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.
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.
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 0.5–inch 28-gauge baby needle.
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.
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.)
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!
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.
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.
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.
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.
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!
Tips for before you start:
- 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.
- 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:
- 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.
- 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:
- 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!
- 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!
- 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:
- 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).
- 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.
- 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! 😊