AboutEdward Joseph Ramirez, MD, FACOG Expertise I am a specialist in infertility and advanced gynecological care. I can answer questions about infertility, gynecology related ills, menopause...virtually anything that affects women's health. PLEASE tell me where you are writing from as I am always interested.
Experience I have been practicing as an Ob/Gyn and Infertility Specialist for over 23 years. Gynecology, advanced laparoscopic surgery, basic infertility, IUI's, IVF, reproductive surgery, and ovulation induction are all areas of my expertise. I am Board Certified. I have been doing In Vitro Fertilization in my clinic for 15 years.
Organizations American College of OB/GYN, American Board of Obstetrics and Gynecology, American Society of Reproductive Medicine, Society of Assisted Reproductive Technology, American Association of Gynecologic Laparoscopists, Fellow of The American College of Obstetricians & Gynecologists,Resolve-National Chapter, Open Path - Northern California, Board of Directors Monterey Medical Society
Publications American Journal of Obstetrics and Gynecology
Education/Credentials Medical Degree from Stanford University, Residency at Tripler Army Medical Center, Reproductive Training at Pacific Fertility Center, San Francisco
Question QUESTION: I have PCOS and very irregular menstrual periods. My first IVF cycle(Jan 2009) resulted in a biochemical pregnancy. I am considering going on bioidentical progesterone cream to regularize my periods and also support embryo implantation. Is progesterone cream recommended to serve this purpose? If I am advised to start the progesterone cream how many days ina month should I use it(I have irregular priods and don't ovulate)?. Also how long before my next IVF cycle should I come off of it?
Thank u
ANSWER: Hello Nans from the U.S.,
You can certainly use progesterone (any type) to regulate your cycles. You would take it from the 16th day of your cycle to the 25th day each cycle.
Most IVF programs precede the cycle with the birth control pill. Does yours? The purpose of the birth control pill is to allow the physician to take control of your ovarian function and schedule your IVF cycle. In that case, you will not need to use the progesterone in that cycle.
You can do an IVF cycle as soon as every other month. If you had a chemical pregnancy, then you would need to wait until the pregnancy resolved itself (<5 on the bHCG), then start on the birth control pill for a month, then you can try again. Some clinics will want you to have a regular natural cycle before beginning the birth control pill, in which case, you can use the progesterone for that cycle.
In most IVF protocols, progesterone is given with the IVF cycle in order to prevent miscarriage from a luteal phase defect (inadequate progesterone priming). In addition, it is required for implantation.
I hope this helps,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Thank u very much Sir for taking the time to give your valuable inputs. I wanted to make sure that I understood your response right. So,I stop using the natural progesterone cream before I start the birth control pills for the IVF cycle, right? but should I continue the cream during the embryo transfer and thereon?
In my fertility specialist's IVF protocol progesterone is given with the IVF cycle. will I be messing with the hormones if I continue to be on the cream during the IVF cycle?
I am 31 yrs old with PCOS and hoping that using the progesterone cream betters my chances of a successful outcome.
Many thanks Dr. Ramirez.
Answer Hello Again,
You would only use the progesterone cream prior to starting the birth control pill. Do not continue it after that. Birth control pills already have a high dose amount of progesterone in them.
Also, if you are doing IVF, you should follow the directions of your doctor. Do not modify his protocols on your own. So if you want to use the progesterone cream, then talk it over with your doc. I am sure he can accommodate your wishes. Progesterone is only used at a specific time in the cycle to prime the uterine lining and help with implantation. If you use it throughout the cycle, you will change the environment and the cycle will not work.
Sincerely,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
