Progestogen Supplementation

Symposium held October 2010 at the American Society for Reproductive Medicine Annual Meeting in Denver, Colorado. Supported by an independent educational grant from Watson Pharmaceuticals.

Faculty

	Elizabeth S. Ginsburg, MD Medical Director, IVF Program Brigham and Women’s Hospital Boston, Massachusetts
	Carol Lesser, MSN, RNC, NP Nurse Practitioner, Boston IVF The Boston Center Brookline, Massachusetts

NEEDS ASSESSMENT
Progesterone is essential to prepare the uterine endometrium for implantation and to maintain pregnancy. It converts the proliferative endometrium to the secretory endometrium, maintaining the uterine glands. Progesterone also maintains the uterine myometrium in a quiescent state during pregnancy, preventing contractions and expulsion of the fetus. Thus, progesterone supplementation has come to be used widely to prevent recurrent miscarriage and preterm birth and to reduce implantation failure.

According to the Practice Committee of the American Society for Reproductive Medicine (ASRM), however, “progesterone supplementation necessarily is empiric and has been applied liberally in clinical circumstances wherein the amount or duration of P production is reasonably suspect.” Data are conflicting as to whether progesterone supplementation associated with assisted reproductive technologies is necessary or even beneficial. Nonetheless, hundreds of Web sites promote the use of progesterone with claims such as “All women free of medical complication can benefit from progesterone supplementation.”

Clinicians and patients are confused about the clinical utility of progestogens and also about the dosage, duration, and type of progestogen to use in particular situations. For this reason, the ASRM issued a report addressing the evidence-based uses of progestogens and the risks associated with progestogen administration.

The goal of this activity is to provide clinicians in reproductive endocrinology and infertility, including physicians, nurses, and allied health professionals, with current perspectives on the use of natural and synthetic progestogens.

LEARNING OBJECTIVES
At the conclusion of this activity, participants should be able to:

1) Describe the physiologic changes in circulating progesterone levels in women.
2) Summarize what is known about the appropriate use of progestogens in women with infertility and recurrent miscarriage and abnormal uterine bleeding.
3) Outline appropriate treatment regimens for the use of progestogens in various clinical conditions.

ACGME COMPETENCIES
Medical Knowledge
Patient Care

ACCREDITATION STATEMENT
The American Society for Reproductive Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

CREDIT DESIGNATION STATEMENT
The American Society for Reproductive Medicine designates this enduring material for a maximum of
1.0 AMA PRA Category 1 Credits^TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

NPWH CREDITS
This activity has been evaluated and approved by the Continuing Education Approval Program of the National Association of Nurse Practitioners in Women’s Health for 1.0 contact hours of continuing education credit, including 1.0 hours of pharmacology content. NPWH Activity no. 10-17A. Each participant should claim only those contact hours that he/she actually spent in the educational activity.

Release date: December 15, 2010
Expiration date: December 15, 2011
Estimated time to complete activity: 1.0 hour

SUCCESSFUL COMPLETION REQUIREMENTS
Successful completion of this educational activity requires the learner to:

• View a course overview page, containing all CME and disclosure information, including acknowledgement of commercial support and disclosure of unlabeled use, prior to the start of the activity.
• Complete a 10-question pretest prior to the module.
• Be given the option of downloading a printed syllabus containing the transcript of the Webcast.
• Participate in the interactive activity by viewing/listening to the Webcast.
• Complete a 10-question post-test, with feedback of correct/incorrect answers, scoring a minimum of 70% in two attempts.
• Complete the evaluation.
• Print certificate of completion.

DISCLOSURE OF UNLABELED USE
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the US Food and Drug Administration.

DISCLAIMER STATEMENT
The content and views presented in this educational activity are those of the faculty/authors and do not necessarily reflect those of the American Society for Reproductive Medicine. This material is prepared based upon a review of multiple sources of information, but it is not exhaustive of the subject matter. Therefore, health care professionals and other individuals should review and consider other publications and materials on the subject matter before relying solely upon the information contained within this educational activity to make clinical decisions about individual patients.

DISCLOSURE POLICY
All speakers were required to complete a disclosure of commercial and financial relationships with manufacturers of pharmaceuticals, laboratory supplies, or medical devices and with commercial providers of medically related services. These disclosures were reviewed and potential conflicts of interest resolved by the Subcommittee on Standards of Commercial Support of the Continuing Medical Education Committee of the American Society for Reproductive Medicine.

DISCLOSURES FOR FACULTY AND PLANNERS
Elizabeth S. Ginsburg, MD, reports nothing to disclose.
Carol Lesser, MSN, RNC, NP, reports serving as a consultant for Columbia Laboratories, Inc.
Andrew R. La Barbera, PhD, HCLD, Scientific Director of the American Society for Reproductive Medicine, reports nothing to disclose.
Nancy A. Bowers, BSN, RN, MPH, Education Specialist for the American Society for Reproductive Medicine, reports nothing to disclose.

COMMERCIAL SUPPORT
This activity is supported by an educational grant from Watson Pharmaceuticals, Inc.

Click here to take the CME/CE pretest.

Click here to skip the pretest and view the Webcast (non-CME credit).

Sexuality, Reproduction & Menopause © 2010 Quadrant HealthCom Inc.