Crinone - Once or Twice?

Well, someone asked me why some women use Crinone (Progesterone Gel) once a day and some use it twice a day.

I am not a doctor but I have some thoughts on this. Also, medical community still does not have a final verdict on what is better (as you can see by example studies below) so I believe it depends on individual cases.

For example, lets take my case. Usually one dose is sufficient enough because it is a very concentrated gel. I was originally prescribed only one. Once I became pregnant, I had unexplained bleeding for 2 weeks of bright red blood and passing clots. Freaky, I know. I decided to add one more dose just to be safe and my doctor agreed, but she said it might not have any advantages, but if I felt like it, just for my piece of mind, then go for it. After I started using two a day, my bleeding still continued, but at least I felt good about doing everything I can with respect to extra progesterone. Crinone 8% is generally used once a day though. Each doctor will individualize the correct dosing of Crinone 8% based on the patient’s needs and their situation.

First, it depends whether you are prescribed Crinone 4% or Crinone 8% gel.

Crinone 8% is generally used once a day though. Each doctor will individualize the correct dosing of Crinone 8% based on the patient’s needs and their situation.

Structure:

Each applicator delivers 1.125 grams of Crinone gel containing either 45 mg (4% gel) or 90 mg (8% gel) of progesterone in a base containing glycerin, mineral oil, polycarbophil, carbomer 934P, hydrogenated palm oil
glyceride, sorbic acid, sodium hydroxide and purified water.

Due to sustained release properties of Crinone, progesterone absorption is prolonged with an absorption half-life of approximately 25-50 hours, and an elimination half-life of 5-20 minutes.

Possible explanation

Assisted Reproductive Technology--Crinone 8% is administered vaginally at a dose of 90 mg once daily in women who require progesterone supplementation. Crinone 8% is administered vaginally at a dose of 90 mg twice daily in women with partial or complete ovarian failure who require progesterone replacement.

Further, Jobanputra et al, in a donor-egg IVF study, showed that 100% “in-phase” endometrial biopsies, reassuring pregnancy rates (46–48% vs. 41%) and mis-carriage rates (14–33% vs. 25%) were seen at both the twice and once-daily dosing levels compared to intra-muscular therapy. Pregnancy rates were as high with vaginal as with intramuscular therapy. There were no significant differences in clinical pregnancy and implantation rate using twice-daily Crinone or once-daily Crinone.
(Jobanputra K, Toner JP, Denoncourt R, Gibbons WE. Crinone 8% (90mg) given once daily for progesterone replacement therapy in donor egg cycles. Fertil Steril 1999;72:980–4.)

Although, In their study, Ho et al 1 report that using vaginal progesterone gel twice daily for luteal support resulted in better pregnancy outcomes than intramuscular progesterone. Vaginal progesterone gel seemed to offer more “targeted” delivery of progesterone to the uterus and improved endometrial receptivity.
(Ho CH, Chen SU, Peng FS, Chang CY, Yang YS. Luteal support for IVF/ICSI cycles with Crinone 8% (90 mg) twice daily results in higher pregnancy rates than with intramuscular progesterone. J Chin Med Assoc 2008;71:386–91.)

Whatever you may choose at the end, make sure you consult with your doctor first.