Progesterone hypersensitivity: A challenge for luteal support

Abstract

Progesterone hypersensitivity is a rare phenomenon which can occur after both endogenous and exogenous exposures. We present a case of hypersensitivity to various forms and routes of exogenous progesterone. A 27-year-old female presented with primary infertility. Investigations revealed Grade 1 endometriosis and polycystic ovary syndrome. Three cycles of intrauterine insemination were attempted which were unsuccessful and in vitro fertilization was proceeded. Six blastocysts of Grade A were formed and cryopreserved. Artificial cycle was used for endometrial preparation for frozen embryo transfer (FET). However, due to failure to use exogenous progesterone due to hypersensitivity reaction, Modified Natural Cycle (MNC) was used. A follicle was formed using ovulation induction with tamoxifen and human menopausal gonadotropin. Ovulation was induced by human chorionic gonadotropin (hCG), and natural progesterone from corpus luteum was used. FET was done when endometrium was 8 mm. Pregnancy was confirmed by transvaginal ultrasound and β-hCG levels and continued uneventfully. Endogenous progesterone can be used as an alternative for endometrial preparation for FET in patients with exogenous progesterone hypersensitivity.

Progesterone Hypersensitivity in Assisted Reproductive Technologies: Implications for Safety and Efficacy

“…Among the articles that reported the route of administration (35 cases), the most common approach for IVF treatment was intramuscular administration, at least as the initial preference in therapy. Intravaginal suppositories, gels, or creams were the initial types of progesterone supplementation in only three cases and were considered as the second or third choice in three cases (Table 1) [12,[20][21][22]. Curiously, one patient, who had been previously exposed to OCs, tolerated induction therapy with medroxyprogesterone and leuprolide but started developing symptoms after intravaginal progesterone gel had been introduced [12].…”

“…Moreover, a significant portion of the cases pertained to individuals who were not undergoing their initial assisted reproduction cycle (Table 2). Notably, three patients reported repetitive unsuccessful IVF attempts, seven patients had an undetailed history of assisted reproductive technologies (ARTs), and one patient encountered recurrent unsuccessful intrauterine insemination [20,21,24]. Among the aforementioned patients, the majority opted for in vitro fertilization (IVF) due to difficulties in conceiving or infertility.…”

“…Furthermore, systemic symptoms, including dyspnea, fever, angioedema, and ultimately anaphylaxis, were reported in the documented cases; however, as comorbidities were not often described, it was not possible to identify factors predicting severe reactions. In patients with intravaginal administration of progesterone pruritus, burning sensations and blistering were described (Table 1) [20,21].…”

“…Among the reports providing a temporal sequence from progesterone administration to the onset of symptoms, three cases indicated immediate hypersensitivity. However, systemic symptoms were observed in a single patient (Table 1) [12,[20][21][22]. Conversely, it is noteworthy that progesterone was administered intravaginally in two of the three instances characterized by the development of APD as a delayed hypersensitivity reaction [20,22].…”

Consensus statement on the use of oral contraceptive pills in polycystic ovarian syndrome women in India

“…All these points should be taken into consideration when choosing hormonal treatment for endometriosis-associated pain. [ 174 175 176 177 ]…”