{"version":"1.0.0","segments":[{"startTime":0.855,"endTime":3.583,"body":"Today we talk about the most powerful"},{"startTime":3.719,"endTime":6.607,"body":"hormone in the world, maybe the"},{"startTime":6.671,"endTime":9.235,"body":"universe. Stronger than Thanos,"},{"startTime":9.575,"endTime":11.075,"body":"stronger than Superman,"},{"startTime":11.735,"endTime":14.195,"body":"stronger than Captain America."},{"startTime":14.982,"endTime":17.49,"body":"excuse me, are you talking about"},{"startTime":18.23,"endTime":20.982,"body":"superheroes? Okay, maybe I got a little carriry right"},{"startTime":21.006,"endTime":23.39,"body":"there. It's the most powerful hormone"},{"startTime":23.47,"endTime":25.61,"body":"infertility called"},{"startTime":26.16,"endTime":28.968,"body":"progesterone. I'm"},{"startTime":29.024,"endTime":31.7,"body":"Dr. Mark Amols, and this"},{"startTime":32.04,"endTime":34.94,"body":"is Taco about fertility Tuesday."},{"startTime":47.08,"endTime":50.008,"body":"Back in 2020, I did a podcast"},{"startTime":50.064,"endTime":52.9,"body":"on the two most important hormones in the female body."},{"startTime":53.3,"endTime":56.02,"body":"But reality, progesterone is"},{"startTime":56.06,"endTime":58.988,"body":"really a super hormone. The reason I wanted"},{"startTime":59.004,"endTime":61.988,"body":"to get back to this podcast was today"},{"startTime":62.084,"endTime":64.716,"body":"I had a patient who was"},{"startTime":64.788,"endTime":67.444,"body":"frustrated because she"},{"startTime":67.492,"endTime":70.092,"body":"thought because her progesterone levels were low"},{"startTime":70.276,"endTime":73.012,"body":"that we weren't treating luteal phase"},{"startTime":73.076,"endTime":75.996,"body":"defects, which means low progesterone, even though we were given"},{"startTime":76.028,"endTime":78.788,"body":"her vaginal progesterone. It was that point I"},{"startTime":78.804,"endTime":81.736,"body":"realized it may not be obvious"},{"startTime":81.928,"endTime":84.728,"body":"that when taking vaginal progesterone, it's"},{"startTime":84.744,"endTime":87.272,"body":"helping things even when your progesterone levels are low in your"},{"startTime":87.296,"endTime":90.224,"body":"blood. And so in today's episode, we're going to talk a"},{"startTime":90.232,"endTime":93.008,"body":"little bit more about progesterone, give you a little science about it,"},{"startTime":93.104,"endTime":95.512,"body":"but also help explain some of these confusing"},{"startTime":95.576,"endTime":98.432,"body":"conundrums so you're not worried about if your"},{"startTime":98.456,"endTime":101.424,"body":"progesterone levels are causing problems. So"},{"startTime":101.472,"endTime":104.272,"body":"what is progesterone? Why do we care about it?"},{"startTime":104.456,"endTime":107.176,"body":"Well, progesterone is the hormone that takes your uterine"},{"startTime":107.208,"endTime":110.192,"body":"lining from under construction to move and"},{"startTime":110.216,"endTime":112.824,"body":"ready. It stabilizes the lining,"},{"startTime":112.872,"endTime":115.848,"body":"preventing it from shedding and making it receptive to"},{"startTime":115.864,"endTime":118.744,"body":"an embryo. It's made after ovulation by"},{"startTime":118.752,"endTime":121.6,"body":"a structure called the corpus luteum, which forms"},{"startTime":121.64,"endTime":123.94,"body":"the follicle that release the egg"},{"startTime":125.08,"endTime":127.424,"body":"if pregnancy happens. The EMY then sends out"},{"startTime":127.472,"endTime":130.36,"body":"hcg, which tells the corpus lithium to keep making"},{"startTime":130.4,"endTime":133.386,"body":"progesterone. If it doesn't, the corpus luunum"},{"startTime":133.418,"endTime":136.298,"body":"breaks down, progesterone levels drop, and"},{"startTime":136.314,"endTime":138.87,"body":"you get your period. So this is important."