Getting a bit ahead of myself: Estrogen patch or pill? Progesterone shot or cream?

I realize I have quite a bit of time to figure this out, but I’m curious to hear about your experiences with various forms of estrogen and progesterone.

Dr. S says, once I begin my DE cycle, I can take estrogen in three ways:

1.) 3 pills a day

2.) Estrogen patches. At the end, I’d be wearing 4 patches in total.

3.) Estrogen intramuscular injection.

I have a latex sensitivity, and I am concerned that I would have a slight allergic reaction to the patches. Dr. S seems to think that there is nothing to worry about, when it comes to having a latex sensitivity and wearing patches, but I don’t want to take the risk. What do you think? Have you had any (good, bad) experiences with the patches? Is there latex in them?

My first inclination is to take the pill 3 x a day. Anyone have experience with this? Is it difficult to remember to take them on time? Any negative reactions to the ingredients in the pills? Or other drawbacks that you know of?

I’m pretty sure I won’t be doing the intramuscular injection—needles make me feel faint, even the little bitty ones. IVF injections—I nearly had panic attacks toward the end!

I can take progesterone in two ways:

1.) Progesterone vaginal cream.

2.) Progesterone intramuscular injection.

Seems like a no-brainer, considering my history with needles. But what are the pros and cons of each, in your experience? Is the injection known to be more effective? I worry about losing so much of the progesterone cream into my underwear that I won’t get enough into my system. (Which is probably silly, as I’m sure the manufacturers have thought of that.)

Thanks for you input, as ever!

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  1. Injection is more effective, but most people do not need it. I needed it, because of my POF. My ovaries need a lot of help working and my lining needs a lot of help growing!!! But for most people, the patch or pills are fine!

    • I know you’ve had some troubles with allergic reactions—hives and so on. Does the patch sound like something that could cause an allergic reaction that could negatively affect implantation?

  2. L

     /  June 7, 2013

    I’m using the patch. I used it for my last IVF and it was fine- in fact, my lining was better than either of the times I’d used PIO. But that could have been due to any number of other factors. My lining check is on Monday so I’ll have more info then on how it’s working this time for DE. I don’t think there’s latex but you could check the manufacturer’s website. It’s called Vivelle Dot. It ain’t cheap but my insurance covered some of it (I have no fertility coverage but I guess women use it for other things so they covered a small portion of the total I needed).

    As for the progesterone, my vote is definitely for the goo. It comes in an applicator like a tampon and takes two seconds to use. I did PIO for my first two IVFs. It hurts, and even worse, you have to have someone else do the shot (unless you are ambidextrous and can twist around like a gymnast). The leakage from the Crinone is nasty, but it’s better than being dependent on my husband for a shot in the ass every night! Downside: it’s really expensive. I was able to buy some half price from a woman in my support group. I have enough to get me through the 2WW, and I’m hoping that if I need it beyond, insurance will cover it since then it will be for pregnancy and not for infertility.

    Good luck! Ordering meds makes it seem really real!

  3. For estrogen: I’ve used both the pills and the patches, but not the shots. One thing to note with the pills, so REs have you insert them vaginally. If this is the case, invest in a case of panty liners. Like L, my lining was the thickest it’s ever been with the patches (~11 mm) with the patches. I did have some irritation with them, but considering I was replacing them every couple of days, I may sure to use lotion on the area that was irritated which helped things heal faster. The benefit of the shots is that you’re getting a better delivery of the hormone, but again it’s a shot.

    For Progesterone: I’ve done both the vaginal cream and the PIO. There are pros and cons to both. For the cream, the obvious one is that it’s not a shot. That said, I leaked goo everywhere and had severe vaginal dryness. In addition, will you be suppressed before your DE cycle? If yes, I would ask if they plan on monitoring your progesterone levels. For my first FET I was on the cream and not monitored. My current RE and I suspect my progesterone levels were very low, resulting in my second miscarriage. With the PIO, the obvious con is that it’s an IM shot. That said, I didn’t have nearly the number of bad side effects with it. In addition, they were able to monitor my levels and we determined that with the standard dose I was still low, allowing me to bump up the dosage. I really believe that it’s because of the PIO that I’ve still pregnant today.

    Hope this helps. And good luck!!!

    • The patches sound great—but I am worried that if it causes irritation on the skin, it is signaling the body in a negative way, of an allergy, and that this could negatively affect implantation. Is this crazy-talk?

      Yes, I’ll be Lupron-suppressed before the month of the cycle. ): So–are you saying that this will cause my progesterone level to be low? Eek.

  4. Amy Mac

     /  June 7, 2013

    I’ve been on all of the above.

