My Love/Hate Relationship with Progesterone in Oil During IVF and Early Pregnancy

By Lindsey Williams

I will be the first to admit: that from the beginning, one of the most terrifying and daunting aspects of pursuing IVF to grow my family was the idea of PIO, or progesterone in oil, injections. Multiple shots a day in the stomach during the egg retrieval stimulation phase? No problem! Well, that’s not entirely true. Those were, of course, still frightening at first. But after the first stomach injections, I realized that it was not as bad for me personally as what I had built up in my mind. Not to mention, the needles for the necessary stimulation drugs leading up to egg retrieval (in my case a daily cocktail of Menopur, Gonal-F, and Cetrotide) were tiny in comparison to the giant needles I had seen people use for PIO.

In a frozen embryo transfer cycle, PIO injections are used as a replacement for your body’s natural progesterone hormone which would normally be produced by the ovaries in early pregnancy. Progesterone helps to prepare the uterine lining, which encourages the embryo to implant, or “stick.” The injections continue to supplement a patient’s natural progesterone after a successful embryo transfer until 8-12 weeks, at which point the placenta has taken over.

To prepare for my first progesterone in oil injection, I watched countless PIO Instagram videos from sweet people all over the world who shared their IVF journeys. In doing so, I saw a variety of methods: injecting while standing up, lying down, solo, with a partner, heating afterward, squats afterward, or my personal favorite, the “slap method” (coined by Monica from @monicas_so_called_life). Once the day came to begin PIO on our own journey, my husband and I felt as prepared as we were going to get.

But right now, at 48 progesterone injections and counting, I am over it. I have hard knots in places I never wanted or imagined I would have knots. It is my least favorite part of every evening. So, why is it that I feel a slight-but-steadily-increasing panic as I near the end of these injections I’ve been fed up with practically since they started? 

I found myself counting down the days until they would be over–24 as of today–but as the date of the last one nears, I inexplicably find myself afraid to stop. These dreaded shots, as despised as they have been, have helped me stay pregnant. They have been keeping this amazing daughter inside of me alive.

Speaking with my therapist about this, she said something that struck me: I am going to be worried about her for the rest of my life. This is just the beginning. But I have to trust that I am capable of keeping her safe, even at this earliest stage when it will become entirely up to my body.

So how do I trust my body with this monumental job, when it’s taken so many drugs and medical interventions to get to this point in the first place? 

I have to remind myself of the fact that this is a normal part of this process, a process in which so many things feel so abnormal compared to what I imagined having a baby would look like. But it is generally normal to stop IVF drugs, including progesterone in oil and estrogen, in the weeks following a successful embryo transfer. My personal stopping point is 12 weeks, the end of my first trimester, but some patients’ protocols see them stopping at 8 or 10 weeks.

Once I reach this point, it is safe to stop the progesterone injections because science has shown that my body is capable of taking over entirely on its own from here. At 12 weeks, my body is producing all of the necessary hormones on its own, and my baby is getting all that she needs from my placenta. 

This is what I try to continuously call to my mind every evening as I count down my remaining injections–every time I sanitize our shot station, prep my syringe, clean the injection site and hand my husband the needle. With each of these nightly rituals, I am one step closer to not medically necessitating these injections, even though they feel like a safety net I’m afraid to leave behind. They’ve brought me this far, but I know that I can take it from here.


Lindsey Williams is a library worker and writer who lives in Arizona with her husband and their dog, Peaches. After 5 years of trying to conceive with dual-factor infertility, she is currently expecting her first child conceived with the help of IVF.