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Progesterone is a hormone that is essential
for the proper development of the endometrium and the maintenance
of pregnancy. During the ovulatory cycle, the endometrium must
thicken and become more vascular and 'receptive' to implantation
of an embryo.
Progesterone is secreted by the corpus luteum-
the name given the ovarian follicle after release of the egg.
Elevated levels are an indication that "quality" ovulation
has occurred and low levels can be associated with a condition
termed a "luteal phase defect". Although the best way
to treat this condition is to improve on follicle growth, many
patients can benefit from the administration of additional progesterone.
In early pregnancy, up to approximately 7 weeks,
progesterone production is sustained entirely by the corpus luteum.
After this time, progesterone is increasingly secreted by the
placenta and is essential to maintaining an ongoing pregnancy.
Progesterone is always administered in IVF
cycles because medications, including Lupron and Ganirelix Acetate/Cetrotide,
interfere with the body's natural production of progesterone.
Progesterone is available as injections, vaginal suppositories
and oral micronized capsules.
Read
a Detailed Article on Progesterone Written by Dr. Chantilis. This Article Includes a Discussion of the Luteal Phase Defect.
Prolactin is the hormone responsible
for stimulating breast milk production in pregnant women. When
prolactin levels are abnormally elevated in a woman who is not
pregnant  (hyperprolactinemia), ovulatory irregularities, including
lack of ovulation can result sometimes along with abnormal breast
milk production.
There are many causes for hyperprolactinemia.
One common cause is undiagnosed thyroid ("under active")
disease. In addition, a variety of medications, including those
used to control hypertension and depression/ mood disorders, can
also cause an elevation of prolactin. Furthermore, hyperprolactinemia
can be caused by the presence of a small benign tumor at the base
of the pituitary gland. Parlodel (Bromocriptine) and Dostinex
(Cabergoline) are medications that are often effective in reducing
levels of prolactin and establishing normal ovulation. Both of
these medications decrease the production of prolactin from the
pituitary by stimulating dopamine receptors.
The major potential side effects
of these medications include dizziness, drowsiness, nausea, vomiting
and diarrhea. These adverse effects are usually dose-dependent,
and more rare with the use of Dostinex (newer medication). Please
see the manufacturers Web site for a full description.
Birth control pills ("Oral Contraceptive
Pills", or 'OCP's') are sometimes used in IVF cycles even
though they are routinely administered to prevent pregnancy. Most
birth control pills contain both estrogen and progesterone that
suppress the production of FSH and LH by the body (pituitary)
which prevents ovulation.
OCP's are given to prepare the
ovaries for an IVF cycle to prevent cysts from developing on the
ovaries. Before starting an IVF cycle, it is important that no
significant cysts are present on the ovaries. The use of OCP's
also adds more flexibility in scheduling the events for an IVF
cycle by making menstrual cycles more predictable.
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