10 Tips for Easy and Painless Progesterone in Oil (PIO) Shots

I dreaded it from the very beginning. But I knew I couldn’t stop it.

It was a bridge I knew I’d have to cross. I was on one side, and my embryo babies were waiting for me on the other side. And I had to do this to get to them. No going around. No skipping over. No alternate routes.

Only going through.

The dreaded progesterone in oil (PIO) shots.

My sweet husband was going to have inject a thick, oil-based medicine into my glute muscle with a 1.5-inch, 22-gauge needle. Twice a day. For over two months.

Before our infertility journey, I had a vague understanding of in vitro fertilization (IVF) and I generally knew that patients usually had to give themselves shots. And probably like most people, I thought I could never do that. And also like most people, I certainly thought I’d never have to do that.

Truly, never.say.never.

But, one of the sweetest things I’ve learned in this journey is that God really does equip you and give you the strength you need to take each step as it comes. When you are in His will, you really can do all things through Christ (Phil. 4:13). He establishes your steps (Prov. 16:9) and He acts on your behalf (Ps. 37:5), making ways in the wilderness and springs in the desert (Isa. 43:19).

So, if you’re reading this because you’re a little (or a lot) nervous about this part of a transfer protocol, I encourage you to trust in God’s faithfulness. I can tell you with 100% confidence that if you are following Him and trusting Him with your story, He will open up the way before you and give you exactly what you need (Phil 4:19) to empower you to do this. The God who formed you in your mother’s womb (Ps. 139:13) and knows the number of hairs on your head (Luke 12:7) really does care about you and these PIO shots. Take it to Him.

Um… Did You Say Butt Shots?

Though I had a general understanding that self-administered injections were going to be a part of the embryo transfer process, I didn’t really know any specifics. I assumed it’d be less involved than what is necessary for IVF, but I didn’t know what that meant. I thought maybe I’d need to do a few stomach shots here and there.

As I shared in a previous post, it wasn’t until the initial appointment with the National Embryo Donation Center (NEDC) that I learned the scope of the injections.

First, I would be doing three weeks of daily stomach injections of Lupron, which shuts down the pituitary gland and prevents early ovulation. These were subcutaneous injections, meaning they go into the fatty tissue under the skin. I could easily give them to myself, as they were quickly administered with a 0.5inch 28-gauge baby needle.

Materials for Lupron stomach injections.
The goods for Lupron stomach shots!

Okay, can do. It’ll be weird, but I know I can do it. I am mentally prepared for stomach injections.

But then, the kicker.

I would also be doing twice daily progesterone in oil injections into my glute muscle through up to 10-12 weeks of pregnancy. The medicine would be THICK. The needle would be LONG. The injection would be DEEP. The supplies would be EXPENSIVE. And the whole thing would probably be painful.

Materials for progesterone in oil injections.
And the goods for PIO booty shots!

Time to Start Googling

Hearing about the PIO shots threw me for a loop the most, out of all the things I learned at that initial appointment. I share more about why here, but being able to look back now, I can honestly say God provided in such a big way—financially, emotionally, and physically. I don’t know about you, but I forget Philippians 4:19 way too easily.

Financially, He provided the funds and helped me navigate my insurance to the point where I simply requested coverage for the PIO medicine and got it covered. Are you kidding me?! Nothing is ever that easy with insurance. Something that would have cost me $300+ per order ended up costing me $25 per order (which was a huge deal because I had somewhere around 4-5 total orders). COME.ON. Emotionally, He kept me steady, organized, and (generally) unafraid. And physically, I had no side effects from the medications and my body responded as it was supposed to (which, in case you didn’t know, doesn’t always happen with fertility treatments).

All God. He is incredible.

But, at that time, I was thrown into a tailspin of questions: Do I have to? Why? Is there no pill for this? (No seriously, how are we able to send satellites to Mars but we can’t get this in pill form?) What if Brian is away on a business trip? How bad will the needle hurt? How will we time this morning and night with work and other commitments? How will we afford that much medication?

Then, I did what you probably did to get to this article: I googled.

I watched videos of official injection techniques as well as informal vlogs from others’ experiences, I read every blog I could find with how-to tips, and I scoured other fertility clinics’ resources.

For reference, I’m including a few injection technique videos here that I thought were really helpful. I’ve also of course included my own vlogs below sharing my personal experience!

