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The inability to conceive a child can be stressful and frustrating, and although infertility affects 10% of reproductive aged couples worldwide, it is highly treatable in many cases. The highly specialized field of female fertility involves a wide range of medical, environmental, and lifestyle causes which also includes many very specific risk factors. However, now that the genetic causes of female infertility are more commonly diagnosed, and several female infertility treatments are readily available, couples having difficulty conceiving, or carrying to term, can often have success with the use of fertility medications.

How is Infertility Defined?

Infertility is defined as a couples' inability to conceive a child even though they've had frequent, unprotected sexual intercourse for a year or longer. According to the Mayo Clinic, infertility results from male infertility factors about one-third of the time, female infertility factors about one-third of the time, and unknown or a combination of male and female factors about one-third of the time.

Are There Other Symptoms of Female Infertility?

As would be expected the main symptom of infertility (male or female) is the inability to conceive. However, if you are a woman age 30 or older, who has had unprotected intercourse for six months to year without getting pregnant, you should have an infertility evaluation. Other symptoms may include:
• an absent menstrual cycle indicating lack of ovulation
• an irregular menstrual cycle that's too long (35 days or more) or too short (less than 21 days)
• an abnormal menstrual cycle that's heavier or lighter than usual
• history of irregular or painful periods, or pelvic inflammatory disease
• repeated miscarriages
• prior cancer treatment
• endometriosis

Most physicians agree that when you seek medical attention should be age-dependent, and that if you’re:
• in your early 30s or younger, try to get pregnant for at least a year
• between 35 and 40, six months of trying
• if you're older than 40, a couple of months

Understanding Female Fertility

Prior to discussing the causes of infertility, let's examine the complex process of fertility from the female perspective. This process begins with functioning ovaries that produce and release a healthy egg (ovulation), and regular sexual intercourse during your fertile time. Then for pregnancy to occur, every step in the complex human reproduction process has to be just right:
• one of the two ovaries releases a mature egg
• the egg is picked up by the fallopian tube
• sperm swim up the cervix, through the uterus and into the fallopian tube to reach the egg for fertilization
• the fertilized egg travels down the fallopian tube to the uterus
• the fertilized egg implants and grows within the uterus

Causes of Female Infertility

As you can imagine a number of female factors can disrupt any step of this process, and female infertility may be caused by one or more disruptive factors. More specifically, infertility causes are traditionally grouped into categories among which are: ovulation disorders; damage to fallopian tubes (tubal infertility); endometriosis; and uterine or cervical causes.
Ovulation disorders represent ovulating that is infrequent or non-existent, and can be caused by flaws in the regulation of reproductive hormones, the hypothalamus, the pituitary gland, or by problems within the ovary itself. Ovulation disorders account for infertility in approximately 25% of infertile couples, and includes:
• Polycystic ovary syndrome (PCOS) – complex changes occur in the hypothalamus, pituitary gland and ovaries, resulting in a hormone imbalance, which affects ovulation; most common cause of female infertility.
• Hypothalamic dysfunction – disruption in the release of the two pituitary gland produced hormones responsible for stimulating ovulation each month, i.e., follicle-stimulating hormone (FSH) and luteinizing hormone (LH); main sign of this problem is irregular or absent periods.
• Premature ovarian insufficiency – a disorder usually caused by an autoimmune response wherein your body mistakenly attacks ovarian tissues or by the premature loss of eggs from your ovaries due to genetic problems or environmental complications like chemotherapy.
• Excessive prolactin – rarely the pituitary gland (or medication contraindications) can induce the excessive production of prolactin (hyperprolactinemia), which reduces estrogen production and may cause infertility.
• Damage to fallopian tubes (tubal infertility) or blockage, prevents sperm from getting to the uterus and egg for fertilization, causes include:
• Pelvic inflammatory disease – an infection of the uterus and fallopian tubes due to chlamydia, gonorrhea, or other sexually transmitted infections.
• Previous surgery in the abdomen or pelvis, including surgery for ectopic pregnancy – a fertilized egg becomes implanted and starts to develop within a fallopian tube instead of the uterus.
• Pelvic tuberculosis – a major cause of tubal infertility worldwide, although uncommon in the United States.

Endometriosis – occurs when extra tissue growth occurs within the uterus requiring surgical removal which can cause scarring that may obstruct the tube and can:
Unexplained infertility – possible combinations of minor factors in both partners underlie unexplained fertility problems. Although it's frustrating to not get a specific answer, this problem may correct itself with time.


What is progesterone?

Progesterone is often called "the pregnancy hormone." It is necessary for preparing the lining of the uterus or womb (endometrium) for implantation of a fertilized egg (embryo). The necessary changes that take place in the uterus at the site where the embryo implants itself are dependent on progesterone. During the first half of the menstrual cycle when the follicles are growing within the ovary, estrogen is the dominant hormone present. After ovulation (which is the release of a mature egg from a follicle) the second half of the cycle (called the "luteal phase") begins and progesterone is produced by the ovaries. Specifically, progesterone is produced by cells of the ovarian follicles that reorganize themselves after ovulation into a structure called the corpus luteum.

If the fertilized egg does not implant itself into the uterus, levels of progesterone drop and menstruation begins. If implantation is successful and pregnancy occurs, corpus luteum production of progesterone continues until about 10 weeks gestation when the placenta takes over and continues to produce high levels of progesterone.
Is progesterone needed to treat infertility?
Progesterone is an essential part of infertility treatment. For example, progesterone is used for luteal phase support during in vitro fertilization (IVF). During IVF, a woman’s normal production of progesterone may be lowered for several reasons:
• Medications used to prevent premature ovulation (such as Lupron, Ganirelix or Cetrotide) may reduce the production of progesterone following egg collection.
• At the time of follicle aspiration to obtain mature eggs, many progesterone-producing cells may also be removed due to the mechanics of the procedure itself.
To assure that the endometrium is prepared for implantation of the fertilized egg, most women undergoing IVF will be given progesterone after the retrieval of her eggs.

How is progesterone given?

Women undergoing IVF may begin using progesterone starting at the time between egg retrieval and embryo transfer. Once a positive pregnancy test is confirmed, progesterone treatment may continue for a total duration of up to 10 weeks – 12 weeks (1st trimester). Progesterone can be given orally (by mouth), by injection, or vaginally. Progesterone taken orally is not reliable because it is metabolized by a woman’s liver after it is absorbed by the digestive tract, which can reduce its effectiveness and cause side effects. Although progesterone injections are effective, this method is the most uncomfortable form for a woman to take.
The use of vaginal progesterone avoids the problems of both oral and injectable progesterone.

Are there different types of vaginal progesterone?

There are four types of generally available progesterone preparations that can be used vaginally:
• Progesterone suppositories are made-to-order by our Compounding pharmacist based on the dose of progesterone and frequency of use as prescribed by the IVF specialist. This form is usually given multiple times a day. Dose 100-200mg Suppository
• Progesterone Gel / Cream is placed in the vagina once a day for progesterone supplementation or twice a day for progesterone replacement using a special applicator. 4-8% Vaginal Gel
• Vaginal Progesterone Pessaries containing progesterone in hydrolyzed coconut Oil and are placed in the vagina multiple times a day 100-200mg Pessary
• Vaginal Capsule is placed in the vagina two or three times a day using a special applicator. 100- 200mg Cellulose Capsule

IVF Compounded Medication
We can supply all your IVF medication and treatment needs — both off-the-shelf and compounded (specially prepared) — and give expert advice on what you’ve been prescribed.
IVF drugs we routinely dispense are:
• Progesterone
• Melatonin
• Progesterone pessaries./ Gel