},{"startTime":139.37,"endTime":142.362,"body":"HCG from a pregnancy rescues the"},{"startTime":142.386,"endTime":145.266,"body":"corpus lithhium. It's destined to die in"},{"startTime":145.298,"endTime":148.13,"body":"14 days and collapse. But"},{"startTime":148.25,"endTime":151.138,"body":"pregnancy creates a hormone, HCG, which"},{"startTime":151.194,"endTime":154.122,"body":"looks like LH and keeps the production"},{"startTime":154.226,"endTime":157.186,"body":"of progesterone. So as you can see, it"},{"startTime":157.218,"endTime":160.132,"body":"literally is a superhero. It saves the day."},{"startTime":160.236,"endTime":162.68,"body":"It rescues the corpus luteum."},{"startTime":163.94,"endTime":166.892,"body":"Let's go a little deeper. Where does progesterone come"},{"startTime":166.916,"endTime":169.596,"body":"from? Well, all"},{"startTime":169.628,"endTime":172.12,"body":"reproductive hormones come from cholesterol."},{"startTime":172.58,"endTime":175.16,"body":"Basically, the pathway is cholesterol"},{"startTime":175.46,"endTime":178.188,"body":"becomes pregnantulolone, which then"},{"startTime":178.244,"endTime":180.916,"body":"becomes progesterone. Then"},{"startTime":180.988,"endTime":183.78,"body":"progesterone is converted to androgens like"},{"startTime":183.82,"endTime":185.91,"body":"testosterone Then"},{"startTime":185.95,"endTime":188.822,"body":"testosterone is converted to estrogen by an"},{"startTime":188.846,"endTime":190.85,"body":"enzyme called aromatase."},{"startTime":191.39,"endTime":193.742,"body":"Interesting. Letrazole, also known as"},{"startTime":193.766,"endTime":196.638,"body":"femaarra, blocks ratase, meaning it blocks the"},{"startTime":196.654,"endTime":198.61,"body":"conversion of testosterone and estrogen."},{"startTime":199.19,"endTime":201.758,"body":"Now, this dance involves two types of cells"},{"startTime":201.774,"endTime":204.142,"body":"in the theca cells which make"},{"startTime":204.166,"endTime":206.926,"body":"testosterone from progesterone, and"},{"startTime":206.958,"endTime":209.758,"body":"granulosa cells that take the testosterone"},{"startTime":209.894,"endTime":212.84,"body":"and convert it into estrogen using aromatase."},{"startTime":213.14,"endTime":215.948,"body":"Now, before ovulation, the system is"},{"startTime":216.004,"endTime":218.852,"body":"estrogen dominant and supposed to be. But"},{"startTime":218.916,"endTime":221.572,"body":"after ovulation, the granulosa cells become"},{"startTime":221.636,"endTime":223.892,"body":"leuteinized. They shift from making"},{"startTime":223.956,"endTime":226.64,"body":"estrogen to producing progesterone."},{"startTime":226.98,"endTime":229.572,"body":"Basically, luteonization is a"},{"startTime":229.596,"endTime":232.596,"body":"hormone career change for the granulosa cells."},{"startTime":232.708,"endTime":235.604,"body":"They stop helping build the lining and they start working to"},{"startTime":235.652,"endTime":238.644,"body":"support it. This transformation is triggered"},{"startTime":238.692,"endTime":241.294,"body":"by the LH surge right before"},{"startTime":241.382,"endTime":244.014,"body":"ovulation. And those newly"},{"startTime":244.062,"endTime":246.718,"body":"ludinized granioa cells become now"},{"startTime":246.814,"endTime":249.638,"body":"progesterone producing powerhouse we call"},{"startTime":249.774,"endTime":252.55,"body":"the corpus lithuteum. Think of it as"},{"startTime":252.63,"endTime":255.342,"body":"estrogen, as the architect that builds the"},{"startTime":255.366,"endTime":258.11,"body":"house, but it's progesterone that furnishes"},{"startTime":258.15,"endTime":261.086,"body":"it. It adds the warmth, the food, the"},{"startTime":261.118,"endTime":264.067,"body":"comfort. So the, embryo can then move in and feel right at"},{"startTime":264.083,"endTime":267.033,"body":"home. The other great thing about progesterone,"},{"startTime":267.211,"endTime":270.205,"body":"as it prevents contractions in pregnancy,"},{"startTime":270.357,"endTime":273.237,"body":"the high levels progesterone literally keep the uterus"},{"startTime":273.293,"endTime":276.189,"body":"quiet until labor begins. This is"},{"startTime":276.229,"endTime":279.157,"body":"why we use progesterone supplementation in"},{"startTime":279.173,"endTime":281.493,"body":"the luteal phase to help prevent"},{"startTime":281.661,"endTime":284.445,"body":"preventable issues that can occur from a luteal"},{"startTime":284.477,"endTime":287.381,"body":"phase defect. So then why does the corpus"},{"startTime":287.405,"endTime":290.245,"body":"luteum shut down after 14 days? Is it"},{"startTime":290.277,"endTime":293.173,"body":"some type of, like California labor law that says it can only work"},{"startTime":293.221,"endTime":295.749,"body":"14 days at $50 per hour?"