinguish bioidentical micronized progesterone from retroprogesterone (dydrogesterone), since oral bioavailability and potency of these compounds differ strongly. This is well illustrated by the fact that treatment with dydrogesterone elicits biochemical changes in a primed endometrium consistent with secretory transformation at a daily dose of 10-20 mg whereas oral micronized progesterone requires a dose of daily 200mg for the same purpose. It is not advisable to use bioidentical micronized progesterone via the oral route in the large doses typically applied for luteal phase support in IVF (vaginal route: usually daily 400-800mg) since this will stress hepatic metabolism and there is also some evidence in the literature of a lack of efficacy of oral bioidentical progesterone for luteal phase support. Things are different for the compound dydrogesterone: two large IVF studies (LOTUS I and LOTUS II trials) have indicated that oral dydrogesterone of daily 30mg is at least as efficacious as micronized vaginal progesterone capsules or gel. More background information is available here (free access): https://linkinghub.elsevier.com/retrieve/pii/S0015-0282(18)30289-9

Georg Griesinger
Professor at University of Luebeck, Germany
Head of Universitaeres Kinderwunschzentrum Lübeck und Manhagen

Please Login/Create Account for adding a new answer

The site is not a replacement for professional medical opinion, examination, diagnosis or treatment. Do not delay seeking or disregard medical advice based on information written by any author on this site. No health questions or information on IVF-Worldwide.com is regulated or evaluated by the US Food and Drug Administration or any other administration, and therefore the information should not be used to diagnose, treat, cure or prevent any disease without the supervision of a medical doctor. Posts made to these forums express the views and opinions of the author only, and serve as an open forum to discuss clinical issues among experts in the field.