Common PIO Problems and their Solutions

Progesterone in Oil Injections: A literal pain in the ass.

Whether you're undergoing IVF, FET, or another fertility treatment, there's a good chance that progesterone injections will be part of your regimen. I took it for 6 weeks leading up to and following my frozen embryo transfer. When I met with the nurse prior to filling my PIO prescription, I was given a brief rundown of where to inject, written instructions, and a very helpful how-to video. However, I had never taken injectable medication before, and my spouse's phobia of needles meant I was on my own. I felt completely lost! So of course, I turned to my beloved online community for help. As always, please consult with your healthcare provider first and foremost for guidance. If you still find yourself struggling (especially with self-administering your injections), I hope that the community-curated tips I've picked up throughout the process can be of some help. Let's get into it! Below are some common injection problems and their solutions:

Knots: Progesterone is delivered into your body via a carrier oil (typically sesame). If this oil doesn’t spread out into your muscle, it can form pockets, which in turn cause a bump or a knot to form under your skin. The thing that has helped me the most in this area is heat, applied in a variety of ways. First, I bring the oil up to my body temperature by tucking the vial into my bra or pants for about 30 minutes prior to the injection. I administer the shot at body temperature, then apply heat immediately afterwards in the form of this little microwavable gel pack. Lastly, my spouse will massage the area with warm hands or a heated ball roller - check out drawer 3 in my PIO setup post for the products I used.

Pain: You can stick your gel pack in the freezer if you're worried about pain, but I haven't personally done that because I'm afraid of knots, which form when the oil doesn't disperse into the muscle. Those who do use ice recommend putting the pack on your skin briefly for a numbing effect before administering the injection. Other pain relief options include lidocaine wipes or creams - but in all honesty, the pain of the injection barely warrants a mention. You (and the person helping you, if you have one) might have to psych yourselves up for the first few shots, but you'll get into a routine and it will feel like less and less of a big deal.

Bleeding / Leaking: Anyone who's gotten a flu shot knows that you may bleed a bit after an injection. However, more than a dot or so might be a cause for concern when injecting PIO. For example, I was heating the injection site before and after the main event, but when my clinic upped my dosage from 1ml to 2ml… well, let’s just say it got dramatic. In addition to blood, I was able to see a bit of oil leaking out of the injection site - and with how expensive these medications are, I’m not letting any go to waste on the waistband of my jeans! According to my clinic’s nurse, heating beforehand may dilate the blood vessels too much, allowing for more bleeding. As mentioned above, heat definitely helps after injection, to facilitate the medication’s absorption. Bleeding may also be caused if you inject into a pocket of oil from a previous injection, so be sure to rotate sites daily.

Bruises / Soreness: Unfortunately, bruising during this process is very normal. However, there are a few things you can do to try to keep it to a minimum. While not all clinics require it, it's typically recommended to aspirate (by slightly pulling back on the plunger to check for blood) before injecting the medication to be sure you are not in a blood vessel. If you hit a small blood vessel, the trauma will definitely cause bruising. Next, make sure you're doing the injection at a steady pace (no starting and stopping), and go slooooooowly. Seriously, slow down - it may prolong an icky experience, but it makes things so much easier to deal with afterward. Lastly, be sure to apply a good amount of pressure after the injection - up to 5 minutes or so with your heat pack is usually good.

Hopefully this covers any issues you're having! Don't see your question mentioned here? Drop it in the comments below! If there's one thing I've learned on this fertility journey, it's that no matter what you're experiencing, someone else online has too - and they have the solution!