What is the best route for progesterone administration during an IVF cycle in terms of efficacy and side effect profile?
The best route of administration has not been clearly established. There are pros and cons associated with each route. Oral preparations – Oral supplementation is not recommended because although some studies have not found a difference in efficacy between oral and other routes of administration, a few studies did report lower implantation rates, lower pregnancy rates, and /or higher miscarriage rates in women receiving oral compared with IM or vaginal progesterone. Intramuscular progesterone – The main downside of IM progesterone is local skin inflammation at the site of injection. At times, this reaction can be quite painful and can lead to induration that may persist for weeks after the injections are complete. Vaginal preparations – Because the progesterone is first absorbed locally, intrauterine concentrations are high despite serum levels that are lower than with IM progesterone. Vaginal progesterone may be administered using compounded suppositories, tablets or 8% gel. The main
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