    My Texas doc (1st and 2nd transfers) prefers oral estrace 2-3/day and crinone. Crinone is NASTY – for me it was one of the nastiest parts of this whole process. The doc added Progesterone in Oil on the day of my beta with my first transfer when I started bleeding heavily and it was determined that my progesterone was really low; the addition of PIO stopped the bleeding but I later went on to miscarry a few weeks later. She likes crinone because she likes to deliver progesterone “directly to the source” but I needed more than Crinone provides.

    Dr. Schoolcraft did my 3rd and 4th transfers and he had me on 4 Vivelle patches a day (which were easy). He also had me on estrace vaginally (and I second the panty liner comment!) and Progesterone in Oil. Every time I used progesterone in oil, my numbers were great and I never had any lining problems. PIO is my safety blanket now and I’m scared to do a transfer without it.

    For all four cycles, I got pregnant and miscarried (even with the last two which were transfers of chromosomally normal embryos from CCRM). We’re working with a donor now and are expecting a retrieval at the end of this month. We’re back in Texas with our donor and the doctor is planning on using crinone + PIO and oral estrace. She said she really likes oral estrace for the donor cycles – not sure why. Originally, she only wanted to use crinone and not PIO but I pushed and pushed and she agreed to use both.

    Estrace and progesterone in oil are relatively inexpensive if that is an issue. Vivelle and Crinone are more expensive. All my treatment is out of pocket, but ultimately I let my doctors pick whatever they preferred as long as the used PIO too.

    On a separate note, this is the first time I’ve commented, but your blog has been a lifeline for me. We have many circumstances in common and your words have helped me through my journey more than I can ever convey. I stumbled across it when I began exploring donor eggs a few months ago and I’m so glad I did. I felt so alone when I first heard the words “donor eggs” and to think that was only a month or two ago and we’re already heading down the home stretch. Thank you.

    • I can’t thank you enough for the input—and I’m so sorry you’ve miscarried multiple times, and with chromosomally normal embryos…does Dr. Schoolcraft have any possible explanation for that? I hope donor egg is the answer for you. Please keep me posted.

      From what I’m hearing, it really does seem that PIO is the safest bet! Do you know if it is possible to stab oneself in the thigh instead of buttock–does it matter where? I was thinking maybe that’d be easier. Oh, I hate needles.

      To hear that my blog has been a lifeline truly made tears spring to my eyes. I’m so touched and just want you to know that comments like yours help me tremendously, help me feel that this experience has been worth it. You’re welcome, and thank you, too, for being on my journey with me. I’m thrilled that my blog has helped you on your way down the DE home stretch!

      • A.

         /  June 11, 2013

        Not the thigh! Oh, please, save yourself. It hurts a lot more. I’m telling you:
        (1) Ice for 10 minutes while PIO warms in a cup of hot water.
        (2) Hand husband giant needle; squeeze eyes shut; go to happy place.
        (3) Apply heating pad for at least 10 minutes until area is toasty warm. Massage helps too.
        I’m being cheeky when I say “happy place” because in all sincerity, if you ice well, it’ll be more traumatic for your husband than you…unless, that is, you opt for the thigh out of some masochistic desire to really get in touch with the experience.

        In the meantime, I’ll send thoughts of vicarious gratitude and love and celebration your way on Friday. I felt dizzy, manic, intoxicated by love on my wedding day–from friends and family and this man–until I felt my heart would burst. I hope yours is much the same :)

        • Such great advice—I will follow this to a T! DH is already shaking in his boots.Thank you for the Friday-wedding-vibes! Your day sounds like it was exactly as it should be, a day of crazy-wonderful love.

  5. L

     /  June 7, 2013

    I don’t have any irritation from the patches.

    When I meet Dr. S on Friday, I’ll get his thoughts on whether a progesterone check is indicated, if using the Crinone.

  6. A.

     /  June 10, 2013

    With progesterone, even though the needle looks terrifying, it was a step up from the yuck-factor of vaginal supplementation, especially for 12 long weeks; it doesn’t exactly make a girl feel sexy. Ice, a heating pad, and your husband’s steel will make PIO injections doable.

  7. Sara

     /  June 17, 2015

    Hi, I just came across your blog. I recently miscarried two genetically normal females (PGS tested). I’m just wondering if you think the lovenox finally made the difference in being able to carry to term? I am struggling with this as I look to transfer my last normal embryo (I’m almost 43). Should I request lovenox even though I have done full blood work-ups and have no blood/clotting issues? Would love to hear from you.

    • I’m so sorry for what you’ve gone through. I would definitely discuss the option w your RE…some REs say that the blood clots and sticks more easily as we age, no matter if we have Factor V or other clotting issue or not. I will never know if Lovenox was crucial— but miscarrying a normal karyotpe donor egg embryo while not on it, then carrying to term while on it, suggests it played a part. I was also on daily baby aspirin. I wish you boatloads of luck this time around.


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