Progesterone in Oil (PIO) injections are a common part of many fertility treatments, such as In Vitro Fertilization (IVF) and Frozen Embryo Transfer (FET) cycles. The progesterone, suspended in a thick oil base, is administered intramuscularly to support the uterine lining. This support creates an optimal environment for embryo implantation and helps sustain an early pregnancy. This information is intended solely for educational purposes and must not replace the direct, personalized training and specific dosage instructions provided by a licensed healthcare professional.
Preparing the Supplies and Injection Site
A successful injection requires gathering the necessary equipment and establishing a clean workspace. Standard supplies include the progesterone vial, a syringe (often 3 mL), two types of needles, alcohol swabs, gauze pads, and a designated sharps container. A wider 18-gauge needle is used to draw the thick oil from the vial. A longer, thinner 22-gauge or 25-gauge needle (1 to 1.5 inches) is used for the actual intramuscular injection.
Before starting, wash your hands thoroughly and set up supplies on a clean, dry surface. Progesterone in oil is highly viscous, so gently warming the vial can reduce its thickness, making it easier to draw up and inject. Warming can be achieved by rolling the vial between your palms or placing it in the crease of your elbow for several minutes. Never use a microwave or boiling water, as excessive heat may compromise the medication’s integrity.
Step-by-Step Administration Technique
Drawing the Medication
Begin by preparing the vial: remove the protective cap and firmly wipe the rubber stopper with an alcohol swab, allowing it to air-dry completely. Attach the larger 18-gauge drawing needle to the syringe. Pull back the plunger to fill the syringe with air equal to the prescribed dose, then insert the needle and inject the air into the vial to equalize pressure.
Turn the vial upside down, keeping the needle tip submerged below the liquid level. Slowly pull back the plunger to withdraw slightly more than the prescribed dose, accounting for potential air bubbles. Flick the syringe barrel to encourage air bubbles to rise, then gently push the plunger to expel the air and excess oil until the exact dosage remains.
Remove the drawing needle and immediately replace it with the smaller injection needle, twisting it firmly onto the syringe. Hold the syringe upright and gently push the plunger until a small droplet of oil appears at the needle tip. This confirms the needle is primed and free of air before proceeding to the injection site.
Site Selection and Preparation
The progesterone injection must be administered deep into the muscle tissue. The preferred site is the upper outer quadrant of the buttock, also known as the dorsogluteal area. This location is chosen to ensure the medication is deposited into the gluteal muscle while avoiding the underlying sciatic nerve and major blood vessels.
It is important to alternate the injection site daily between the left and right sides. This prevents the accumulation of oil, which can lead to soreness, bruising, or the formation of painful lumps. Before injection, cleanse the selected site thoroughly with a new alcohol swab and allow the skin to dry completely.
Injection Process
Stabilize the skin at the injection site, often by pressing the skin taut with the non-injecting hand. Hold the syringe like a dart and insert the needle quickly and smoothly into the muscle at a 90-degree angle, ensuring the needle is fully inserted.
After insertion, perform the aspiration technique by gently pulling back on the plunger for a few seconds. This check confirms the needle has not inadvertently entered a blood vessel. If blood flows into the syringe, the needle must be withdrawn, discarded, and a new injection prepared for a different site.
If no blood appears, slowly and steadily push the plunger to inject the oil into the muscle. This injection may take up to 60 seconds due to the oil’s thick consistency. Once the syringe is empty, count to five before quickly withdrawing the needle at the same 90-degree angle.
Post-Injection Care and Pain Management
Immediately after removing the needle, gently apply firm pressure to the injection site with a clean gauze pad. A small amount of bleeding or oil leakage is common and should not cause concern. The used needle and syringe must be immediately disposed of in a designated, puncture-proof sharps container.
Managing discomfort and preventing painful lumps is a significant part of post-injection care. Applying warmth, such as a heating pad or warm compress, helps the thick oil disperse into the muscle tissue and improves absorption. Gentle massage of the area for five minutes also aids in distributing the medication and reducing the risk of knot formation. Engaging in light physical activity, like walking or doing a few squats, immediately after the injection can further encourage blood flow and absorption.
Recognizing Complications and Safe Storage
Mild soreness, bruising, and localized redness are common side effects that typically resolve quickly. However, certain symptoms require immediate contact with a healthcare provider to prevent serious complications.
Signs of infection, such as increasing warmth, spreading redness, fever, or the presence of pus at the injection site, must be addressed urgently. Severe allergic reactions, including hives, spreading rash, difficulty breathing, or swelling of the face or throat, are considered medical emergencies. Persistent or spreading pain, numbness in the leg, or bleeding that does not stop after several minutes also warrants immediate medical attention.
Progesterone in oil must be stored correctly to maintain its effectiveness and potency. It is typically a room-temperature medication, kept between 59 and 86 degrees Fahrenheit (15-30 degrees Celsius), and protected from light exposure. Refrigeration is generally not recommended as it causes the oil to thicken, making it difficult to draw and inject. Always check the expiration date and follow the specific storage instructions provided by the pharmacist or clinic before use.