Progesterone: Challenges in Fertility Treatments

Questions about progesterone?

Hello Doctor: Over the past year, I have been undergoing artificial insemination without polycystic ovary syndrome.
My prolactin and thyroid hormone levels are normal, but whenever I use Clomiphene Citrate, my menstrual period is delayed for two months (without pregnancy).
My daily body temperature remains at 37 degrees Celsius and does not decrease.
An ultrasound shows that the corpus luteum has not regressed on its own and there are cysts present.
I ultimately have to take a higher dose of progesterone.
Recently, I have noticed that during the two weeks of using Clomiphene Citrate, there are not many drug residues, but after stopping the medication, I have been experiencing oily discharge every day for over two weeks.
When I do not use Clomiphene Citrate, all my physiological functions are very normal.
I am unsure if the excess progesterone supplementation is causing my body to be unable to absorb or metabolize it, or if my body is sensitive to this medication, disrupting my endocrine system, which is quite concerning.
I am uncertain whether I should use Clomiphene Citrate again for my next artificial insemination cycle, or if there are any ways to resolve the issue of the corpus luteum not regressing on its own when medication is used.
Thank you.

Claudia, 30~39 year old female. Ask Date: 2015/08/28

Dr. Lü Lizheng reply Obstetrics and Gynecology

Using progesterone may interfere with ovulation, leading to a delayed menstrual period.
Please discuss with your physician whether adjustments to the timing or dosage of your medication are necessary.
Sincerely, Dr.
Lu Li-Cheng, Taoyuan Hospital.

Reply Date: 2015/08/28

More Info

Understanding the role of progesterone in fertility treatments is crucial for individuals undergoing assisted reproductive technologies (ART) such as in vitro fertilization (IVF) or intrauterine insemination (IUI). Progesterone is a vital hormone that prepares the uterine lining for implantation of a fertilized egg and helps maintain pregnancy. However, the use of progesterone, particularly in the form of medications like Utrogestan (micronized progesterone), can present challenges and side effects that may complicate fertility treatments.

In your case, it appears that you have been experiencing irregular menstrual cycles and difficulties with ovulation, which are common issues in fertility treatments. The fact that you have normal prolactin and thyroid hormone levels is a positive sign, indicating that some of the common hormonal imbalances that can affect fertility are not present. However, the challenges you face with progesterone supplementation, particularly with Utrogestan, raise important questions about your body’s response to this treatment.

When progesterone is administered, it is intended to support the luteal phase of the menstrual cycle, which is crucial for implantation and early pregnancy maintenance. However, some individuals may experience side effects such as prolonged menstrual cycles, hormonal imbalances, or even the development of ovarian cysts, as you have described. The presence of fluid or cysts in the ovaries can indicate that the body is not metabolizing the hormone effectively, potentially due to an excess of progesterone or sensitivity to the medication.

The symptoms you are experiencing, such as elevated basal body temperature and the presence of oily discharge after stopping the medication, could suggest that your body is reacting to the hormonal changes induced by Utrogestan. It is also possible that the progesterone is preventing the natural regression of the corpus luteum, leading to prolonged luteal phase symptoms. This situation can be frustrating, especially when trying to conceive, as it may feel like the medication is counterproductive.

In terms of your next steps, it is essential to have a thorough discussion with your fertility specialist. They may consider adjusting the dosage of progesterone or exploring alternative methods of luteal phase support. Some practitioners may recommend using lower doses of progesterone or switching to different formulations that might be better tolerated by your body. Additionally, monitoring your hormone levels more closely during treatment could provide insights into how your body is responding to the medication.

It is also worth considering lifestyle factors that can influence hormonal balance, such as diet, exercise, and stress management. These factors can play a significant role in overall reproductive health and may help improve your body's response to fertility treatments.

In conclusion, while progesterone is a critical component of fertility treatments, individual responses can vary significantly. Your experience highlights the importance of personalized care in reproductive medicine. Open communication with your healthcare provider about your symptoms and concerns is vital to finding the most effective and tolerable treatment plan for your situation. Remember, fertility treatments can be complex, and it may take time to find the right approach that works for you.

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