Many hormones play a role in successfully preparing your body for an embryo to implant and to carry a pregnancy. During your medicated embryo transfer cycle, your doctor will prescribe medications to take the place of the natural hormones that would occur during the menstrual cycle.
Patients take estrogen alone during the first half of their medicated embryo transfer cycle. After estrogen is used to grow the endometrial lining, your doctor will prescribe progesterone to change the texture of the lining to make it optimal for the implantation of an embryo and the two hormones will continue to be taken together to support the possible pregnancy.
In the natural menstrual cycle, progesterone is produced by the remnants of the follicle that ovulated this month. This structure is known as a corpus luteum. The progesterone produced by the corpus luteum is not only necessary to change the lining texture for embryo implantation, but it is also responsible for maintaining the pregnancy until the placenta takes over at around 10 weeks of gestation.
The progesterone can be prescribed in a few ways, vaginal inserts, vaginal gel, and injectable progesterone.
Vaginal Progesterone inserts: are capsules that contain a cream-like progesterone inside. Many of the inserts come with an applicator that is used to insert the capsule deep into the vagina near the cervix. Once in the vagina, the outer shell of the capsule breaks down and releases the progesterone where it is absorbed through the mucous membranes of the vaginal wall.
Vaginal progesterone gel: works similarly to the capsules, but rather than inserting a capsule vaginally, the gel is dispensed into an applicator and the gel itself is placed in the vagina. The progesterone hormone is then absorbed from the gel through the vaginal wall where it enters circulation.
Injectable progesterone: is mixed in oil, so you can expect that it can be quite thick when drawing up the medication and depressing the plunger to inject it. There are a variety of oil preparations to choose from, the most common is ethyl oleate, but other common options are olive oil and sesame oil. The injectable progesterone is given through an intramuscular injection. The most common location for these injections is the upper, out quadrant of the butt.
Click here to read more about how to do intramuscular injections like a pro.
Examples of vaginal and injectable progesterone.
Vaginal progesterone (both capsule and gel) tends to leak out after inserting. This is normal and doesn’t mean that it isn’t working! It is recommended to wear a panty liner and change it frequently to prevent skin irritation.
Injectable progesterone in oil can leave knots or bumps under the skin after injecting. Two ways to help avoid this are to massage the injection site gently after the injection to help disperse the medication and a warm compress on the injection site following the injection. Be sure not to ice the progesterone injection site as this can coagulate the oil and make it harder to absorb.
Your clinic will instruct you on when to start the progesterone based on when your transfer is scheduled and what stage of growth your embryo is. Typically, blastocyst embryos are transferred on the 6th day of progesterone, so your clinic will count backwards from your transfer date and give you instructions for what date and time you’ll need to do your first injection or insert.
The progesterone is continued at least through the blood pregnancy test that takes place 9-14 days after the transfer. If the pregnancy test is positive, the progesterone is often continued for another 4-6 weeks when the placenta will take over the production of progesterone to maintain the pregnancy.