},{"startTime":296.049,"endTime":298.849,"body":"No, it's because the corpus luteum has a built in"},{"startTime":298.889,"endTime":301.429,"body":"expiration date, about 12 to 14 days."},{"startTime":301.929,"endTime":304.737,"body":"Unless it gets a very specific signal,"},{"startTime":304.913,"endTime":307.761,"body":"LH from the form of HCG from the"},{"startTime":307.785,"endTime":310.601,"body":"growing embryo. Without the HCG, the"},{"startTime":310.625,"endTime":313.561,"body":"LH levels will drop. The lutinized granulosis"},{"startTime":313.585,"endTime":316.537,"body":"cells stop receiving stimulation, which then causes the"},{"startTime":316.553,"endTime":318.777,"body":"corpus luteum to undergo a process called"},{"startTime":318.833,"endTime":321.731,"body":"apoptosis, which is just a fancy way of saying programmed"},{"startTime":321.755,"endTime":324.651,"body":"cell death that causes your progesterone"},{"startTime":324.675,"endTime":326.971,"body":"levels to drop and that leads to"},{"startTime":326.995,"endTime":329.571,"body":"menstruation. Because remember, the estrogen was the"},{"startTime":329.595,"endTime":332.539,"body":"architect. The progesterone is the support."},{"startTime":332.659,"endTime":335.155,"body":"And if you lose support, everything comes tumbling"},{"startTime":335.187,"endTime":338.179,"body":"down, causing menstruation. And this"},{"startTime":338.219,"endTime":341.131,"body":"timer, it's hardwired into the system. It ensures"},{"startTime":341.155,"endTime":344.115,"body":"that your uterine lining only sticks around if there's an embryo"},{"startTime":344.147,"endTime":347.095,"body":"to support it. What this means is if you have"},{"startTime":347.127,"endTime":350.039,"body":"A very long cycle, let's say like 35"},{"startTime":350.079,"endTime":352.943,"body":"days. It's not that the middle of the"},{"startTime":352.991,"endTime":355.783,"body":"cycle is in the middle, but Instead you"},{"startTime":355.831,"endTime":358.823,"body":"ovulate 12 to 14 days before you get your next period,"},{"startTime":358.991,"endTime":361.951,"body":"which means it's the follicular phase, the part where the focollicle is"},{"startTime":362.015,"endTime":364.967,"body":"developing, the estrogen dominant portion that"},{"startTime":364.983,"endTime":367.879,"body":"is being extended, and that the luteal phase"},{"startTime":367.959,"endTime":370.871,"body":"after ovulation always stays the same because that"},{"startTime":370.895,"endTime":373.571,"body":"is hard wired. Now, it's true if you have a"},{"startTime":373.595,"endTime":376.547,"body":"luteal phase defect, it may be shorter, but"},{"startTime":376.563,"endTime":379.539,"body":"it's not going to be longer. Now, is it possible?"},{"startTime":379.579,"endTime":382.123,"body":"Could be longer, yes, but then that's pathological,"},{"startTime":382.211,"endTime":384.899,"body":"meaning you might have a cyst, like a corpus luteial"},{"startTime":384.939,"endTime":387.683,"body":"cyst, and that could be creating progesterone"},{"startTime":387.771,"endTime":390.419,"body":"that's causing you not to get your period. But in general,"},{"startTime":390.539,"endTime":393.079,"body":"like women who have polycystic ovarian syndrome,"},{"startTime":393.579,"endTime":395.979,"body":"if you have a 45 day"},{"startTime":396.019,"endTime":398.259,"body":"cycle, you're not actually"},{"startTime":398.379,"endTime":401.197,"body":"ovulating in the middle, around the 20s."