Saturday, September 12, 2015

How to Make PIO Shots Your Friend

**Even though we're still in the gray area of denial & acceptance of our 1st failed IVF cycle, I wanted to post this in the hopes of MAYBE helping ease some fears of anyone worried about progesterone injections. I've actually been working on this post for the past week and was planning to post it even if our cycle worked. Regardless of the outcome, we've done 2 weeks of PIO pretty smoothly and I wanted to share it. ((*Side note: We weren't originally going to share the results of our test BUT we were shocked when it came back negative this week and it hurt more than I imagined it would. We couldn't keep it in and so here we are. We can't start up right away, Dr. suggestion, so will be keeping busy in the meantime.))

How to Make PIO Shots Your Friend 
... or at least not the most dreaded thing on Earth.

It's no surprise that I hate needles. I am practically terrified of them! Infertility hitting the #TeamRicci house 4 years ago pretty much meant life was laughing in my face and throwing me right into the fire of facing my fears. Lots and lots and LOTS of needles... Acupuncture needles. Multiple blood draw needles. Hormone injection needles. I've become somewhat used to these 3 kinds and they are honestly pretty small in relation to the big league of needles. Even though I slowly got semi used to them, I still always feared THE BIG ONES- the PIO needles. A one and a half inch needle that needs to go into the butt/hip muscle. Ouchy. One big reason I was scared of moving to IVF was because I dreaded the PIO shot. Now being on the flip side, I'm telling you it's not nearly as bad as I feared. Here are my reasons for choosing it and some tips that have worked wonders for not making it so bad! I hope they help! 

Why PIO? 
PIO is short for "progesterone in oil". Progesterone is a necessary hormone for getting pregnant and staying pregnant. It's needed in IVF cycles because you're essentially tricking your body into what's happening and re-wiring the system by supplementing it until it produces enough of it on its own. 

There are a few forms of progesterone to choose from (apparently there is a pill (?? still confused on this and the success of it but it's been mentioned in a few places. I wonder if it's just a mythical creature at this point!) but that option was not given to me... I obviously would have chosen that one in a heartbeat if so!!)... Progesterone injections -OR- vaginal suppository cream. Yup, you read that right. Eww. Quite honestly, NEITHER of these sound fun. It was a big toss up to me in the beginning and became a game of which is the lesser of the 2 evils. Avoiding needles was the easy choice for me, but I did a lot of research and thinking, and the thought of being uncomfortable literally ALL day from the suppositories was NOT a welcoming thought whatsoever. I would have needed to use them 2-3x a day and I know I would have been EXTREMELY self conscious, uncomfortable, and downright miserable... All. Day. Long. I was not looking forward to the injections and the big needle either, but I knew it would only be literally a few minutes of misery compared to all day. So a tough decision became an easy one: injections it was. 

These injections are IM, intramuscular, hence why the needle is so long. The baby needles I used for the stimulation drugs are only a half inch and go into the fat of your stomach, so they can be shorter. Going into the muscle requires a longer needle. They also need to be in the upper outer quadrant of your butt/hip muscle. This image is perfect because it shows a grid and gives a general target zone for each side. It's 1 injection and night and is recommended to alternate sides each night so that you give your muscles a break. The picture below is a general guideline. Use the top of the butt crack (for lack of a better term, sorry) as a horizontal line point. Then split each butt cheek vertically in half. Inject in that upper outer section. This helps avoid your sciatic nerve, which would not be fun to hit. I've seen images where the shaded area is down and more in the butt than hip, and I've read that either are fine. I've heard it hurts more in the lower outer area because it's fattier and that's also where you actually sit/bend from. We used this image and I was pretty comfortable most days (once I realized to NOT tense up so much. The first 2-3 days were rough bc I was tense so my muscles obviously hurt at injection site but also my back was tight and on fire from tensing that up as well).  It's helpful to have your nurse draw target zones at first if you want. 

In hindsight, I'm so glad I chose the injections. Little did we know at the time, but it is a really wonderful way to involve Scott. He offered to do them before and I knew he kind of wanted to, but he would joke about looking forward to sticking me with a needle. (Brat :) ). When it came time for the first one (our trigger shot), he froze and almost couldn't do it. But he did, partly because we had no choice, and he was great at it!! Now, he really enjoys doing them for me. 

