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Progesterone is a key hormone for pregnancy and its role in IVF cycles is equally as important.
Studies show that taking progesterone shots during IVF can increase your chance of having a baby. People who took progesterone were more likely to have a live birth (34.2%) than those who didn’t (24.1%).
This makes progesterone shots a staple in most IVF protocols. Let’s take a deeper look at progesterone injections — why they’re important, when to start them, and all the other details you need to know.
Key takeaways
- Progesterone preps the uterus for pregnancy and supports implantation.
- Studies show that supplementing with progesterone increases the birth rate in IVF patients.
- The time to inject progesterone depends on the type of embryo transfer. For fresh, progesterone typically starts around the time of the transfer. For frozen, it varies depending on your natural ovulation and the stage of the frozen embryo.
- Progesterone supplementation typically lasts 6-12 weeks until the placenta takes over progesterone production.
- Vaginal progesterone is an alternative to progesterone injections. It’s equally as effective and less invasive.
- A common side effect of progesterone in oil injections includes pain and discomfort at the site of injection. You may also experience swelling and other skin reactions.
- You can manage side effects with ice packs, relaxation techniques, and over-the-counter pain medication.
Why is progesterone important in IVF?
Progesterone helps get the body ready for pregnancy by preparing your uterus to welcome a baby.
For starters, this hormone thickens your uterine lining to nourish your developing embryo. Progesterone also keeps your uterine muscles from contracting (uterine contractions can prevent implantation).
However, studies show that some IVF drugs can interfere with your body’s natural production of progesterone.
For example, during a fertility treatment cycle, your doctor may have prescribed drugs called GnRH agonists or antagonists for ovarian stimulation. These meds help prevent the egg from releasing prematurely. But they can make it harder for the ovaries to produce progesterone. And we know progesterone is needed for a healthy pregnancy. When progesterone levels are low, implantation becomes more difficult.
To remedy this and boost progesterone, doctors often prescribe progesterone shots. Because the progesterone is suspended in oil, these are also called progesterone in oil injections.
Know more: A Comprehensive Guide to Progesterone Supplements
When do you start taking progesterone shots during IVF?
The timing of your progesterone injection depends on the type of IVF process you’re undergoing.
Fresh embryo transfer
If you’re using a fresh embryo, you’ll start progesterone injections on the day you have your eggs retrieved.
Frozen embryo transfer
The process for a frozen embryo transfer is a bit different. Before your cycle, you will take medication to reduce ovarian activity. Then, once your cycle starts you’ll be given estrogen from to inhibit follicle-stimulating hormone (FSH) and help prep the uterus to accept the embryo.
If your uterus is ready for the embryo transfer, progesterone injections are started 2, 3, or 5 days before the scheduled transfer. The timing depends on how developed the frozen embryo is.
How long do you take progesterone shots after an IVF transfer?
Typically, you take progesterone for the first 6-12 weeks of pregnancy. But, the exact duration varies from person to person. These weeks of supplemented progesterone help the pregnancy grow strong.
Once you reach 10-12 weeks, your body’s placenta should be able to make enough progesterone on its own. Always talk to your healthcare professional about your individual circumstances. Each body is unique.
Know more: Progesterone Injections: Everything You Must Know
Is it necessary to take progesterone during IVF?
TLDR: yes.
Studies show that taking progesterone during IVF can help the embryo transplant. It also reduces the risk of miscarriage.
This is especially important when using frozen embryos since the body doesn’t make progesterone on its own. Research has found that with this type of IVF, low progesterone around the time of transfer means a lower rate of pregnancy.
Additional research backs this up. It shows that of the women who had progesterone supplementation, 34.1% had a live birth. This is compared to 24.1% without progesterone supplements.
Most doctors recommend taking progesterone for 6-12 weeks after the embryo transfer. However, some studies suggest that taking it for less time might be okay.
One study found that women who stopped taking progesterone two weeks after an embryo transfer had the same delivery rate as those who took it for the full 12 weeks.
Another study looked at women who took progesterone for 6 weeks. They had the same chance of a successful pregnancy as those who took it for 11 weeks.
These studies suggest that taking progesterone for longer might not be necessary. But, most doctors err on the side of caution and recommend taking it for 6-12 weeks.
What are some alternatives to progesterone shots in IVF?
