by Alison O'Donoghue

Created on: July 01, 2008

Infertility treatments: the role of steroids in boosting fertility

The female sex steroid hormone progesterone has a key role to play

The sex steroid hormone progesterone is an essential hormone in the process of reproduction. If progesterone levels are inadequate, the lining of the womb (endometrium) is not adequately prepared for the implantation of a fertilized egg. Progesterone is produced by the corpus luteum the remains of the ovarian follicle once it has released an egg. The period of progesterone production is therefore termed the luteal phase and if progesterone production is inadequate, a "luteal phase defect" (LPD) is said to be present. LPD has been diagnosed in 3-20% of patients who are infertile and in 5-60% of patients experiencing recurrent pregnancy loss. Therefore progesterone supplementation (either orally, vaginally, as a suppository or sometimes by injection) is often given to women with a LPD who are attempting to become pregnant, especially if they have a history of recurrent miscarriages or threatened miscarriages. The treatment is usually continued until at least the end of the first trimester of pregnancy. As progesterone is a natural substance, it is safe and well tolerated and has no adverse effect upon the pregnancy.

When women have assisted reproduction treatment (ART) (such as in vitro fertilization [IVF]) to help them conceive, the levels of natural progesterone naturally present can be disturbed by the fertility drugs used during the process. Therefore, after the embryo has been implanted, progesterone support will be given. Clinical trials have shown that the use of progesterone support during ART increases the chance of becoming pregnant.

CRINONE 8%, was the first natural progesterone treatment to be approved by the Food and Drug Administration (FDA) for use as part of ART. It is a vaginal gel which must be applied once daily. In 2007, another treatment was approved by the FDA as progesterone supplementation in ART ENDOMETRIN. This is a vaginal insert administered two or three times daily with a disposable applicator. ENDOMETRIN and CRINONE are both effective progesterone supplementation therapies. A large clinical trial has compared the two treatments in women undergoing ART and was recently reported in the journal Fertility & Sterility. The trial authors stated that "pregnancy rates were high and similar in all treatment groups, with biochemical rates exceeding 50%, clinical and ongoing rates >/=40%, and live birth rates at

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