Q&A: On Progesterone, and Embryo Implantation Issues

A woman on our Choice Moms Over 40 discussion board asked women for tips on how to reduce pain from injections, which she was worried about. One woman noted that she took vaginal progesterone suppositories.

Another woman wrote and warned that sometimes women don’t absorb the suppositories well. She had insisted on getting bloodwork done and they did discover that she needed the PIO shot instead.

A third woman then wondered:

I did 4 IVF cycles and one FET, and although all the embryos were of excellent quality, nothing ever stuck. I had also been told that the progesterone inserts would prevent menstruation, but mine would start even while on it… could that be an indication that I was not absorbing them well?”

Dr. Rafat Abbasi, Columbia Fertility Associates

Dr Rafat Abbasi, M.D
Columbia Fertility Associates

To address that medical question, I asked Dr. Rani Abbasi, of Columbia Fertility Associates (D.C.), a long-time adviser to the Choice Mom community. Here is what she said:

“What does ‘excellent’ mean? Did these embryos undergo pre-implantation genetic screening? Or is ‘excellent’ a morphological description?

The most frequent cause of failure to implant is that the embryo is not chromosomally normal. So if these embryos were not screened, I would recommend that as the first step.

If they were screened and were normal, then I would investigate other causes for failure to implant. These include an anatomical assessment of the cavity — a thrombophilia work-up to rule out clotting factors. The endometrium needs evaluation for receptivity. There are tests available to assess that.

Progesterone in oil (PIO) is the traditional way to use progesterone. The suppositories or the inserts are absorbed quite well vaginally, but it may not work for everyone.

If bleeding is occurring while on progesterone support, then I would agree that it might be time to change the route of administration.”


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