},{"startTime":401.333,"endTime":404.069,"body":"Instead you're ovulating around day"},{"startTime":404.109,"endTime":406.733,"body":"31 and then you're getting your menses on day"},{"startTime":406.781,"endTime":409.741,"body":"45. So then overall,"},{"startTime":409.805,"endTime":412.209,"body":"why do we give progesterone supplementation?"},{"startTime":412.669,"endTime":415.277,"body":"Well, there's a couple reasons. Sometimes we suppress"},{"startTime":415.373,"endTime":417.941,"body":"ovulation and bypass it. So we have to get"},{"startTime":417.965,"endTime":420.249,"body":"progesterone like in a frozen embryo transfer."},{"startTime":420.589,"endTime":422.849,"body":"But even when we do a retrieval,"},{"startTime":423.189,"endTime":425.981,"body":"we disrupt those granulosa cells when we"},{"startTime":426.005,"endTime":428.797,"body":"pull the eggs out, and that can lead to a"},{"startTime":428.813,"endTime":431.781,"body":"disruption in progesterone production and"},{"startTime":431.805,"endTime":434.757,"body":"that could potentially cause problems. So instead we"},{"startTime":434.813,"endTime":437.277,"body":"supplement it. Now, when it comes to"},{"startTime":437.373,"endTime":440.365,"body":"IUIs, we probably do overdo it. We probably"},{"startTime":440.397,"endTime":443.021,"body":"don't need to getgesterone all the time. But in the end"},{"startTime":443.165,"endTime":445.941,"body":"it's not harmful, it could only help."},{"startTime":446.125,"endTime":448.909,"body":"And so a little bit of prevention may go a long"},{"startTime":448.949,"endTime":451.689,"body":"ways, and that's why we end up using it in IUIs."},{"startTime":452.029,"endTime":454.757,"body":"The question is, what's the best route?"},{"startTime":454.933,"endTime":457.901,"body":"Well, this is what actually caused me to do this podcast, because"},{"startTime":457.925,"endTime":460.917,"body":"of that person getting frustrated thinking that her"},{"startTime":460.973,"endTime":463.949,"body":"lower progesterone level meant she wasn't"},{"startTime":463.989,"endTime":466.957,"body":"getting enough progesterone. We'll get that in just a"},{"startTime":466.973,"endTime":469.141,"body":"minute. There are essentially three ways to"},{"startTime":469.165,"endTime":472.037,"body":"geterone vaginal, which can be"},{"startTime":472.053,"endTime":474.205,"body":"through gels, suppositories or tablets,"},{"startTime":474.397,"endTime":477.085,"body":"intramuscular, which means that painful muscle"},{"startTime":477.117,"endTime":479.973,"body":"shot or oral. Now,"},{"startTime":480.021,"endTime":482.529,"body":"in the US we don't really use the oral one because"},{"startTime":483.079,"endTime":485.751,"body":"progesterone ends up undergoing a first"},{"startTime":485.815,"endTime":488.647,"body":"pass effect in the liver, which then removes a lot of the"},{"startTime":488.663,"endTime":491.087,"body":"progesterone and Less gets to the"},{"startTime":491.183,"endTime":493.975,"body":"uterus. However, in other countries they have a"},{"startTime":494.007,"endTime":495.543,"body":"different form of progesterone called"},{"startTime":495.671,"endTime":498.495,"body":"digidrogesterone and that has"},{"startTime":498.567,"endTime":501.503,"body":"better absorption and more progesterone gets to"},{"startTime":501.511,"endTime":503.919,"body":"the uterus. Fortunately, that is not in the US"},{"startTime":503.959,"endTime":506.775,"body":"yet. Now, the gold standard is going to be"},{"startTime":506.807,"endTime":509.473,"body":"intramolcular progesterone. That's because it gives"},{"startTime":509.521,"endTime":512.361,"body":"high consistent blood levels that absorbe into the"},{"startTime":512.425,"endTime":515.377,"body":"entire body and that goes through the muscle which then absorbed by"},{"startTime":515.393,"endTime":518.249,"body":"the blood vessels. Unfortunately, this"},{"startTime":518.289,"endTime":521.153,"body":"does come with daily injections in the glute, which"},{"startTime":521.201,"endTime":523.657,"body":"can