For the Lupron stomach injections, I liked this one and two from Nurse Linda who does NOT mess around (info about Lupron and subcutaneous injection technique). For PIO injections, I liked the videos from the same people: this one and the two again from Nurse Linda (info on PIO and intramuscular injection technique).

The First Stomach Shot

Finally, the time came for my first shot on April 13, 2020, exactly one month before my scheduled transfer.

For that first stomach shot, I just needed to overcome the mental hurdle of “I’m about to stab myself with a needle and I do not feel at all qualified for this…” I even remember that once I put the needle in, Brian had to remind me to actually inject the medicine because I sort of just stood there, shocked, staring at this needle I’d just shoved into my stomach.

But, when I got past that initial “Holy goodness, am I really giving myself a shot?!” thing, the stomach shots were easy. (Note: I did bruise a lot with my first injection, but I think that was because I injected too hard and too fast, haha. I didn’t have any bruising after that first time.)

Materials for Lupron stomach injections when they first arrived in the mail.
Lupron injection kit and some other meds for the transfer day. Receiving this medicine in the mail made everything feel so real.
Drawing up the Lupron medicine.
Drawing up the Lupron.
Icing the injection site.
Icing the spot for a few seconds to numb the surface a little. Loved this part. Also, note the bruise I referenced from the first day!
Injecting the Lupron.
The stomach injections are truly fast and painless. Just have to get over the whole “giving yourself a shot” mental hurdle, and you’re good to go!
Husband documenting the process!
Brian loved documenting the process.

It didn’t take me long to feel like a pro at the stomach injections. I basically just numbed the surface a little with an ice pack, cleaned the area, pinched the skin, stabbed quickly and smoothly, injected the 10 units, and released. That was it; the whole process took me about 1-2 minutes.

Check out the video below if you’re interested in seeing the process; a few tips/tricks are included in the video!

This was from my very last stomach injection, Day 21/21! … And I was still terrible at drawing the medicine, haha.

The First PIO Shot

The PIO shots? Those were a whole different story. These things were gonna require an entire routine.

Did it suck losing 30 minutes of our day per shot? Yepp. But it was totally worth it.

Once we got into a groove, I had nearly pain-free PIO injections, minimal muscle knotting, no bruising, and only occasional soreness. (To be fair, it wasn’t always rainbows and unicorns—there were days when my hips hurt more than other days—but overall, it really wasn’t bad.)

We woke up early on a Sunday morning in May, anxiously preparing for the first shot. On top of our bedroom dresser, we set up our sharps container, some gauze, two alcohol swabs, the 18-gauge drawing needle/syringe and the 22-gauge injection needle, the progesterone in oil, and a heating pad.

PIO materials on our dresser.
Our work station!
The PIO medicine in a cottonseed oil base.
Progesterone in a cottonseed oil base. Believe it or not, this vial only lasted 5 days.

We nervously talked through everything one more time and I “supervised” as Brian prepared the medicine. Though I had given myself 21 stomach shots by this point, it was Brian’s very first time drawing up and preparing medicine, and this medicine was much thicker than my Lupron and required a needle swap. As expected though, he handled it like a pro.

Husband preparing the PIO injection.
I can’t give my hubz enough credit in this process. He was absolutely amazing.

As he finished prepping the medicine, I laid down on the bed with a pillow and nervously started praying. Brian picked a spot, and we talked through our injection plan one last time.

Heating the PIO medicine before injecting.
Heating the medicine to get it ready to inject!

Then, while I tried to distract my brain, he wound up his arm to put the needle in with a quick, throwing-a-dart motion, and… nope, too scary.

He wound up again, and… NOPE—still not yet.

After a few more psych-outs, he gathered his courage and just did it. And the needle was in.

I want to give my incredible husband Brian a shout-out here. From the time we found out about these suckers, he kept assuring me that he was going to be great at the PIO shots. Whether he was saying it to convince me or himself I’ll never really know, but he truly was amazing.

PIO shots involve a lot of trial and error to figure out what works for you and how your body responds, and he was careful, thoughtful, and open to learning to find something that worked for me. He continued to perfect his technique to make the whole process as comfortable for me as possible.

Administering the PIO injection!
It may sound weird, but it actually is a great way for your partner to be involved in this process!
He’s simply the best.

Over the course of 123 total PIO shots twice a day for 2+ months, we found a good routine and learned a few good tips along the way. And so now, I’m hoping our experience can help someone else have pain-free PIO shots too. 😉

So here we go, what you’ve actually been waiting for—my tips and tricks for painless PIO shots.

