During an IVF cycle, we provide luteal phase support with estrogen and progesterone after the embryo transfer, to assist implantation. Traditionally, in the past, the progesterone was given in the form of deep intramuscular oily injections. These oily injections are horribly painful, and most patients say that the one thing they hate the most about an IVF cycle is the fact that they need to take these daily injections . They make the butt very sore, and create hard lumps.
I still can't understand why doctors are so unkind and continue giving these intramuscular injections when progesterone is much more easily administered in the form of vaginal pessaries. Not only is the intramuscular progesterone much more painful, it also doesn't act as well as the vaginal progesterone , because it doesn't get absorbed well into the bloodstream. It forms a hard painful lump, so that very little of the progesterone enters the circulation. Even worse, this progesterone then gets metabolized by the liver, so that the amount which actually reaches the endometrium ( the uterine lining, which is where it finally acts) is reduced.
On the other hand, when we give the progesterone vaginally, it bypasses the liver, and reaches the endometrium directly, so that the levels reached at the final target are much better. It's true that the vaginal pessaries are messy, but this is a small price to pay, and most patients are happy to put up with this discomfort. IVF patients who have used progesterone pessaries will never agree to use intramuscular progesterone again !
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