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Let’s talk PIO

I looked up this IVF calculator today.  According to this, I am 3w3d pregnant.  How weird is that?

With the retrieval and the transfer, I had every intention of discussing my PIO injections, but time got away from me.  So I have been wanting to post this for awhile.  Because anything involving a sharp needle, a booty, and an inexperienced husband deserves some recognition.

I have done 7 injections so far.  For about a week before my first one, I was frantically searching the internet for PIO tips.  Asking my infertile friends, reading blogs.  “Does it hurt?” “What if he hits my sciatic nerve?” “Can I use a smaller needle?” “Oh gawd, please don’t make me do this!”

To put it bluntly, I would rather ride the wrecking ball with Miley Cyrus than let him do these shots.  The first IVF, we had to do one IM HCG shot before retrieval.  I iced that area so thoroughly, I was numb for a week.  So I didn’t feel it.  With the last trigger, this happened.  So I wasn’t quite ready to have him get behind me with a sharp needle again.  Especially because the area is supposed to be warm, to allow the oil to spread out.  Icing is out of the question.

I made him practice with a needle and a lemon first.  I didn’t like the way he continuously stabbed the lemon with that gleam in his eye.  But time was ticking and we had to get at it.  I stuffed the progesterone vial into my bra (I lied, I wasn’t wearing one; I stuffed it under my boob) and slapped a warm rice pack on my butt and lied like that for 20 minutes.

We went to the bathroom and I put my elbows on the sink, concentrated and relaxed my butt and told him to do it.

And guess what?  It actually wasn’t bad.  I think I squeed a little when the needle went in but it wasn’t bad.  Afterward, he massaged the area (our new version of foreplay), we put the heat pack on and then bundled up and went for a walk.  Piece of cake.  As long as he doesn’t screw up.

When I was on bed rest, we just had me lay on my side and relax my butt.  Obviously I couldn’t walk but he did a lot of massage.  Sexy.  So far, knock on wood, we don’t have any issues. 

So I’ve decided to give you all the tips I know about PIO.  I would love to hear your feedback and any tips of your own.  I want to make a separate tab for it on my blog for reference.

Here’s what I’ve learned:

Before the injection:

  • Heat the area with a heating pad, warm washcloth, or rice bag (that you heat in the microwave). A sock with rice in it would work too.  Heat for up to 20 minutes, but I do 5 minutes sometimes and it seems to work. 
  • Warm up the vial (I shove it into my bra for 10-20 minutes.) This makes the oil thinner and easier to draw out.  I don’t recommend using the microwave because it can get too hot and can actually burn your tissue.  You could also run it under warm, not hot water.
  • I had someone draw out the injection area on both sides of my butt for my husband to target.  You won’t have to worry about hitting that sciatic that way.  Otherwise, just make sure it’s on the outer upper quadrant. 
  • It doesn’t matter what time of day you give the shot, as long as it is consistently at that time.  Don’t give your shot and go straight to bed, because the oil won’t be able to spread and that is how those painful lumps develop.  I chose to do them around 6:30 pm so that I can have the rest of the night to walk around.
  • The oil is going to be difficult to draw up.  I have my husband keep the warm pack on the area while I am drawing up the oil, to heat the area until the last second.  While he’s doing this, I pull the plunger down past the 1 mL mark (the normal dose) and let the oil flow in and then push the extra out until you are at 1 mL (or whatever dose you are on).  Then I switch needles.  This means you will inject with a sharp needle, which hurts a lot less. Pushing the needle in the vial dulls the needle.  Again, coming from experience, this HURTS.
  • When the new needle is on, push the plunger until a drop of the oil beads out of the tip.  This will also help lubricate the tip.  Don’t ask.  It works.

