Progesterone in oil (PIO) shots vs. vaginal suppositories

Before starting the IVF process, what I feared most were the injections. Little did I know that the daily stimulation injections leading up to egg retrieval were actually done with small, manageable needles administered on your abdomen, meaning, well, there’s a decent amount of fat on your stomach, so they won’t hurt very much beyond a tiny sting.

The “scary” injection is actually the progesterone in oil (PIO) shot, which is done to prepare your body (endometrium/uterus) to accept the embryo during an embryo transfer. The PIO is particularly ‘unpleasant’ as my doctor says because the liquid you are injecting yourself with is very very thick (hey, it’s called “oil” for a reason), which means you need to use a higher gauge needle, which… is not only thick, but it’s long… like SUPER LONG, 3-4 inches. And, as the added bonus, this needs to be administered on your butt. Yep, on your butt cheek.

You’re also expected to continue taking progesterone in various forms through the 9th to 12th week of pregnancy, assuming your transfer was successful. I asked my doctor about this during the IVF consult, and he said that this clinic actually had stopped using PIO because vaginal suppositories of progesterone were just as effective, if not more, than PIO (this is, of course, assuming that you as an individual do not have any known problems with an embryo “sticking,” so definitely take this statement with a grain of salt depending on your individual case and reason for going down the IVF route to try having a baby). So, I would not need to mentally prepare for PIO while at this clinic.

That was honestly like music to my ears. No butt shots. No big, fat, long needle. No butt icing. No butt heat applications. Phew.

But vaginal suppositories, at least the ones I am taking, are like vagina pills. Really. They come with an applicator similar to a tampon applicator, and you insert it through your vagina as far as it goes.Then pushing on the applicator, the pill pops out. That pill is then supposed to dissolve and be your body’s added progesterone to support your pregnancy. So lucky me, for this mock cycle, I get to insert this three times a day, as soon as I wake up, right before bed, and at some point in the middle of the day. As you can probably imagine, the middle of the day insert is not super convenient and would be even worse if it weren’t for this work-from-home/global pandemic situation.

No one told me this would be messy. I had quite a mess with some of the progesterone leaking out and had to clean my underwear twice. It really feels like a dissolved pill, mushy, white, and pasty. And so, I’ve learned my lesson and am wearing a panty liner from now on. Oh, the joys of IVF.

4 thoughts on “Progesterone in oil (PIO) shots vs. vaginal suppositories

  1. Shady Grove Fertility did a study in 2017 and found vaginal suppositories alone yielded 1/3 of the pregnancies of PIO. So dont rely only on suppositories. You can google the study.

    • Hi Anna – thanks for responding. I did actually read that study, but in addition to that, I’ve read many other studies that say that depending on the reason for pursuing IVF, it may not make a difference. In my case, our reasons for pursuing IVF have nothing to do with me, as all my hormone levels are normal, and it was really due to MFI. So, in my case, it made sense to do Endometrin. Thanks for reading.

  2. Thanks for this info, Yvonne. Do you know anything about the cost difference of using progesterone in oil vs vaginal suppositories?

    And I’d be interested in reading any study you found about the effectiveness of progesterone vaginal suppositories compared to progesterone in oil! I’m in the same MFI situation.

    • Hi Emily – thanks for reading. The cost difference is pretty significant, as the vaginal suppositories are a lot more expensive than PIO. I was lucky, though, because my IVF medications were covered by insurance with a small copay. But yes, cost is something to consider. I didn’t find any study that compared effectiveness of progesterone vaginal suppositories vs PIO, though I am sure if I asked my clinic, they could probably have pointed me to one. As you would probably be aware, a successful embryo transfer cycle has many factors that contribute to its success, and progesterone supplements really only help if that is an area that could be a problem. If you don’t have problems in that area, it probably won’t make a huge difference. Good luck to you in your journey.

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