When to start progesterone after ovulation?

*STRICTLY NO RE-POSTS*

UNDER REVIEW FOR PUBLICATION

When to start progesterone after ovulation?

Introduction

Progesterone is a critical hormone in the body that plays a pivotal role in pregnancy. In order to aid the process, it is recommended that it be given 3 days after ovulation (https://www.goodrx.com/progesterone/fertility-basics-progesterone-as-a-fertility-med.). Progesterone supplementation is necessary for preserving pregnancy, preparing the uterus for embryo implantation, and regulating a variety of immune reactions.

Do you understand the mechanics of the menstrual cycle? Let us understand the same (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4436586/) :

It has two sections:

1. The follicular phase

2. The luteal phase

Ovulation takes place in-between both phases. Estrogen and the maturation of the ovum (egg) are the dominant factors in the follicular phase. The follicle ruptures at the end of this phase to release the ovum.

What happens in the luteal phase?

The follicle that has ruptured is known as the Corpus Luteum, and at this point, it serves as the main source for the production of the pregnancy hormone progesterone. Consequently, this stage is known as the luteal phase. The ovum then moves from the ovary into the uterus through the fallopian tube.

The luteal phase lasts for approximately 14 days before menstruation. It is, however, subject to numerous variations.

Why is the luteal phase so crucial?

During ovulation, women may experience luteal phase deficiency ( LPD), which impairs progesterone release. Reduced progesterone reduces the likelihood of the embryo implanting and results in miscarriages.

According to a previous study, only a 2% increase in successful live births was seen with supplementation of progesterone, hence suggesting that progesterone did not actively promote pregnancy. It safeguards the uterus and prepares it for the implantation of the embryo.

So we conclude that the accurate determination of the ovulation time is necessary to diagnose Luteal Phase Deficiency (LPD). and the correct diagnosis of LPD guides us to plan the progesterone supplement therapy.

In light of this, progesterone taken within three days of ovulation can promote a fruitful implantation of the embryo.

Uses of progesterone:

1. It thickens the lining of the uterus, thereby preparing a bed for the sticking of the embryo.

2. Throughout the pregnancy, it preserves uterine health.

3. In order to avoid implantation rejection, it stops the uterus' muscles from contracting.

4. Progesterone has been shown to modulate the immune response, thereby preventing any auto-immune conditions.

Tests to determine the exact time of ovulation (https://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/ovulation-detection/#:~:text=There%20are%20several%20ways%20to,body%20temperature%20(BBT)%20chart.):

1. A kit to test the hormone levels in urine is available; luteinizing hormone (LH) levels rise 12 to 36 hours before ovulation, and progesterone levels rise during and after ovulation. As a result, urine testing can begin two days before the anticipated ovulation time.

Normal ovulation:

• Ovulation is anticipated to occur between days 13 and 15 of a 28-day cycle.

• Ovulation takes place between days 13 and 20 for cycles that are 27 to 34 days long.

Under the close supervision of the gynecologist, testing can be stopped once ovulation has been confirmed, and progesterone therapy can begin about three days later.

1. Transvaginal ultrasound measures the size of the follicle to determine the ovulation time.

2. Uterine lining biopsy: a thickened lining will indicate an increase in progesterone hormone, which suggests ovulation.

3. Progesterone levels are also determined by a blood test.

4. During ovulation, a woman's body temperature rises above her basal body temperature (BBT).

Let's examine the PDG urine test for ovulation at home in more detail (https://clinicaltrials.gov/ct2/show/NCT03230084):

The two procedures that are currently the most trustworthy for determining the ovulation time are the ultrasound and the blood test. These tests have some disadvantages as well:

1. Only when progesterone levels are sufficient or high enough are both tests conclusive. Therefore, they don't help with progesterone supplementation therapy for ovulation.

2. Expensive

3. Time-consuming

Pregnanediol-3a-glucuronide, or PDG, is a progesterone hormone marker. PDG is the hormone's excretory product in the urine after it breaks down. Within 24 to 36 hours of ovulation, PDG increases.

How can the PDG test be useful?

It is the only FDA has approved ovulation home test. Before considering any progesterone supplementation or infertility treatments, you can conduct a quick urine test at home to supplement the results of the other tests and determine the ovulation time.

Let's discuss the suitable time to take progesterone supplements, now that we are clear on the ovulation period:

1. Progesterone begins to be released 1 to 3 days before ovulation or 4 days after the LH surge.

2. Progesterone therapy in in-vitro fertilization (IVF) begins 1-2 days after the egg retrieval.

3. Progesterone therapy is resumed after the transfer of the frozen embryo to the uterus,

Why is it crucial to know when you ovulate and how consistent is this ovulation time?

The progesterone administration is guided by the known ovulation time. The likelihood of a tubal pregnancy increases if hormonal supplementation is begun too soon.

Low progesterone levels can be caused by:

1. Sedentary lifestyle.

2. Obesity.

3. Poor diet.

4. High-stress levels

5. Insulin resistance.

Low progesterone levels are a very common symptom of PCOS, which affects young females.

Indications for progesterone supplementation

1. Previous miscarriages

2. Obstacles to conception

3. In-vitro fertilization ( IVF)

4. Frozen embryo transfer (FET)

Types of supplementary progesterone:

1. Oral supplements

2. Vaginal preparations

3. Injectable preparations.

4. Subcutaneous preparations ( in the trial phase)

Treatment of a luteal phase deficiency (LPD):

Support during the luteal phase is essential to ensure healthy implantation of the embryo and pregnancy maintenance. Infertility and pregnancy loss are two direct effects of LPD. Supplemental progesterone is crucial to treat it.

Assisted reproduction therapy (ART)

This includes IVF, FET, and intracytoplasmic sperm injections. Progesterone supplements form an integral part of ART.

How can progesterone secretion be increased naturally?

1. Foods that stimulate progesterone synthesis:

• Beans, broccoli, Brussels sprouts

• cabbage

• cauliflower

• nuts

• pumpkin

• spinach

• whole grain

1. Maintain body weight.

2. Exercise regularly.

3. Stress reduction protocol.

Summary:

The process of figuring out if and when ovulation is happening can be frustrating and time-consuming, but it is necessary for getting pregnant. Currently, this is the most scientific indicator to start progesterone therapy.