During the injection:

  • You can lie down, on your side is best, with the top leg (the side receiving the injection) slightly forward and relaxed.  You can also stand, leaning over the bathroom sink.  I wouldn’t recommend leaning over the bed, as this was my mistake last time, and I think it stretches your butt muscle too much and it can hurt more.  On the side the injection is going to go, make sure your leg and glute is relaxed, with your foot turned slightly inward (this relaxes the glute).
  • Right before the injection, I wrap the syringe with oil in the heat pack for a few seconds.
  • It helps to have the person inject while you are exhaling.
  • Slightly spread the skin in the area your injecting apart with your fingers.  I have heard that pinching the skin can make it hurt more.
  • The injection should go in quick, like a dart.  If you try to go slow, you are not doing the person any favors.  
  • One the injection is in, you can pull back slightly on the plunger to check for blood.  This means you are in the vein, not the muscle, and will need to start over.  I have heard conflicting things about this.  Some don’t do this step, and hitting a blood vessel is rare.  It takes only a second to do, however, so this is how I have trained my husband 🙂
  • The oil is THICK!  It may take about 30 seconds to inject it all in.  Inject it nice and slow.
  • After all the medication is in, leave the needle in for a few seconds so that when it’s pulled out, the oil doesn’t leak out.  If that happens, it’s ok.
  • Pull out the needle quickly.  Again, pulling it out slowly is not doing the person any favors.

After the injection:

  •  Massage the area with a piece of gauze, or cotton ball.  Don’t be timid.  This helps spread the oil throughout the muscle.
  • Apply heat again, and heat and massage for several minutes.  Walk around after for 20 minutes or so.  The muscle movements also help spread the oil.
  • Award yourself.  You deserve it. 🙂 

Any other tips?

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38 Comments on "Let’s talk PIO"

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Erika
Guest

AHHHHHHHH. This was the scariest post I've ever read. You (and all the other ladies doing this craziness) deserve some kind of prize (hopefully in the form of a baby). YIKES!

Just T
Guest

I spit my water out with your Miley comment! LOL……
Sounds like you have this under control.

Amanda
Guest

ahhhhh! OMG… I kind of wanted to vomit with all the "put the needle in" "pull the needle out"… I'm obviously not ready for this at all! If reading about it gives me the willies, I'm not sure I'll ever make it to ACTAULLY injecting meds. Thanks for all of the helpful tips!

Heather S. @ I Should B ...
Guest

Thanks for all the tips. DH and I are not at this point but if we ever do get here I'll know I have a great resource.

nogoodeggs
Guest

haha yes! ideally that is the prize!!! and whats weird is how normal is becomes!

Ashley Sanderson
Guest

OH boy! DH and I start these shots tomorrow! We had our egg retrieval yesterday. I think this was the scariest thing out of the whole process! Ugh! I hope I don't pass out, let alone my husband!!

Ashley
Man and Wife and Two Fur Babies

Hillary
Guest
For as serious as your post is it made me laugh pretty dang hard. 🙂 I remember trying to continue to "live life" while enduring the needle. My SIL was the brave soul that's seen more my ass than my hubby and we decided to take the kiddos to a jumpy place. We got the kids settled and then went to the bathroom with all my setup. She did the injection and nicked a vessel and I spurted blood all over that stupid bathroom, my maternity pants (I was prego at the time…), just everywhere. It was hilarious, painful, and… Read more »
Sarah J
Guest

I fear (hope) I will be having to deal with this soon, so I greatly appreciate all the helpful advice! You are a tremendous asset to this community, is do many ways.

shay
Guest

I think you got the process down pretty well. Sounds pretty much what I do… though I don't usually warm the oil before injecting. I find it doesn't make that much of a difference. I do like to sit on the heating pad both before and after though. Also I think if I don't have a counter to lean on, the door frame works well. Cheers to PIO! LOL! Let's hope we have 90+ days ahead for us! (My dr makes us do them the entire 1st trimester)

Mae
Guest

If you have to do it yourself, do the lean on the counter thing, dangle or relax the injection side, use the same hand as leg, take aim, do it quick, don't think too much. Have ice cream ready for your reward!

Caroline
Guest

So glad that you got the process down!!

Jessah @ Dreaming of Dimples
Guest

Great tips! I've never made it to PIO but I feel like I need to bookmark this for when I do.

