The meaning of a randomised controlled trial is that during the trial, 2 subjects are run head to head and the results analysed as to which is the best. There is no difference in the absorption between intra muscular and vaginal progesterone at all – this has been proven numerous times. So therefore, common sense does not prevail in this instance. It is up to the attending physician in consultation with the patient to decide which form of progesterone supplementation will be used to support the luteal phase. Most people would prefer not to have a painful injection, one that is not without side effects I might add, if there is a less invasive and proven equally effective method such as vaginal pessaries in the correct dose.

With regards to your friend as mentioned in the question: We have a very similar case in the clinic at the moment and the only reason why we have decided to change to the injectable progesterone is because the discharge that follows the insertion of the pessary is socially not acceptable to her.

- Week 16 answers kindly provided by Dr. Stephan Volschenk -

The “endometrial function test” is not a new concept. It will never and should never become a standard pre-IVF test. The literature is very divided on this topic as there is literature to show that the results are of no value in patients with normal healthy uteri. At our clinic the test is performed when there is a clear indication that it may be of some value in establishing a diagnosis. This is usually when the endometrium does not respond in a way that would be adequate for the situation, for example a thin endometrium with appropriate estrogen levels as measured in the blood.

- Week 15 answers kindly provided by Dr. Stephan Volschenk -

No. Not ovulating is the cause for the thin endometrium as there is no estrogen production to grow it. Diabetes is however not a reason for this and the problem should be sought elsewhere (reasons for anovulation)

- Week 10 answers kindly provided by Dr. Stephan Volschenk -

If your gynaecologist has excluded a local cervical reason for the post coital bleeding, then it is probably due to the mild drop in the estrogen level post ovulation This might lead to sloughing of the top cell layers of the endometrium leading to the slight bleeding.It has been suggested that should the patient be symptomatic, that endometriosis should be excluded.

- Week 8 answers kindly provided by Dr. Stephan Volschenk -

The ideal thickness is between 7 mm and 14 mm . There are however patients that will conceive if it is less than 7mm or more than 14mm. This is however in a minority of cases.

- Week 7 answers kindly provided by Dr. Stephan Volschenk -

High levels of insulin leads to the production of insulin growth factor. This in turn is very similar at a molecular level to Luteinising hormone and abnormal high levels of insulin are potentially detrimental to endometrial receptivity.From a holistic point of view is is beneficial to fall pregnant in a normal insulin and glucose state as increased levels may be detrimental to the health of both the mother and developing foetus.

- Week 2 answers kindly provided by Dr. Stephan Volschenk -

There is no clear evidence in the literature to date of an increase in cancer rates among IVF patients. However, there is definite evidence that continuous use of clomifene citrate for 12 consecutive months, may lead to ovarian cancer. Untreated PCOS has an increased prevalence of endometrial cancer.

The longest period should be 3-4 months. Waiting too long to withdraw can lead to endometrial hyperplasia (abnormal thickening of the lining) If pregnancy is not an issue, staying on the pill will give the added benefit of monthly shedding. If a pregnancy is wished for, the best route to follow would be ovulation induction

New literature supports the fact that excessive stimulation is detrimental to the outcome of an IVF cycle from the point of view that it has a negative effect on the endometrial lining from an implantation point of view. According to ISMAAR, a milder approach may lead to a better outcome.

ANSWER

The longest period should be 3-4 months. Waiting too long to withdraw can lead to endometrial hyperplasia (abnormal thickening of the lining) If pregnancy is not an issue, staying on the pill will give the added benefit of monthly shedding. If a pregnancy is wished for, the best route to follow would be ovulation induction.

- Week 3 answers kindly provided by Dr. Stephan Volschenk -