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Progesterone in Oil Intramuscular Injections at Hopeful Beginnings

Every fertility journey has its delicate moments — the ones where science meets patience and hope meets precision. At Hopeful Beginnings, one of those moments often arrives with a small vial and a deep breath: the progesterone in oil intramuscular injection, sometimes called the “PIO shot.”

This part of treatment can feel intimidating at first. You’re tired, juggling medications, and suddenly handed a syringe that’s supposed to help your body hold on to something precious. But you’re not doing this alone. Our nurses personally administer your injections to make the process easier and more comfortable. They’ll walk you through each step and explain what to expect in the hours that follow.

These injections play a quiet yet powerful role. They help your uterine lining stay receptive and strong while your body prepares for or supports early pregnancy after an embryo transfer.

What Exactly Is Progesterone in Oil?

progesterone injection

Progesterone is one of those behind-the-scenes hormones that holds everything together in early pregnancy. It helps thicken the uterine lining and prevents it from shedding too soon — almost like keeping the soil rich enough for a seed to take root.

Under normal circumstances, the corpus luteum — a structure that forms in the ovary after ovulation — produces progesterone naturally. However, during IVF treatment, the medications that stimulate the ovaries can interrupt or reduce this natural rhythm. That’s why most patients need supplemental progesterone.

The intramuscular form, known as progesterone in oil (PIO), is simply progesterone suspended in a sterile oil — usually sesame, peanut, or cottonseed oil. Once injected, the oil releases the hormone slowly over about 24 hours, helping maintain a steady and consistent hormonal balance. (Healthline, 2023)

Compared with pills or vaginal gels, this injectable form provides more consistent absorption and stronger hormone levels, which can make a measurable difference in implantation success and early pregnancy outcomes. (GoodRx, 2024)

Why It Matters So Much

Keeping the Luteal Phase on Track

In early pregnancy, progesterone is your body's anchor. It strengthens the uterine lining, helps an embryo attach securely, and keeps uterine contractions quiet.

In IVF cycles, because the ovaries may not produce enough progesterone on their own, injections step in to fill the gap. Without them, the chance of implantation drops and the risk of early pregnancy loss goes up.

Think of the injections as your body's "steady hand" during a fragile window. They give you consistency when your hormones are fluctuating wildly from stimulation meds and retrieval.

Why Intramuscular Delivery Works Best
  • Even absorption: The oil releases progesterone slowly, maintaining stable levels through the day.
  • Reliable support: IM progesterone has long been the gold standard for IVF.
  • Predictable timing: One injection once every 24 hours, no more guessing or overlapping doses.

It is common for the initial injections to cause mild discomfort or feel unfamiliar. Many patients acknowledge experiencing some apprehension before beginning the process — until they recognize that each injection soon becomes a routine part of treatment, a small yet meaningful act of care contributing to their future family.

why progesterone matters

When and How to Take Progesterone in Oil

The Timing
  • In fresh embryo transfer cycles, injections usually start the day after egg retrieval.
  • In frozen embryo transfers (FET), they begin after estrogen has thickened the uterine lining.
  • You'll likely continue until about 10–12 weeks of pregnancy, when the placenta takes over progesterone production.
The Dose

Most patients take 50 mg (1 mL) once a day, though your doctor might adjust between 25–100 mg depending on your hormone levels and body weight. Your fertility doctor routinely checks your blood levels throughout the cycle and will fine-tune the dosage if necessary.

injection timing

At Home Injections

Our team ensures complete oversight of your injection administration, accompanied by detailed, transparent explanations to enhance your understanding—and your partner's, if desired—on how each injection is prepared, where it is administered, and how to minimize post-injection soreness. In addition, we offer personalized, step-by-step instructional sessions and direct access to our Expert Guidance team for any questions or concerns. We recognize that this process is not solely a medical procedure but an emotional experience as well—and we are here to support you through both.

Most patients report greater reassurance and comfort when injections are administered by a qualified medical professional in a home setting. At Hopeful Beginnings, you can choose either option. You can also visit our Injection Plans page for detailed guides.