Progesterone in oil injections are the most common method of supplementation. But, they aren’t the only option.
Vaginal progesterone is another route you can take. It can be given as a gel, suppository, or tablet. Some people prefer this alternative to the shot. It’s more convenient, less invasive, and less painful.
Know more: Progesterone Suppositories: Benefits & How To Use Them
And research shows that vaginal progesterone is just as effective as injections.
Here are a few studies that support this:
- IVF patients supplementing with progesterone suppositories had a much higher pregnancy rate.
- A vaginal progesterone gel is equally as effective as injections and is easier to tolerate.
- Pregnancy rates between vaginal and intramuscular injection (IM) progesterone are similar. Patients were more satisfied with the pain-free vaginal option.
Should you monitor your progesterone levels while on progesterone?
The answer to this really depends on your clinic.
Some may opt to track levels (and adjust the dosage accordingly), while others may go ahead with a standard dose of progesterone.
What are the side effects of progesterone shots?
Progesterone shots are great for boosting your levels of this key pregnancy hormone. But they don’t come free of side effects.
The biggest side effect people experience is a reaction at the injection sites. The progesterone is suspended in a thick oil, they need a thick needle. This means greater pain where it’s injected.
Another injection site side effect that women experience is panniculitis. This is inflammation of the subcutaneous fat. Lumps and swelling at the site are common too, and a sterile abscess may also form.
Other side effects associated with progesterone injections include:
- Headaches
- Sleep struggles
- Changes in libido
- Nausea and vomiting
- Breast tenderness
Some progesterone in oil injections can also bind to androgen receptors, which increases the risk of hypospadias in male infants. This birth defect causes issues with the formation of the boy’s urethra.
Always talk to your doctor about any severe side effects such as intense pain, bruising at the injection site, extreme discomfort, or anything else that concerns you. Your doctor may offer alternatives such as vaginal progesterone.
Ultimately, it’s up to you and your doctor which form of progesterone supplementation is best for you.
How do you reduce the side effects of progesterone in oil injections for IVF?
There are a few things you can do to reduce the effects of these injections.
Injection technique
You want to change up your injection site each time to avoid irritation in one spot. The most common areas to inject your progesterone are your outer thigh, buttocks, or upper arm. And follow your doctor’s instructions on how to inject.
This can help prevent unnecessary bruising and pain at the injection site. If you aren’t sure how to inject, ask your doctor to show you.
Ice and compression
Follow the injection with an ice pack on the area for 15-20 minutes. This can help with swelling and pain at the injection site.
You may also choose to wear a bandage or some kind of compression garment to help cut the swelling.
OTC pain relief
Over-the-counter (OTC) medications like Ibuprofen or acetaminophen may help with pain and discomfort.
Relax
It may be challenging, but try to relax the muscle before injecting. A good way to do this is by lying down or bending your knee on the injection side.
Numbing cream
Your doctor may prescribe you a numbing cream to help alleviate pain at the injection site.
FAQs
This time varies from person to person. It could be anywhere from 6-12 weeks.
Talk with your doctor to determine the length of time that is best for you and the type of IVF process you’re undergoing (fresh vs. frozen).
You typically start taking intramuscular injections a few days before your IVF transfer. But, the exact timing varies depending on your IVF process and the stage of the embryo.
Your doctor will advise you on the best duration for your circumstances.
Your doctor will likely decide whether checking your levels is important. If you have a history of miscarriage or fertility challenges, monitoring progesterone may be best.
You may also need to check progesterone levels if your IVF protocol is complicated. This ensures the levels are in the range that best sets you up for a healthy pregnancy.
Monitoring progesterone levels may also help rule out causes of side effects such as hormonal imbalances.
Usually, progesterone is started a few days before the scheduled transfer. This gives the uterine lining some time to thicken and prepare for implantation.
However, the exact timing depends on the stage of the frozen embryos and your natural ovulation.
Your doctor will help you determine the best time to start your intramuscular injections.
The standard protocol is to continue taking progesterone through the first trimester of pregnancy. Once you reach 10-12 weeks, your body’s placenta should naturally take over and produce progesterone.
However, other things play a role in the timing of stopping progesterone. These include:
- Your pregnancy history
- Overall health
- Type of progesterone
- Any underlying medical conditions
Your healthcare professional will determine the best length of supplementation for you.
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