Dr. Kaylen Silverberg, the Medical Director of Texas Fertility Center, spoke at the Pacific Coast Reproductive Society meeting on Vaginal Progesterone Supplementation in Fertility Patients
Dr. Kaylen Silverberg, the Medical Director of Texas Fertility Center, spoke at the Pacific Coast Reproductive Society meeting in Palm Springs, CA on April 28, 2009. This program was designed to update Fertility Specialists on the use of different types of progesterone supplementation during fertility treatment cycles.
Dr Silverberg’s presentation compared the use of standard injectable progesterone with the newer vaginally delivered forms of progesterone. Complaints from patients and healthcare providers alike about the pain and inconvenience associated with injectable progesterone are the main reason that manufacturers are working to develop alternative delivery systems for this medication. “Intramuscular progesterone has been considered to be the gold standard in IVF”, Silverberg said. “This has been true despite the studies showing that the overwhelming majority of patients don’t like intramuscular progesterone. Many even stop pursuing fertility treatment rather than continue with progesterone injections”. In recent studies that compared vaginal forms of progesterone to injectable progesterone, vaginal applications have been shown to produce comparable results in terms of both pregnancy and live birth rates. Patients also state that vaginal progesterone is much easier to self administer; it removes their partner from the position of causing pain by giving the IM injection as well as the potential ramifications of improper administration. . Unlike their injectable counterpart, vaginal progesterones are not associated with abscess formation, injection site inflammation, or allergic reactions to the base oil.
The commercial manufacturing of many vaginal progesterone preparations also creates a more consistent product for consumers. In the past, local pharmacies compounded vaginal applications using a variety of different recipes and techniques resulting in product inconsistency from pharmacy to pharmacy. These differences ultimately lead to inconsistencies in the dose received by the patient. With the advent of commercially available vaginal preparations, such inconsistencies have been eliminated. Although vaginally administered progesterone is much more widely accepted by patients, it is not without its problems. Discharge and bleeding are the major complaints attributed to the vaginal products . For the physician’s office, vaginal progesterone can be challenging due to difficultly monitoring traditional blood levels achieved following administration. The duration of progesterone administration varies between patients, and many practices rely on serum progesterone levels to wean patients off of medication. Unlike injectable progesterone, the vaginal products do not raise serum levels, making weaning more of a challenge.
After reviewing the data in the current literature, Dr Silverberg stated that “Vaginal progestins have been proven to be just as effective as IM progesterone, without the associated pain”. “The combination of equal to superior efficacy plus significantly greater patient acceptance, affords practitioners the opportunity to continue to enhance the patient care experience”. This is certainly good news for patients going through fertility treatment.
Benefits associated with vaginal progesterone:
- More patient acceptance to the vaginal form than the injectable
- Easier for the patient to self administer
- Less problems with administration site infections and reactions
- Local effects in the uterus with application of progesterone vaginally
- Similar if not statistically better pregnancy and live birth rates
- Commercially available with more consistent production controls and concentration than products compounded by local pharmacies
Problems associated with vaginal progesterone:
- Vaginal discharge can be annoying to patients
- Increase bleeding in early stage pregnancy (not related to miscarriage)
- Low blood levels of progesterone make monitoring difficult for nurses
ABOUT THE TEXAS FERTIITY CENTER
The Texas Fertility Center is one of the nation’s leading infertility practices, providing advanced reproductive endocrinology services for patients throughout Texas and the Southwestern United States for over 30 years. With over 60 years of combined medical experience TFC has been recognized nationally for unprecedented pregnancy rates, cutting edge laboratory procedures and innovative research programs. For more information please visit www.txfertility.com
Press release PCRS Palm Springs, CA May 2009AH