A trained nurse will check in with you, ensure your comfort, and help you relax before the injection. During the visit, the nurse will:
  • Warm the vial slightly so the oil flows better.
  • Draw up your dose with a sterile needle.
  • Inject into the upper outer quadrant of the gluteal muscle.
  • Recommend a warm compress and light massage afterward.

The process is brief—typically completed within 5 to 10 minutes—and provides the reassurance that each injection has been administered with precision and care.


Making Injections More Comfortable

Progesterone in oil is thick — it moves slowly through the syringe and into the muscle. That's part of what makes it long-acting, but it can also make the shot feel heavy. A few small tricks make it easier:

  • Warm the vial between your hands for a couple of minutes.
  • Use a large needle to draw the medication, and a smaller one (22–23 gauge) to inject.
  • Alternate sides each day to let the muscle rest.
  • Massage the area gently afterward.
  • Apply a heating pad for 10 minutes post-injection.
  • A short walk or gentle stretch afterward can help too.

If the site stays sore for more than a day or a lump forms, let us know.

Sometimes changing the injection angle, site, or carrier oil (like switching from sesame to cottonseed) helps tremendously. Our nurses are always available to help adjust your comfort plan.

Side Effects and Safety

Most people do well on progesterone in oil injections, but mild soreness or bruising can happen. Fatigue, bloating, and breast tenderness are also common — and honestly, they're hard to tell apart from early pregnancy symptoms.

More serious side effects are rare, but it's important to watch for:

  • Redness that spreads or feels hot
  • Fever or chills
  • Shortness of breath
  • Signs of an allergic reaction (hives, itching, swelling)

If anything feels off, call us right away. You’re not “bothering” anyone — that’s what we’re here for. Safety always comes first.

safety monitoring

How Progress is Monitored

Throughout your IVF cycle, your IVF clinic will monitor your progesterone levels and uterine lining through bloodwork and ultrasound. If the numbers drift too low, your doctor might increase the dose or change how it's administered.

If you're sensitive to certain oils or needles, they'll personalize your plan — switching formulations, adjusting timing, or pairing with additional hormonal support if needed.

Why Patients Choose Hopeful Beginnings

You deserve fertility care that feels personal — not procedural. Every patient brings a different story, different emotions, and a different response to medication. Our job is to meet you exactly where you are.

Here's What Makes Our Approach Stand Out

  • Personalized injection schedules: Each appointment is scheduled according to your individualized lab results and treatment cycle to ensure optimal timing and precision.
  • Real-time communication: Questions never go unanswered — our Expert Guidance team is always available.
  • Focus on comfort: Heat therapy, injection rotation, and relaxation tips are part of every care plan.

You can read more about our philosophy on the About page or see all our Services.

What the Process Looks Like

  • Consultation – You will coordinate directly with Hopeful Beginnings to schedule a time that aligns with your treatment plan and daily routine.
  • Cycle Setup – The timing of estrogen and progesterone administration is established by your physician in accordance with your individualized treatment protocol.
  • Training – Our nurse demonstrates injection prep and positioning.
  • Injection Phase – A registered nurse will come to your residence and begin daily progesterone in oil shots. 
  • Monitoring – Labs are drawn at your fertility clinic to ensure your hormone levels stay optimal.
  • Transition – Around week 10–12, your placenta takes over hormone production, and the shots stop.

Visit our Contact page for appointments or insurance details.

Frequently Asked Questions
What do progesterone in oil injections do?

They help your uterine lining stay strong and receptive to the embryo during IVF.

Why can't I just take oral progesterone?

Oral forms break down in the liver and aren't absorbed as consistently as the intramuscular form.

When do I start them?

Typically the day after egg retrieval or as part of your frozen embryo transfer schedule.

How long do I need them?

Usually 10–12 weeks, until the placenta naturally produces progesterone.

Are the injections painful?

They can sting a little, but with proper technique and heat afterward, most people tolerate them well.

Can I give them myself?

Yes. We offer an self-administration education option

What if I miss a dose?

What are the side effects?

Mild tenderness and bloating are common. Severe pain or swelling should be evaluated immediately.

Can I switch to another form?

This will need to be discussed with your fertility endocrinologist 

How do I know it's working?