But first, a little disclaimer: I am NOT a medical professional. The information in this post is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment. All content in this post, including text, pictures, graphics, and video, is for general information purposes only. Please consult your doctor for any medical questions or concerns.

10 Tips and Tricks for Painless PIO Shots

In the vlog below, I show you the entire process and we talk about our tips and tricks for each step of the process as we do it in real-time. But, if you just want the highlights of my top ten tips, scroll past the video!

ALL my tips and tricks for painless PIO shots, right here!

Tips for before you start:

  1. Make sure your partner is invested in this process with you. It makes a HUGE difference having someone who is willing to listen, learn, and figure out what works for you.

  2. Give yourself time. These are not the kind of shots you can (or want to) do in five minutes. So especially early on, prepare to set aside a good 20 minutes so you can take your time, get comfortable with the process, and establish a routine.

Tips for preparing the injection:

  1. Exercise the plunger on your syringe (move it back and forth a few times). This is a tip from Brian, as he realized this helped him have a smoother action when drawing and injecting the medicine.

  2. HEAT THE OIL. Your muscle can absorb the oil more easily if it’s warm. We noticed a HUGE difference (fewer knots, less soreness) when we started heating the oil in the heating pad. After the medicine was in the syringe, we just placed it inside the heating pad for a minute or so, making sure it didn’t get too hot. You can also warm the syringe in your armpit, run it under warm water, etc.

Tips for the injection:

  1. CHECK FOR KNOTS!! Doing these shots with this frequency might leave you with some muscle knots, despite your best efforts. Totally normal. But it’s good to avoid injecting into a knot when you have them. Have your partner feel around for any muscle knots (feels similar to when you have a kink in your neck!) and avoid that spot so it can heal.

    Early on, I remember this one injection where I could literally feel the medicine going into my body in a way I hadn’t before, and it left me with a pretty strong tightness/pain in my booty and leg for the rest of the day. Looking back, I think we had injected directly into a knot, and my body didn’t like it. 😊 I took some Tylenol and it was fine, but avoid if you can!

  2. Don’t ice. If ice or numbing cream works for you, then okay—go for it! But for me, I found it just wasn’t worth it. I tried icing early on, but because I didn’t want my muscle to get tighter, I only left it on for about 30 seconds, and that obviously didn’t really do anything to numb the spot anyway. I found that the injections really weren’t bad (usually just a quick little pinch!), so it just wasn’t worth it to me. You want your muscle to be warm and relaxed anyway to better absorb the medicine!

  3. Hold the syringe like a dart and insert the needle quickly. The slower the needle goes in, the more you will feel it. And I know you don’t want that. No hesitations—just go for it. But for the actual medicine, inject that slowly. Unlike the needle, the faster the medicine goes in, the more you will feel it. Take your time with this! Brian would inject a little bit, wait a few seconds, inject a little more, wait a few more seconds, and so on. Doing this part slowly gives your muscle time to absorb the oil and that will really cut down on the soreness in the long run. We also recommend holding the syringe firmly against the skin so it’s not wobbling around during the injection!

Tips for after the injection:

  1. Massage the area. Is it fun having your partner massage your booty? Under normal circumstances maybe, but it’s less fun after you’ve stabbed yourself with a 1.5-inch needle and injected a bunch of thick medicine for a few minutes. You know how your arm feels after a flu shot? Now imagine massaging it. Hard. Over and over. That’s probably a little what this will feel like, but it’s 100% worth it. Have your partner press into the spot for a few seconds and then massage the area. Brian massaged the injection area for a full five minutes, and then he switched to the other side and massaged there for three minutes (remember, we were injecting into both sides each day).

  2. Use a heating pad. Typically, I would try to sit on a heating pad for 10-15 minutes after the injection. I really feel this helped my muscle to stay loose and helped the oil continue to absorb.

  3. Move around. I found it helpful to be up and moving after the injections to try to keep my muscles from getting stiff. Do a few squats/lunges or go for a quick walk. You might find it doesn’t make a huge difference for you, but it certainly doesn’t hurt.

Infertility warrior, you’ve got this. You’ve overcome much to get to this point, and you are gonna keep being an overcomer. You absolutely CAN do this.

Now… go get ‘em! 😊

This Post Has 19 Comments

  1. Sarah

    Thank you, thank you! I am a nervous wreck about these PIO injections! Like you, I’m scouring over every site I can find to get as much info and tips to ease my mind. God is good and we’ve see him come through many times during our journey.

