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Re: OB: Progesterone supportFrom: George M. Grunert (grunert@ICSI.Net)Thu Aug 27 17:19:12 1998
> I have just seen two infertility patients from differnt, reputable > clinics, who are on Progesterone Gel, Crinone, for support in the first > trimester. I am not familiar with using it, but both patients told me > that their docs told them that following the progesterone level was not > appropriate, since it acts locally, rather than systemically. > > Can any of the repro endo guys shed some light? > > Garry > > PS--I did not bring this up to debate whether support is necessary, and > when it is necessary, since these patients (rightly or wrongly) come > from the infertility docs on support quite often. Crinone is essentially progesterone in a vaginal gel. It's available in 4% (45 mg of micronized progesterone per dose) and 8% (90 mgper dose) strengths, depending on if it's used for augmentation of endogenous progesterone production or for total replacement, as in egg donation cycles. It has been used successfully for embryo transfer cycles where there's no endogenous progesterone production (Experience with a novel vaginal progesterone preparation in a donor oocyte program. Gibbons WE - Fertil Steril - 1998 Jan; 69(1): 96-101). Because the systemic absorption is variable, you cannot rely on serum progesterone levels to adjust the dose. The serum prog levels will begin to rise with placental production at about 6 to 8 weeks. When they exceed 20, usually at about 8 weeks, I begin to decrease the dose - in egg donation cycles, I decrease from 8% bid to 4% bid and recheck prog levels. If there's no change, I decrease to 4% once daily, and then off.
-- George M. Grunert, M.D. Director, Assisted Reproduction Program Obstetrical and Gynecological Associates 7550 Fannin Houston, Texas 77054 713-512-7851 fax 713-512-7853 grunert@icsi.net
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