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Step-by-Step Progesterone-in-Oil Injection Tips {to Make Them a LITTLE Less Miserable}

Raise your hand if you’ve been personally victimized by a progesterone in oil injection:

Raise your hand if you've been personally victimized by progesterone in oil | progesterone in oil injection tips

Um, YES.

Of all the tortures infertility brings – estrogen patches, clomid, metformin, twice daily stim injections, ultrasounds upon ultrasounds, daily blood draws – progesterone in oil is the ultimate torturer. The worst of the worst. The Bastard-King Joffrey.

(For my non-Game of Thrones fans, just trust me, he was the worst.)

Some are ~lucky~ enough to get to use progesterone in suppository form, like I was with my first transfer.

(If you consider paying upwards of $50/day and having cement-like discharge for 3 months “lucky,” that is.)

However, most are blessed with the opportunity to stab ourselves in the butt daily with the world’s largest needle.

Step-by-step Progesterone in Oil injection tips to make it a little less painful!

IVF Stims vs. PIO Injections

When I talk about my IVF journey with fertile bitches–er, I mean, friends & family–they almost always tell me they could just never give themselves shots when I get to the 3 times a day stim injections. And I’ve always insisted:

Oh the shots are no big deal! They’re almost the easiest part. The needles are tiny and they just go right into your belly fat, you barely even feel them.

And for the most of the IVF shots – that’s true! It’s an itty bitty little needle, it’s preloaded with meds in a handy pen, and you genuinely can’t feel more than a pinch.

The worst part about the IVF stims, for me, was just the bruising that inevitably results from being jabbed three times a day for 2+ weeks. Your tummy becomes a bloated, black and blue battleground.

But the shots themselves? Easy peezy.

The Progesterone-in-Oil Difference

But then, with my Frozen Embryo Transfer in 2017, I was introduced to the joys of progesterone in oil, or PIO. And I had to eat my words.

First of all, they assume you have some sort of medical degree to administer it (although, to be fair… by this stage of infertility treatment, you probably have earned yourself a nice Dr. Google degree). The PIO comes in a vial with multiple needles and intensive instructions.

There’s mixing and drawing out the liquid with one needle, then switching the gauge to a different – but equally terrifying – needle, then an incredibly specific location for injecting. My nurse actually drew circles on my butt in permanent marker where the needle should go – it was about a 1.5″ radius. Not a lot of room for error!

And that little circle isn’t around a nice little fatty buffer area. This bad boy has to be injected directly into the muscle. I’m talking straight-up GLUTE.

And the liquid you’re shooting into this big, tough muscle? It’s thick. And cold. It’s like trying to push marmalade into a tree trunk. With a needle.

And then, after what feels like a lifetime, when the injection is complete, the muscle tenses up and acts like you just did 100 lunges (except with none of the benefits).

Progesterone-in-Oil injections are brutal – and you repeat them over and over and over throughout your IVF process.

…for three months, if you’re lucky and you get knocked up.

So you can imagine how it feels to walk (or sit, or stand, or God forbid, actually work out) after a week or so of this torture.

But never fear – I’m here to help!

I amassed some lifesaving progesterone-in-oil tips and tricks throughout my three-month reign of PIO-terror. I won’t pretend they make the experience pleasant or completely painless, but I can guarantee they’ll make it ~less awful.~

(Rule #1 in inferility is to set your expectations low, right?)

Give this step-by-step PIO injection approach a try, and let me know what you think!

1. Take your PIO vial out of the fridge, and stick it in your bra. (I know, you think I’m crazy! But trust me, your body heat will warm it up and make it flow a little bit easier out of the syringe.)

2. Meanwhile, grab an ice pack out of the freezer, and stick it in your pants over the injection site.

(I promise there’s more to this process than just making yourself cold enough to not notice the injection.)

3. Meanwhile, stick your heating pad in the microwave. You’re going to want it ready for right after the injection.

(Wild temperature swings, I know!)

4. Put on your wannabe-nurse hat, and get your supplies ready: grab your alcohol wipe, cotton swab, and your needles.

5. Roll the vial in your hand for a few seconds to really work the liquid around and warm it up. Then draw out the correct amount of PIO, and switch to the injection needle.

(Don’t forget to swap the needles! The thicker one is for drawing out the progesterone, and the thinner one is for injecting it.)

6. It’s almost go time. Lay down on the couch or bed, on your stomach. Your goal is to keep that butt muscle as relaxed as possible, so you don’t want your weight on it.

7. Prep the injection site: remove the ice pack, wipe the spot with the alcohol wipe, and take a deep breath. Get your phone ready with some kind of distraction – Instagram, Pinterest, whatever… just go to your mental happy place.

8. Have your partner (whoever is actually doing the injection) count down from three – this may hurt some more than it helps, but for me, it helped me to consciously relax the muscle. 3… {breathe in} 2… {breathe out} 1…

9. STICK! Tell your partner not to be scared – you really do have to go all-in with a swift and dart-like motion, just like the instructions say.

Trust me, I tried it slowly, and it is way. way. worse. Do your best to zone out! It takes a long time, so just breathe through it.

10. Immediately after removing the syringe, have your partner press the cotton swab hard on the site, and massage it around. You want to disperse the liquid throughout the muscle.

11. Grab your heating pad, and sit on it. If your injection is at night (we did ours at 8:00 every night), embrace the excuse to plant yourself on the couch on top of that heating pad until bedtime.

And there you have it! Your lower back / upper butt will still be a bruised and beaten up mess, but at least it’ll be tolerable. It really does get easier after a couple weeks – or maybe you just get used to it.

Either way, you got this.

Let me know if these progesterone in oil tips worked for you, and if you’ve picked up any tricks of your own!

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Step-by-step progesterone in oil injection tips! Click to read the full post with detailed instructions to minimizing pain and making the shots as easy as possible.


Wednesday 11th of May 2022

Thank you so much for sharing. I was on Day 4 and just about ready to cry (and I generally pride myself on being pretty tough!) For Day 5, we followed your plan and I feel so much better. Only felt the very end of the injection and my hot water bottle relieved a lot of the ache. I'm sure there'll still be bruising but it'd be nice to not be dreading this each day!


Wednesday 16th of February 2022

Oh man, I’m so jealous of everyone who has a partner to do injections for them. I’ve been doing ok doing everything on my own (and I found out I’m pregnant Monday so that helps!). I’ve mostly found it not too bad, but trying to give them on the left side when I’m right handed is so hard! And now I’ve been reading lots of women’s posts about doing PIO and I’m starting to second guess if I’m truly putting them in the exact right spot (like 3 weeks in…). Oof. It’s so hard to judge on the little diagrams vs when you are actually doing the injection. I almost miss doing subq, I didn’t know how easy I had it haha!


Saturday 4th of December 2021


I am on my second retrieval. So, when is PIO shots used during the IVF process? What is the average days to take them?

Praying for everyone and their journey!


Truly Tired

Tuesday 27th of July 2021

You made me cry. Not sure I can keep doing this but I'll try.


Friday 10th of September 2021

@Truly Tired, it's not as bad as perceived here. It's a small pinch but if you find it too much there is always suppositories and oral pills to take.


Wednesday 9th of June 2021

Did you by chance try heating the injection site before the injection verses icing? If so, did icing first work best?