    1. Jenna Bieber

      Awh I was so nervous too! The build up and anticipation is worse than the shot! Everyone feels it differently, but if you put the needle in quickly, it’s really not bad–it’s more about managing the pain that can come from the medicine in terms of soreness! Praying everything will go smoothly for you.

  2. Naomi

    Your site is so helpful, I just discovered it and am SO THANKFUL! My husband and I have our transfer at the NEDC next week and are about to start the PIO shots! I’ve been nervous for sure, and 9-10 weeks of them just sounds so long. Thank you for your help and encouragement to others!

    1. Jenna Bieber

      Awh yay! I’m so glad to hear it’s been a helpful resource for you–that’s exactly what I hoped it would be! 🙂 Yay for your upcoming transfer! Praying your PIO shots go well and that the transfer goes beautifully 🙂 Honestly, the shots go by faster than you’d think–they take some getting used to though for sure, haha.

  3. C Mantovani

    Love your blog, recommended videos and your videos. I was so nervous about PIO!!! Started this morning. I’ve watched everything you recommended and your own videos. Love the heating pad warm up recommendation. That was great. Using water seemed messy and I wasn’t looking forward to that. Laying on the bed, warming up the oil in the heating pad and taking a walk later seems to be working here too! Thank you so much for making this video.

  4. Liz

    This has been so, so helpful. I’ve been putting the syringe in my heating pad and it made a HUGE difference. But now I’m worried that I’m overheating it. I generally draw the syringe, go make coffee, and then inject. I emailed my nurse who said she wasn’t sure about heating with a heating pad and recommended I just rub between my hands. Sorry but that doesn’t work for me. Already tried it and had pain for days with each injection. But you used a heating pad and it was fine? Should I just make sure it is just for a minute?

    1. Jenna Bieber

      We did use a heating pad and I have seen many others do the same, but yes–we didn’t leave it in very long. Just enough for it to get warm. You definitely don’t want it to get too hot!

  5. Monica Naim

    I want to say thank you… this part of the process has truly given me the MOST anxiety. I’m bookmarking this as we speak.

    1. Jenna Bieber

      So happy to be able to offer some tips that worked for us! 🙂 Hoping they help you out!

  6. Jolene

    OMG!!! You guys are the BEST!!!! I love watching your PIO video. Your sense of humor is very similar to my husband and me. I’m on day 5 (transfer tomorrow!!!) and these shots are soooo bad. You gave me a nice laugh, thank you!

    1. Jenna Bieber

      So glad we could provide encouragement and a laugh! 🙂 Hoping your transfer went well!!

  7. Brit

    Thank you for this!! I’ve done 4 of the progesterone injections and as I sit on a heating pad was wondering how I was going to handle this for another 8+ weeks, your tips will defiantly help!

  8. Victoria

    Wow thank you for this! God is good, He led me to this site after I prayed about having to do these shots myself (my husband will be away for a month!) I start them in a few days and after the meds for the egg retrieval I thought I could handle this, but seeing the needle made this doctor almost pass out! Bless you for posting this.

  9. Sasha

    Thanks for this blog post !! Appreciate it <3

  10. Kat

    Thank you both so much for sharing your heart, your journey, AND your pro tips. Starting PIO shots tomorrow and am only *slightly* terrified. 😉 So grateful for your tips going into them; and even more than that, just hearing others’ journeys makes it all feel so much less lonely, so thank you again. God bless you and your sweet fam! 🥰

  11. Luciana

    Jenna, what heating pad did you use? I want one that I can sit on afterwards, like yours.

  12. Cassie

    Thank you so much for this! This shot has been the one I am most nervous about and this was so helpful! Thank you! We start IVF in December and things like your blog and videos are so so appreciated!

  13. Madeline

    Thank You So Much For Posting This! We just started the progesterone oil yesterday and the pharmacy gave us the needles, but we had no direction only a YouTube video from cvs, and were inserting the wrong one bc we thought we had to switch needles. I found your blog and it was so helpful. Also, I love all your Bible quotes. God is so good!! I saved my eggs when I was 23yrs old and about to undergo Brain cancer treatment. 9 years later I’m alive, happily married and undergoing IVF with my frozen eggs! So thankful and blessed! You and your husband are an inspiration! Praying 🙏🏼 for you both!

    1. Jenna Bieber

      I’m so glad you found this helpful! 🙂 What an amazing story you have; I pray that your IVF is successful and most of all that God reveals more of His faithfulness to you in this journey!

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