be painful. It can sometimes even cause some"},{"startTime":523.673,"endTime":526.625,"body":"irritation. If it wasn't so good, we"},{"startTime":526.657,"endTime":529.441,"body":"wouldn't use it. We realized that those injections are"},{"startTime":529.465,"endTime":532.297,"body":"painful and the only reason we use it is because it"},{"startTime":532.353,"endTime":535.311,"body":"is the best option. Now, that doesn't mean"},{"startTime":535.335,"endTime":537.751,"body":"there aren't other options. Like we talked about. Vaginal"},{"startTime":537.775,"endTime":540.487,"body":"progesterone. Matter of fact, if you are dealing with a"},{"startTime":540.543,"endTime":543.183,"body":"fresh transfer, there is literally zero"},{"startTime":543.231,"endTime":546.143,"body":"difference between using injectable progesterone"},{"startTime":546.311,"endTime":548.939,"body":"or vaginal progesterone suppository."},{"startTime":549.479,"endTime":552.247,"body":"However, it changes a little bit depending on the treatment."},{"startTime":552.423,"endTime":555.335,"body":"If you're doing a frozen embryo transfer, there is"},{"startTime":555.367,"endTime":558.207,"body":"a difference between used in vaginal progesterone, the intramuscular,"},{"startTime":558.343,"endTime":561.053,"body":"you do not want to use vaginal progesterone only."},{"startTime":561.231,"endTime":563.993,"body":"Now, it doesn't mean you can't use a combination. There are"},{"startTime":564.041,"endTime":566.669,"body":"several studies out there looking at using combinations"},{"startTime":567.009,"endTime":569.993,"body":"where you use injections and vaginal progesterone."},{"startTime":570.121,"endTime":573.049,"body":"But using just vaginal progesterone from the very"},{"startTime":573.089,"endTime":575.985,"body":"beginning for the frozen embro transfer is not"},{"startTime":576.057,"endTime":578.809,"body":"a good method. Now, what's unique about the vaginal"},{"startTime":578.849,"endTime":581.785,"body":"progesterone, Instead of going through the whole body"},{"startTime":581.937,"endTime":584.537,"body":"in a systemic way, it delivers the"},{"startTime":584.553,"endTime":587.521,"body":"hormone directly to the uterus through a phenomenon called the first"},{"startTime":587.585,"endTime":590.223,"body":"uterine pass effect. The uterus"},{"startTime":590.311,"endTime":592.503,"body":"absorbs most of the progesterone"},{"startTime":592.631,"endTime":595.087,"body":"locally, spilling very little into the"},{"startTime":595.103,"endTime":597.919,"body":"bloodstream. That's why blood levels often look"},{"startTime":597.959,"endTime":600.503,"body":"low on your labs, even though the uterine"},{"startTime":600.551,"endTime":603.391,"body":"lining is getting everything it needs. So in the"},{"startTime":603.415,"endTime":606.375,"body":"case this morning, when she was told her progesterone was low,"},{"startTime":606.487,"endTime":609.327,"body":"she assumed that now the progesterone was too low in"},{"startTime":609.343,"endTime":611.783,"body":"her body and that's why the pregnancy didn't"},{"startTime":611.831,"endTime":614.807,"body":"continue. But the reason the progesterone levels were"},{"startTime":614.823,"endTime":617.819,"body":"low in her body is because unfortunately the pregnancy wasn't working."},{"startTime":618.209,"endTime":621.025,"body":"And so the levels told us the corpus luteum"},{"startTime":621.137,"endTime":624.121,"body":"was crashing. But it doesn't tell us the progesterone"},{"startTime":624.185,"endTime":626.825,"body":"in the vagina wasn't getting to the uterus it"},{"startTime":626.857,"endTime":629.833,"body":"was, but I can appreciate the concern there."},{"startTime":629.961,"endTime":632.753,"body":"And so don't be worried when you see those lower progestero"},{"startTime":632.801,"endTime":635.309,"body":"levels when you're taking suppositories."