Progesterone-in-oil and further education

20140328-092845.jpgThis morning I crawled out of bed in the wee hours in order to get my ass (literally my ass) to the Center for Human Reproduction. I wasn’t feeling nervous until the nurses gave me all sorts of sympathy, because they thought I was nervous, and then I did start to wonder: Is something wrong? Is the low progesterone level actually a problem?

Irrational? Yes. PTSD? Yes. Stoppable? Not quite. A nurse told me that Dr. SR wanted to test my progesterone level again, and then he wanted to talk to me directly, before she trained me in the PIO shot. Everything suddenly sounded ominous, and I could feel myself beginning to tailspin a little, wondering, Why would he need to speak with me? I calmed down by using Nadi Shodhan Pranayama (alternate nostril breathing), which I highly recommend).

Turns out he wanted to speak with me directly because he is awesome. He wanted to reassure me. I didn’t ask for this; he did. I seriously love him.

He said that the 4.5 is absolutely not an indication of anything going wrong or developing improperly in the pregnancy. He wanted to test my blood-progesterone again this morning because if the number is back up to 8 or so, that means that I definitely do not need to switch to PIO. He said we could do it this one day, and then switch back to

He said that has been around for 15 years and there have been multiple studies of its effectiveness, objective, peer-reviewed studies. All live-birth outcome data shows that the results of using PIO and are exactly the same. “The only differences are that the gel is more expensive, and the shots are more painful.”

He told me that there is one study in particular that supports the use of over PIO—and not just because it is less painful and easier to do for the patient. I am perhaps going to get the exact numbers a little wrong, but it was something like this: A large group of women who were going to have hysterectomies for one reason or another were part of a randomized trial. Half of the women were given PIO for a few weeks before their hysterectomies, and half of the women were given for the few weeks before their hysterectomies. Just before surgery, their blood-progesterone was tested and the women who had used the gel had numbers like 8, 10, while the women using PIO had numbers many times higher. But when their uteruses were taken out and examined, something quite interesting was discovered. When they chopped up the endometrium and tested the progesterone level in the tisssue of the target organ itself, the progesterone levels were three times higher in the uteruses of the women who had used the gel. That study shows that not only is as effective as PIO; it might be more effective.

Dr. SR said that he really encourages use of the gel and tries to phase out the PIO. “Now if you’d had a baby using progesterone in oil, I’d say, okay, let’s use that, let’s go with the voo-doo.”


SO all of this means is that this afternoon I might have another decision to make. If the number comes back in the 4-5 region, I’ll definitely switch to PIO. But if it comes back normal, I might stick with the gel…

Or I might not. After all, it is rather nice to be able to measure the progesterone level in the blood and monitor it…

I don’t think I would be saying that if I hadn’t had a great training session with my sweet, funny, spirited nurse at CHR. This is what she taught me, in case it’s useful to you:

How to administer a PIO shot:

1.) She drew circles with a Sharpie where the needle should go on either hip/buttock. Before I bared my bottom, I warned her: “You’re going to see a peace sign striped in the colors of a Rasta flag that I got spring break, senior year of high school. Just warning you.” She cracked up. I didn’t even listen to much Rasta music, and still don’t, but there she is, my dime-sized token to the Natural Light inspired idiocy of my youth, on my ass forever, amen.

2.) The Rastafarian-striped peace sign has nothing to do with how you administer PIO, unless laughing about it relaxes you.

3.) Do not ice the area. This encourages tightness of the muscle and coagulation of the oil that the progesterone is suspended within. You want the progesterone to not coagulate, but flow. So putting a heating pad on the injection site afterward is a good idea.

4.) Draw up.

5.) Lean over bathroom or kitchen counter.

6.) If you are going to get a shot on the right side, shift all of your weight to the left, and bend your right knee so that you are not bearing any weight on that side. This relaxes the muscle that is about to be injected.

7.) Partner spreads skin where he or she will stab you on the upper outer quadrant of your buttock. Spreading skin pushes some of the fat out of the way.

8.) He or she punctures you with the 22 gauge 1 1/2 inch needle. This should be done in a quick, dart-like fashion. The quicker and dartier, the less it will hurt.

9.) He or she then gives the plunger the teeniest, tiniest tug upward, to see if any blood fills the syringe. If he or she cannot budge it at all, don’t panic; that means all is well. If a needle is in a blood vessel, the plunger moves freely, and the blood shows up in the syringe immediately.

10.) He or she then injects the medication into your muscle. This should take him or her approximately 20 seconds.

11.) Put a little bandage on the side you injected, to remind yourself where you did it last. You want to rotate back and forth, from right to left, each day. She did not recommend trying the thigh; she said it is extremely painful.

I’ll keep you posted!


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  1. Wow. Very kind doctor. But in the spirit of rhetorical questions from the bottom of my aching heart (aching from my own situation, the part reserved for you is joyous and hopeful :-)): Why does all of this have to be so anxiety-provoking, complicated and exhausting?

    Sending love and light your way as always.

  2. Sounds like a wonderful doctor.

    I’m doing PIO and Endometrin tabs. I’ve done Crinone in the past and hated it. It never dissolved in my body it just mostly just hung um… around…ew! At least the Endometrin has the sense to vacate the area if it’s not being absorbed.

    Good luck with the PIO shots. Hoping that they aren’t too painful! I don’t find mine that bad, especially if hubby goes fast!

  3. Good luck and hope it goes well. This time, I asked my doctor if I could take the PIO shots in the morning (instead of the evening) because I figured it would be better to be up and moving all day instead of letting it sit in my muscles overnight. I also figured that if I took it in the morning, I wouldn’t be dreading it all afternoon. So far, that’s worked out better for me – noticeably less soreness.

    Sounds like your doctor is really wonderful!

  4. Love your doctor! Ironically, the Crinone is covered by my insurance and the PIO is not and I am using the PIO. The shots aren’t an issue for but the lump of progesterone that sits in my muscle is. I almost feel like I am running out of room in my butt and it is only 5 days in. I am going to be strong though! You are awesome and looking forward to updates! Love and hugs!

  5. After all this… My next level came back at 10, and I had two REs who’ve been doing this for 20-30 years and 4 nurses telling me: you don’t need PIO. So there was no reason to switch. Also, after hearing about that study from Dr. SR it sounds like the gel is more effective anyway! So back to Crinone. At least now I have total confidence in it.


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