How do we make it bearable? 
This is our nightly routine:

1. Apply a small amount of numbing cream (We use lidocaine cream; got it on Amazon but some Drs may prescribe it. Ours said we could just buy it. It was about $20 on Amazon and it's a 1oz bottle which doesn't seem like much, but we've barely dented it with 1-2 weeks worth.) Cover the area with a piece of plastic wrap and let it take effect for about 25 mins. (Maybe less but this number works for me!)

2. Ice Ice Baby. I've read some people say no to ice, but a bunch of my friends also recommended it, so I've used it since day 1 and it's helped. My Dr office never gave any tips either way, they said whatever works (they felt some was psychological but it all helps me, the worrier). Anyway, ice works for ME, I wrap an ice pack on a paper town and hold it right over the plastic wrap for about 5-10 mins (maybe start with 10 your first time). 

**During this time play some music to motivate you. Maybe it's something upbeat to put you in a good mood; maybe it's something sentimental; whatever works. It helps distract me anyway. 

3. Take off plastic wrap & clean skin with alcohol swabs. Scott uses 2 each night- one to wipe away the cream and another just to make sure it's all gone. 

4. Decide if you're standing or laying down; do whatever works for you. We prep everything on the kitchen counter and when it's time, I stand and lean over the counter on my elbows. I use a small couch pillow and actually lean on that for support & comfort (and to bury your face in if scared). I also put all my weight on the opposite leg and relax the leg of the side that's being targeted. It helps relax the muscle so you're not tense. 

4. Go time. Do not look, just let hubby do his job. (*If doing them yourself, Way to go!! I give you tons of credit.) I find that not looking at the needle helps me forget how big it actually is. (1.5inch, 22 gauge). Scott usually draws it up and preps it for me while I'm numbing or icing... We were instructed to do 1cc or 1mL each night but I suppose that could be different for different protocols. (We were given 18g needles to draw it up and 22g to inject. Look at the thickness of the 18g and suddenly the 22g doesn't seem so bad!! Look once if you've already seen them and are scared. If you haven't seen them, don't look.)

This bottle gets us about 10 injections. (10mL)

*I swear that on most days all I feel is a little pinch. Sometimes I can feel the oil going in, but it just feels like a little pressure, not pain. Breathing through it also helps. 

(Photo credits here to our close friend, Manny, who was visiting at time of transfer & got to document our shot process. Not sure I want to post the video yet though bc I am always self conscious and hate myself on video- haha!) :)

5. When done, Scott applies gauze and massages the injection area for a minute or so. This helps the oil settle and spread/absorb. Apply a bandaid when done massaging the area (just for fun- it's not actually needed!). The bandaid also serves as a target for next time so you remember the spot. 

6. Apply a heating pad. This is like a nice treat at the end. :) We heat ours in the microwave for 1-1.5 mins and then I relax on the couch with it. 

That's it!! You certainly don't have to follow all (or any!) of our steps, but just sharing what works for us. Just for reference, one night last week I experienced just how well the numbing cream and ice work for me... I had an awful migraine the other night and since I couldn't take anything but Tylenol (at least until the pregnancy test, and beyond if we are pregnant), the migraine wasn't going anywhere but was actually getting worse. It hurt so bad I literally threw up bc it was so severe. In the time I got sick, my numbing cream wore off and we didn't have time to ice it because we wanted to get the shot done before I possibly got sick again. Cream wearing off and no ice made the needle hurt and I realized just how well our little system works. 

*SOME YouTube videos work well too. Key word= Some... Some made me inspired and it looked like a piece of cake. Others made me more nervous than I already was. These are my 2 favs...

Progesterone Party- Self Injection (I love this one because she makes it FUN... and she gives it to herself (eeeek!! Props to you, girl!!). She makes it look so easy & this is where I got the idea for the numbing cream)

Tips from a nurse (I liked this one because it's professional advice and she makes it not seem so scary!!)

I would say our experience was pretty on par with these videos. I hope the links work- if not, I'll try to fix it later on. 

Good luck! Hang in there!! If I can survive it, so can you!! 



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