},{"startTime":635.809,"endTime":638.721,"body":"But on the other hand, if you're pregnant, those levels should still"},{"startTime":638.745,"endTime":641.145,"body":"be high because you should be getting in the blood"},{"startTime":641.297,"endTime":644.181,"body":"from the corpus luteum. Unless you did"},{"startTime":644.205,"endTime":647.173,"body":"a frozen embryo transfer, which, again, you shouldn't be using"},{"startTime":647.221,"endTime":650.029,"body":"only vaginal progesterone as well, but then"},{"startTime":650.069,"endTime":652.981,"body":"you wouldn't have a corpus lututeum, so your only progesteroion"},{"startTime":653.005,"endTime":655.229,"body":"would be coming from the vaginal"},{"startTime":655.269,"endTime":657.909,"body":"suppositories. Now, as I mentioned, in the"},{"startTime":657.949,"endTime":660.813,"body":"U.S. really, no one uses oral progesterone, and"},{"startTime":660.821,"endTime":663.333,"body":"that's because it gets broken down the liver, and so it's not as"},{"startTime":663.341,"endTime":665.853,"body":"efficient. But as I mentioned, there's that"},{"startTime":665.901,"endTime":668.789,"body":"synthetic oral form, and that one in another"},{"startTime":668.829,"endTime":671.819,"body":"country shows some promising results and potentially may come to the"},{"startTime":671.859,"endTime":674.491,"body":"US at some point. So"},{"startTime":674.555,"endTime":677.483,"body":"overall, the route matters in different"},{"startTime":677.531,"endTime":680.275,"body":"situations. If you created a corpus"},{"startTime":680.307,"endTime":683.155,"body":"luteum M, you should never be worried about using vaginal"},{"startTime":683.187,"endTime":686.051,"body":"progesterone because you are only supplementing in"},{"startTime":686.075,"endTime":688.971,"body":"that situation. However,"},{"startTime":689.155,"endTime":691.835,"body":"if it's a situation where you did not make a corpus"},{"startTime":691.867,"endTime":694.035,"body":"luteum, you do need to use"},{"startTime":694.147,"endTime":697.105,"body":"either injectable progesterone or"},{"startTime":697.137,"endTime":700.121,"body":"some type of combination of IM and"},{"startTime":700.145,"endTime":702.945,"body":"vaginal progesterone for better support. So"},{"startTime":702.977,"endTime":705.833,"body":"here's where the conundrum comes. Why is it,"},{"startTime":705.881,"endTime":708.801,"body":"if you're taking vaginal progesterone and you don't get"},{"startTime":708.825,"endTime":711.681,"body":"pregnant, you'll get your period, but if you're"},{"startTime":711.705,"endTime":714.441,"body":"takingramuscular progesterone"},{"startTime":714.585,"endTime":717.345,"body":"and you don't get pregnant, you don't bleed"},{"startTime":717.497,"endTime":720.345,"body":"until you stop the medication. Based"},{"startTime":720.377,"endTime":723.257,"body":"on everything I've told you, that would make you think that the"},{"startTime":723.273,"endTime":725.983,"body":"progesterone levels weren't good enough, and that's what caused"},{"startTime":726.121,"endTime":728.963,"body":"the bleed, because the progesterone supports the"},{"startTime":728.971,"endTime":731.747,"body":"endometrium. And although that sounds logical,"},{"startTime":731.883,"endTime":734.811,"body":"that is not correct. And this is because when"},{"startTime":734.835,"endTime":737.779,"body":"you use IM progesterone, the systemic"},{"startTime":737.819,"endTime":740.483,"body":"levels are high enough to suppress menstruation"},{"startTime":740.571,"endTime":743.523,"body":"longer. Basically, progesterone going everywhere"},{"startTime":743.571,"endTime":746.395,"body":"to the brain and the pituitary and telling everyone, hey,"},{"startTime":746.427,"endTime":749.171,"body":"we're still pregnant. But when you take vaginal"},{"startTime":749.195,"endTime":752.091,"body":"progesterone, the uterine levels are high, but the blood levels"},{"startTime":752.115,"endTime":754.831,"body":"are low. So the body sometimes starts the"},{"startTime":754.855,"endTime":757.739,"body":"menstrual clock because it doesn't sense pregnancy."