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Hum. Reprod. Advance Access originally published online on June 24, 2004
Human Reproduction 2004 19(8):1806-1810; doi:10.1093/humrep/deh316
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Human Reproduction vol. 19 no. 8 © European Society of Human Reproduction and Embryology 2004; all rights reserved

Acute eosinophilic pneumonia associated with intramuscular administration of progesterone as luteal phase support after IVF: Case report

Y. Bouckaert1, F. Robert2, Y. Englert3, D. De Backer1, P. De Vuyst2 and A. Delbaere3,4

1 Department of Intensive Care, 2 Chest Department and 3 Fertility Clinic, Erasme Hospital, French-speaking Free University of Brussels, Brussels, Belgium

4 To whom correspondence should be addressed at: Fertility Clinic, Erasme Hospital, 808 route de Lennik, 1070 Brussels, Belgium. Email: adelbaer{at}ulb.ac.be

We report two cases of acute eosinophilic pneumonia induced by i.m. administration of progesterone used as luteal phase support after IVF. For both patients, the symptoms began 3 weeks after the first injection of progesterone. Both patients were in respiratory distress, and one of them required ventilatory assistance for a week, with 5 days in the intensive care unit. Symptoms improved as the i.m. form was shifted to a vaginal form of progesterone together with the administration of corticosteroids. Sesame oil (used as excipient) and benzyl alcohol (used as preservative) could both be incriminated in the development of the hypersensitivity reaction. The need for luteal phase support is clearly established in IVF cycles with GnRH agonist protocols, and progesterone is the generally recommended compound. However, there is no definitive consensus regarding the optimal route of administration of progesterone. These two cases of acute drug-induced disease show that the use of i.m. progesterone can be associated with a severe morbidity in otherwise healthy young patients. This is an additional argument to advocate the use of vaginal progesterone as luteal support in IVF.

Key words: benzyl alcohol/eosinophilic pneumonia/IVF/progesterone/sesame oil


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