Christmas. This can bring challenges when it comes to fertility treatment as many clinics go into a slowdown of sorts over the holidays (if you’re undergoing treatment now – it’s October as I write this, it’s worth asking about clinic closures and how they might impact your cycle).
My period came on Dec 20, right before their closure, but due to the holiday slow down, I had to go on birth control until Dec 27. This basically delays your cycle, forces another light bleed, and you can begin cycle day 1 again.
We were waiting to begin a new Frozen Embryo Transfer (FET) with one of our Euploid embryos.
FET prep varies depending on the clinic, but most of the protocols I have seen involve Estradiol (Estrace, Lupin Estradiol, etc.) for a number of days, basically shutting down your ovaries for that month. You take that for a couple of weeks or more, and they bring you in for a baseline ultrasound (we meet again, Wanda).
You become intimately familiar with this machine and it’s phallic ultrasound wand. For a FET you may go in for internal ultrasounds upwards of 4-5 times in a two week span. Early AM appointments usually beginning around 7am. You get really used to people being up in your business. It’s much like a pap smear, minus the speculum (I hate the speculum). It can be a bit uncomfortable if they have trouble locating your uterus or getting the right picture.
For the FET they are checking for uterine lining thickness, which is juiced up by all the meds you’re on. You eventually add progesterone suppositories into the mix, and for me I was lucky to have to take them 3x a day up the hooha for almost 4 weeks.
Along with many other people I know, I suffer with thin endometrial lining, so it takes a while to build it to the thickness they require for the transfer. Our clinic looked for 7mm and it wasn’t without difficulty getting there. If it takes too long, you’re at risk for a cancelled cycle, and you have to begin again on your next period start. It’s not an exact science, but it’s close.
In addition to the suppositories and the oral medication, a FET differs from a fresh transfer in one other way…
Progesterone in Oil – the bane of my existence. (PIO)
This was my first experience with PIO. Before this, I had to brave my fear of needles with subcutaneous injections – these are done around the bellybutton area and the needles are 1/2″ in length, and quite thin (27 gauge if you are curious). Scary for someone beginning to inject on their own, but all in all tolerable. Not completely void of pain, but I’d classify it as a mild and brief discomfort.
PIO was a whole other ballgame. PIO is thick, as it’s actually oil, so it requires a thicker needle. The kicker with PIO is that it is injected intramuscularly. This means the needle is also longer. 3x longer to be exact. 1.5″ of thick, scary pokiness. You inject PIO into the upper butt, almost on your lower back, directly into the muscle. Because of the location, I had to let go of my control-freak tendencies and let my husband help me. I’ll include my PIO workflow at the bottom in case anyone is curious and scared for their first poke.
My protocol involved taking 2 Prometrium suppositories 3x a day, 2-5 Estradiol orally a day (depended on time in cycle), and PIO every 3 days at a certain point in my cycle after thickness reached it’s minimum.
It took a while for me to get to the 7.5mm required, I was 5mm on CD20, and finally bulked up to 11.3 by CD27. I was ready to roll. They started me on PIO and my FET was scheduled, this time in my home city, 6 days later on Feb 19, 2023.
PIO for Beginners
For anyone staring PIO in the face, I HIGHLY recommend using an auto injector device. This was recommended on a couple of threads I read, and I am SO glad I ordered it. The shipping was fast and I got it in time to start my injections. It also helps if there’s a chance you might not have someone there to inject for you. Takes the guesswork out of needle depth, angle, etc. The injector I used can be found here: https://unionmedico.com/90-super-grip/. It’s not cheap and I felt sketchy ordering something from Europe, but it works like a charm. See photo at the bottom.
Drawing it up/pre-injection:
- Lay out all your stuff (needle, syringe, alcohol swab, tissue, injector if you have one, sharps container)
- Turn on a heating pad, or warm up your hot pack
- Wash your hands
- Swab the top of your PIO vial
- Swab anything else (end of syringe, needle attachment, etc.)
- Attach the needle to the syringe, ensure it’s secure.
- Pull back the syringe to your dose line (mine was 1ML) with air
- Pierce the top of the vial, inject the air into the vial
- Tip upside down, and draw back your dose of PIO. (I always take more than I need, give it a few flicks to remove air bubbles, and plunge the access/air into the vial)
- Remove the needle from the vial
- Re-wipe the top of the vial with the alcohol wipe
- Heat the area you’ll be injecting into for 10 minutes approximately (see image below for ideal placement – check with your clinic if you’re told otherwise or not sure. Some clinics recommend using the upper thigh, but I have heard this hurts more).
- I also put the syringe somewhere warm to warm the oil, like an area below the heating pad, in my bra, etc. It shouldn’t be too hot, but warm enough to reduce viscosity.
- After 10 minutes, I swab the area to inject with the alcohol pad
- I get any remaining air out of the syringe, and load it into the injector
- We steady ourselves to ensure no movement occurs, and inject the needle at a 90 degree angle to the skin.
- PIO takes a little while to plunge due to it’s thickness, go slow and it will hurt less. Avoiding movement or shaking also hurts less.
- When the plunger has been fully plunged, pull the needle out and wipe the area with a tissue or swab.
- IMPORTANT: Massage the area for approximately 2 minutes vigorously, down into the muscle. This helps distribute the PIO and will prevent pain in the days to come.
- Heat for another few minutes, then stretch those muscles for 2-5 mins to further distribute the meds.
- Discard your needle in the sharps container.
- Voila, you’ve been jabbed successfully.
