Thursday, October 8, 2009

Progesterone Injections & Travel After IVF


Dear Sir,

Our first IVF (during June 2008) failed and so, we are going for the second IVF which is FET (frozen embryo transfer). I have the following questions:

a) Progesterone-in-oil shots: During the last IVF it was very difficult and stressful to have the intra-muscular shots every day. After a week, the muscle became very rigid and at some point could not even poke the needle into the muscle. Will it be okay if I do a hot water massage after every shot? I am concerned because some nurses are saying it may raise the body temperature and could cause problems.
Are there any alternatives for intra muscular injections (for progesterone)? One of the nurses is suggesting to apply directly into the vaginal area. Since we haven't done that before we are not sure how tedious is that and the possibilities it could go wrong.
b) Will it be okay to travel long distance (approx. 3 hours) in a car - three days after the transfer?
Thanks so much in advance for your valuable suggestions.


Dear Roger,
The progesterone injections are probably the worst of all the injections because it requires a bigger needle and the fluid is thick. I have changed from a prgesterone in sesame oil to a progesterone in canola oil that my pharmacy make us (MDR). Because it flows easier, we can use a smaller bore needle to reduce the pain and it doesn't harden up. You might want to check into that formulation. MDR Pharmacy is an infertility specialty pharmacy and you can get your meds via mail. It is also less expensive.

In terms of hot packs at the injection site, that would be fine. I don't expect that will change anything at all if it stays local.
Also, make sure you are rotating the sites i.e. one buttock then the other. You can also change the specific sites in the buttocks as long as you are in the upper outer quadrant. Make sure your nurse shows you all the areas that you can use.
As an alternative to IM progesterone, you can also use vaginal progesterone. There are several formulations: Crinon 8%, Prochieve 8%, Endometrin 100mg and pharmacy formulated versions. Several very good studies have shown equal efficacy to IM progesterone. However, most RE's are trained on IM Prog and so don't want to make any drastic changes. I happen to use both. Some programs, such as USC, have switched to vaginal completely. If your wife cannot tolerate the IM Prog or has an allergic reaction to it, then you can switch to the vaginal version. Crinone and Procheive are twice per day, and Endometrin is three times a day. They are messy but they don't hurt.

In terms of travel, yes it is okay to take a three hour trip after the transfer. As long as your wife is in a resting position, such as sitting, then you can travel. I only don't recommend strenuous activities such as exercise, karate, horse back riding, running and the like.

I hope this helps!

Edward J. Ramirez, MD
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program

Monterey, California, U.S.A.

Check me out on Facebook and Twitter with me at @montereybayivf


  1. Had the worst reaction skin reaction to the progesterone in sesame seed oil so I found this post interesting to say the least!

    Fortunately, the mail-order pharmacy that I was getting my injectables from was completely familiar with my reaction and acted quickly in sending me a different progesterone-oil version!

    Wow...what us IVF moms will go thru to get that medical miracle. My turned 5 in August!

    BTW...great blog. Wish I had known about blogging 5+ years ago when I was struggling with infertility and undergoing IVF.

    (Mom2Two: 1 IVF and 1 BONUS Baby!!!)

  2. Thank you Valerie, for the comment! It is always helpful for patients to hear about the personal experiences of others. I switched to the thinner oil mainly because of the lower possibility of an allergic reaction and because it allows the patient to use a smaller bore needle as well. Glad to see that you have been an IVF success story & with a bonus as well! Take care.

  3. Hello Dr. Edward

    I stay is United States. Had a failed IVF cycle - fresh in early Oct. My doctor wants to try FET in last week of Nov (24 Nov). We have plans to travel to India the next day - 25 Nov.
    Do you recommend going for FET on 24 Nov?


  4. We have made the mistake of injecting PIO on the lower quandrant of the butt.will the PIO still be effective? It's been very painful

  5. Hello Chep,

    It should not affect absorption of the Depo, but stay away from the lower gluteus. There are nerves, veins and arteries near there. Also, why are you doing your own injections of this medication? That is not correct!



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