9 Tips for Easier PIO Shots in IVF

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pio shots_female injection into buttocks

If there was one single injection that anyone undergoing IVF dreads the most, it would be PIO shots, or Progesterone in Oil. Nobody looks forward to IVF injections as it is, but this phase of needles is undoubtedly the least favorite. Why? Well for starters, the needle is 1.5-inches long. Yikes!

If you’re in the preliminary IVF research phase, we recommend starting with Questions to Ask Your Fertility Doctor at Your Consultation. If you’re in the early days of hormone injections in your IVF cycle, be sure to check out What to Expect on IVF Egg Retrieval Day and IVF Egg Retrieval Recovery Essentials, as your retrieval will come before your embryo transfer, whether you are doing fresh or frozen!


I won’t lie – giving yourself or receiving injections is no fun, even if you have a high pain tolerance. In an effort to ease your nerves, make shots easier, and answer any question you may have, I put together this guide with some helpful tips you can implement right away.

What you’ll need:


What are PIO shots in IVF?

Progesterone in Oil (PIO) for fertility is exactly what it sounds like – it’s a medication comprised of progesterone and oil.

Progesterone is a hormone that the female body produces if a pregnancy occurs, and levels remain elevated to help support and maintain the pregnancy. PIO shots are used in IVF because progesterone supports implantation, but the IVF process inhibits your body’s ability to produce it naturally. Therefore, it must be supplemented.

PIO injections use olive oil, sesame oil, or peanut oil, to name a few. However, olive oil is common because it helps the muscle absorb the progesterone more easily.

You will need injection syringes, drawing needles, alcohol pads to disinfect the injection site, and a vial of progesterone in oil.

How long do you take PIO after IVF?

The length of time you will take PIO shots after your embryo transfer will depend on your fertility provider and your personal case. However, it is common for the patient to continue daily injections until at least 8 to 10 weeks after their egg retrieval and fresh or frozen embryo transfer (FET).

Where to do PIO shots

Progesterone shots are made in the upper quadrants of the buttocks. Some choose to do the injections on their own while standing up, and others receive help from their partner.

If you’re wondering where to inject PIO, we recommend alternating sides with each injection.

PIO Side Effects

PIO injections side effects are not guaranteed but are common. They are known to cause:

  • Muscle knotting/lumps
  • Bruising at the injection site
  • Soreness

However, not everyone experiences side effects, and some may be avoided or alleviated with the following tips for PIO shots.

How long do you take progesterone shots after IVF transfer?

Many IVF clinics recommend taking progesterone shots for 8 to 10 weeks after a transfer.

Tips for Easier PIO Injections

PIO shots can admittedly be painful, but there are some simples ways you can make this phase easier.

1. Get comfortable and relax

You’ll want to be as relaxed as possible when taking your PIO shots. If your partner or someone else is helping you, try laying on your stomach. This position will naturally help your mind and your muscles feel less tense.

2. Ice the injection site first

If you don’t take needles easily, you may want to consider numbing the injection site with ice for a few minutes beforehand. This will make the shot a little less painful and easier to receive both physically and mentally. If you choose to ice, be sure to follow tip number 7 after your injection.

3. Warm up the loaded syringe for 2-3 minutes before injecting.

Because this medication is based in oil, it runs a but thick – especially since it’s stored in the refrigerator. Warming up the syringe after loading it with your dosage can make the injection flow out a bit more fluidly. It also makes it easier for your muscle to absorb the medication

You can do this in your armpit, between your hands, with a heating pad, or in your bra (my preferred method)! Just be sure to cap the needle beforehand and be mindful not to overheat.

4. Take deep breaths

There’s a reason yoga and meditation have such a heavy focus on breathing. Both practices rely heavily on focused breathing, which is a mentally active process that will leave your body feeling relaxed, calm, and focused. This will not only help reduce any stress or anxiety you may be feeling, but also increase your brain’s oxygen supply which promotes a state of calmness.

If ever there was a time to quiet your mind…

5. Insert quickly and steadily, inject slowly

Let’s be honest, inserting a needle is not enjoyable… whether you do it slowly or quickly. But you can at least make it less unenjoyable if you are swift with it!

Carefully hold the syringe with the tip pointing directly at the injection site – like a dart. Insert the needle quickly. Don’t think about it too much if you are doing it yourself, and focus on something else if someone is doing it for you!

Once the needle is inserted, you’ll want to inject slowly. If you inject the medicine too quickly, you are more likely to feel it, and it’s not exactly comfortable. Going slowly will give your muscle time to absorb the oil and thus prevent against soreness and knots.

6. Massage the injection area after

Right after each injection, massage the area for 3–5 minutes to distribute the oil across your muscle.

You can massage with your hands, your partner’s hands, a muscle roller or handheld massage gun that vibrates. This will help keep lumps at bay.

7. Follow up with a heating pad

The warmth of a heating pad will not only soothe any soreness resulting from the injection, but also loosen up the oil so your muscle can absorb it more easily. This will help prevent against any knots.

Heating pads are also soothing in general. We all know that IVF can be a high-stress process, so take some time to relax on your heating pad after you inject each night. A heating pad after egg retrieval is also highly beneficial!

You may also like:
IVF Egg Retrieval Recovery Essentials

8. Alternate injection sites

Because you will be doing PIO shots every day for the next 8–10 weeks, you’ll really want to approach it with a strategy. It’s best to avoid injecting your medications on the same side on consecutive days – as you may have learned with with your egg retrieval injections.

To avoid excessive bruising, soreness, and knots, alternate sides to give your muscles and skin time to heal.

9. Be on the same page with your partner

This final tip is perhaps the most important. It is critical that your partner is committed to this process and listening and responding to your needs. Because PIO shots are given on your backside, it can be difficult to do it alone, so chances are you will be having someone do them for you. However, you call the shots here (see what I did there?).

Be sure your partner hears your preferences and is willing to learn along the way so you can be as comfortable as possible.

My own experience with PIO shots

I made the mistake of not starting my PIO injection phase with heat and massages. I got several knots that only seemed to get worse with each dose, not better. By the time I neared the end, I was so lumpy that I joked with my husband that I looked like I had a second butt.

I can not express how important it is to do what you can to avoid these knots because they are incredibly uncomfortable. You are doing these shots daily, so if you aren’t taking care to avoid them, you’re eventually going to run out of spots that aren’t tender from previous PIO shots. If you do get knots, don’t fret. They are completely normal.

As for duration, my fertility doctor allowed me to stop taking my injections once I was 8 weeks pregnant – a welcome relief!

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