Oral versus intramuscular progesterone for in vitro fertilization: a prospective randomized study

Pregnancy outcomes in oocyte donation recipients: vaginal gel versus intramuscular injection progesterone replacement

“…Compared with IM and vaginal routes, oral progesterone has been associated with significantly lower rates of implantation and pregnancy during in vitro fertilization-embryo transfer (IVF-ET) [6,7]. Crinone® (progesterone gel; Columbia Laboratories, Inc., Livingston, NJ, USA) is a vaginally administered gel containing 90 mg of micronized progesterone in an oil-water emulsion in a polycarbophil base.…”

Luteal Phase Support in ART: An Update

“…progesterone. There was no significant difference in pregnancy rate between both groups [37] As mentioned above parenteral administration of progesterone, vaginally or I.M, does not subject the compound to the significant metabolic consequences of oral administration. Progesterone administered orally is subjected to first-pass prehepatic and hepatic metabolism [23].…”

Progesterone Vaginal Ring for Luteal Support

“…Oral progesterone route is ineffective, requiring high dosing, resulting in less active metabolites secondary to a hepatic first-pass effect [1, 8,[16][17][18]. Oral formulations appear to be clinically inferior for luteal support, whereas intramuscular and vaginal preparations lead to comparable rates of implantation and clinical pregnancy.…”

“…The most popular theory was that the aspiration of the granulosa cells affected the levels of progesterone. However, various studies have demonstrated that follicular remnants postaspiration are capable of steroidogenesis [5,6,8]. In addition, a study by Kerin et al showed that aspiration of preovulatory oocytes in natural cycles did not result in an apparent LPD, so the suggested mechanism for LPD following multiple follicle aspiration is more likely related to the use of GnRH agonist itself [9].…”

“…Another theory postulated is that the supraphysiological levels of estrogen and progesterone due to ovarian hyperstimulation during IVF lead to endometrial changes. Estradiol inhibits both FSH and LH via negative feedback inhibition at the pituitary level [3,5,6,8]. This decrease in LH may effect the endometrial transformation resulting in an inadequate and out of phase endometrium, which in return may affect implantation and pregnancy rates [5,6].…”