Anonymous
Guest

Emla cream is amazing – if you put it on about an hour or so before the shot, you can hardly feel anything! 🙂

JoJo
Guest

Awesome tips. Never thought of heating my buttox before th injection. I truly do not look forward to PIO.

belovedburnttoast
Guest
ALWAYS draw back and check for blood! OMG this happened to me once, so scary. Eric ended up calling his mom (a nurse) while the needle was still stuck in my ass. Turns out you just take it out and re-plunge close by, no new needle necessary. Anyway, I shudder to think what would happen if he had injected it into the vein. I can't help but picture a vein explosion or something (gross). That's too funny that you had someone draw a diagram on you! I had Eric's mom do the same. I said to her, "Did you ever… Read more »
Risa
Guest

I know! Trust me, it's scary. However, I have to say, once you are in the midst of it, it becomes a part of life (shudder)

Risa
Guest

Ha! I know that was a good one. Yep, took all my tips and tricks I learned and am passing them on 🙂

Risa
Guest

It's creepy. It's best not to think too much about it.

Risa
Guest

Yay! I'm glad. I have it as a tab now, so feel free to bookmark away!

Risa
Guest

Ashley, great job fertilizing All Of The Eggs. Nice work 🙂 You will do awesome. Let me know how it goes!

Risa
Guest

This made me gasp and LOL at the same time. Holy geez girl. I would have freaked out. What a memory.

Risa
Guest

Aww thanks so much Sarah 🙂

Risa
Guest

I know, they told me if I am pregnant, it will continue up to 10 weeks. I agree! Let's hope we both are sick of shots by the time we're done!

Risa
Guest

I have seen that. I don't think I can bend that way. I tried it and I get all spasmy. I will add it to the list for the flexible people!

Risa
Guest

Me too! The most stressful part was mentally preparing myself with all the Internet tips.

Risa
Guest

Bookmark away!

Risa
Guest

I've heard that. I don't even think the shot hurts per se, it just makes me wince initially going in.

Risa
Guest

Yep, the nurses at the clinic told me to do that. Helps the oil spread. That was a good tip. I am scared of getting lumps.

Risa
Guest

Ha! (I pictured a vein explosion too!) The circles are Essential! There is no way I was trusting him to stab blind.

Jennifer T
Guest

I will definitely be referring back to your tips if I have to do these shots again. These are the worst! I hate them more than any other shot. Too funny you had your hubby practice on a lemon 🙂

Amber
Guest

I am such a big weenie when it comes to shots, but I managed to do the PIO for 3 months! This is a great list of tips you've put together. I think everyone is intimidated by these shots, but then, you just do them because you have to and find out they really aren't that bad. I hope you have many, many more shots ahead for you.

Jen
Guest

You sound like a champ (and Chris too)! I had to give myself PIO for 5 transfers and am still traumatized by the memories of the lumps that lasted for months. I am glad it is going better for you!!

Melissa Long
Guest

Great tips! Sounds like you're a pro at this now! (Unfortunately!)

infertilityabsurdity
Guest

This is fantastic! We never made it to the PIO round in IVF #1, but hoping to make it there in IVF #2 in a few weeks. I am printing this out and sticking it next to my big old box of drugs for when (please universe) that time comes. Thanks!!

Amateur Nester
Guest

I'm totally book-marking this post for my first IVF cycle. I'm totally freaked out now, but I'd rather be freaked out from information than freaked out from ignorance. Thank you for posting this!

Aubrey
Guest

Just looking at the PIO vial makes my bum hurts 🙁 Ahh!

Baby On Mind
Guest

Love this post. In all my previous IVF cycles, my RE didn't require me to do PIO. But now for my FET of adopted embryos, I will have to do it. I have to admit this is the scariest part of the process… not the retrieval, the other shots, etc. This PIO is scaring the crap out of me! I start PIO in a couple of weeks. Wish me luck! And lots of courage!

yetanotherbitterinfertile
Guest

Those sound like great tips! I'm thankful that I don't have to do the PIO injections. My RE let me choose Crinone instead. Which is especially nice, because DH refuses to give me shots.

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