},{"startTime":758.039,"endTime":760.727,"body":"And this can be actually quite traumatic"},{"startTime":760.863,"endTime":763.663,"body":"because you may think you're pregnant because you haven't got your period when"},{"startTime":763.671,"endTime":766.599,"body":"you're using IM shot, in reality, you're just not getting your"},{"startTime":766.639,"endTime":769.567,"body":"period because of the progesterone. Additionally, if one of"},{"startTime":769.583,"endTime":772.215,"body":"you are taking vaginal progesterone and other ones taking"},{"startTime":772.287,"endTime":775.247,"body":"IM and the first person ends up getting their"},{"startTime":775.303,"endTime":778.223,"body":"period, they may feel like, wow, I didn't get pregnant. But"},{"startTime":778.271,"endTime":781.145,"body":"they did. When in reality, maybe both didn't get"},{"startTime":781.177,"endTime":784.113,"body":"pregnant. But just because of the way you're using"},{"startTime":784.161,"endTime":787.033,"body":"progesterone via the route is why you had"},{"startTime":787.081,"endTime":789.269,"body":"different experiences."},{"startTime":790.089,"endTime":792.393,"body":"So overall, is progesterone a"},{"startTime":792.441,"endTime":795.385,"body":"superhero? Well, if you're the corpus luteum, I would"},{"startTime":795.417,"endTime":798.305,"body":"think you would say yes. But overall, the"},{"startTime":798.337,"endTime":800.953,"body":"important thing here is when it comes to progesterone,"},{"startTime":801.121,"endTime":803.537,"body":"how we give it matters, where it goes"},{"startTime":803.593,"endTime":806.223,"body":"matters, and what it does matters"},{"startTime":806.361,"endTime":809.275,"body":"more than what a lab number says. If you're taking"},{"startTime":809.427,"endTime":812.387,"body":"IM progesterone, you can follow the lab numbers and"},{"startTime":812.403,"endTime":815.203,"body":"they're going to be very accurate. If you're using"},{"startTime":815.371,"endTime":818.147,"body":"vaginal progesterone, you can't follow the lab"},{"startTime":818.203,"endTime":821.171,"body":"numbers. It's only telling you what the corpus luteum is"},{"startTime":821.195,"endTime":824.011,"body":"doing in a little bit of what the vaginal progesterone is"},{"startTime":824.035,"endTime":827.027,"body":"doing. But it doesn't give you the full picture because you"},{"startTime":827.043,"endTime":829.603,"body":"can have low blood levels and still have a very"},{"startTime":829.651,"endTime":832.527,"body":"receptive uterus when taking vaginal progesterone."},{"startTime":832.723,"endTime":834.659,"body":"So we salute you progesterone."},{"startTime":835.399,"endTime":837.819,"body":"Thank you for protecting our babies."},{"startTime":838.239,"endTime":841.071,"body":"Maybe you've had this question before where you thought, isn't that"},{"startTime":841.095,"endTime":843.951,"body":"weird? I'm getting my period but I'm on progesterone. Maybe have a friend"},{"startTime":843.975,"endTime":846.695,"body":"going through this. Either way, if you liked this"},{"startTime":846.727,"endTime":849.727,"body":"episode or know someone who it may benefit, please tell about"},{"startTime":849.743,"endTime":852.647,"body":"it. And as I always say, if you like this podcast, give us"},{"startTime":852.663,"endTime":855.447,"body":"a five star review on your favorite medium. But most of all,"},{"startTime":855.503,"endTime":858.059,"body":"keep coming back. I do this because of you,"},{"startTime":858.239,"endTime":861.075,"body":"so please let me know topics you'd like to do. Send"},{"startTime":861.107,"endTime":862.839,"body":"an email to tbft"},{"startTime":863.699,"endTime":866.531,"body":"newirectionfertility.com or you can even"},{"startTime":866.555,"endTime":869.411,"body":"just tag me in a Facebook post. Until our"},{"startTime":869.435,"endTime":872.307,"body":"next super hormone adventure, I look"},{"startTime":872.323,"endTime":875.259,"body":"forward to talking to you again next week on Taco Bel"},{"startTime":875.379,"endTime":876.519,"body":"Fertility Tuesday"},{"startTime":881.339,"endTime":881.779,"body":"Avengers."}]}