nav

Wednesday, August 13, 2014

how do you prefer your progesterone?

so i almost wish that my RE would have given me a solid recommendation on progesterone supplementation. instead, he said that the suppositories and injections are both equally as effective and i could choose whichever one i prefer. 

if i chose suppositories, i'd be taking oral (prometrium) with whichever suppository i selected. so here are the options.
crinone (suppositories)
endometrin (suppositories) 
PIO - progesterone in oil (injections)

i did a lot of research before deciding. it is basically a missed bag. here are some of the things i read.

progesterone in oil 
- gold standard in IVF. most RE's recommend using it
- levels can be measured in your blood while the suppositories can't
- some people have allergies to the oils and could have a bad reaction
- a lot of pain at injection sites from big fatty needle

endometrin
- seems to be the more commonly used suppository 
- complaints of bleeding from irritated cervix 

crinone
- less messy than prometrium because it absorbs better instead of leaking out
- a little bit more expensive than promethium 

after reading all of this, i decided to go with nightly crinone suppositories with a side of oral endometrin. i have to admit that i was scared of the PIO needle. i figured, why give myself injections if i don't have to? plus, my friend gave me her leftover crinone from her IVF cycle so i had the cost covered.

on the first night of suppositories, i was looking through the ginormous booklet in the box for the instructions on how to insert the crinone and came across this warning.
"Risk to the fetus. Birth defects have been reported in the offspring of women who were using Crinone during early pregnancy. These included an abdominal wall defect and a cleft palate. A causal association has been neither confirmed nor refuted. You should check with your doctor about the risks to your unborn child of any medication used during pregnancy." (under the title of "Risks of Crinone")
what the heck? um, no thank you. my nurse swears that it is safe but that little warning didn't make us feel very comfortable. there was a similar warning on the endometrin box. but no warning like this in the PIO booklet. so after two nights, i switched to PIO shots. why risk it? i'd rather endure the pain in my ass (literally) from 2cc PIO injections every night than risk birth defects.

but i know a lot of y'all used suppositories. i'd love to hear your experiences and hopefully this post will help others who are seeking information about progesterone supplementation. 

my nightly routine


60 comments:

Just T said...

Great decision! I personally hate the PIO. It gets old really quick and is not comfortable. I personally liked the endometrium suppositories. Both those and Crinone will give you some weird discharge, but no pain!!

Just T said...

Oops I completely misread your post. The PIO definitely get the job done. I just wasn't a big fan of the soreness for so many weeks. Not sure when you get to stop, by my RI in Chicago wanted me on them until about 15 weeks. Finally I stopped and switched over. Of course my progesterone was always over 80 without supplements.

Melissa Long said...

I used prometrium suppositories from during my TWW through about my 13th week of pregnancy. I took them 3 times a day. I had a little bit of (scary) spotting a few days after I stopped taking it, but aside from that my baby boy was fine, no birth defects! I honestly don't think he'd be here without the supplements. My blood level was 9 two days after my BFP so I feel like if I hadn't already been on them, I might have lost him. I hope that shots aren't too hard on you!

Krystal Sullivan said...

I've done both Crinone and PIO (Crinone with my twins and PIO with this little one now). Crinone is messy and quite frankly, disgusting. It is supposed to be absorbed but it absorbs so slowly that you really end up discharging a lot of it yourself. My OB also mentioned risk of infection from it, since every day you are putting something up into your hoo-ha. PIO sucks. Today I am sitting on my bruised, swollen butt. PIO, though, IMO, is better than the Crinone. Not as messy, can track P4 in your bloodstream, and once its over its OVER - no dealing with the un-absorbed Crinone. I think you made a great choice!

Amie said...

I use the crinone but of course don't have a pregnancy to confirm or refute that there are these side effects. I guess as always I would say go with your instinct, so far that has never led me wrong.

Elena Ridley said...

I've used both Crinone and PIO. Although the Cronine is easier, the PIO like you said, is the gold standard. Really it's not that bad either, of course it hurts, but not nearly as bad as I thought. I just jumped right onto a heating pad for about 20 mins after the shot, I had no lumps or anything. A little soreness was all !

"B" said...

I used suppositories the first cycle and pregnancy until week 12. it was messy and I always felt out of wack since I always wanted to shower LOL. With my second we did the PIO and though my poor hiney was bruised (I had to continue them until week 37 of my pregnancy) I felt WAY better throughout the duration of my pregnancy. No mess and no feeling like I needed to shower. To eaches I own I guess. I definately preferred the PIO though. Hopefully you will NOT have to ensure them as long.

JoJo said...

I used the oral suppositories to induce my cycle and it works! Went for my baseline ultrasound and my lining was still at a 10mm. Any how, this up coming FET I will be on the suppositories instead of PIO. Don't know how I'm taking them yet. As for the PIO...My butt has sensitive spots do to the injections. Don't know if they'll ever go away.

Non Sequitur Chica said...

I didn't want to do any more shots so I went with crinone. No issues with it- but I was certainly glad to be done with it!

Anonymous said...

I did the PIO - my RE didn't even offer the suppositories with my FET. I found that icing my behind (I used a bag of frozen peas) and warming up the progesterone vial in a little cup of warm water made all the difference. The heat thins out the oil slightly (but doesn't affect it) so it injects a bit more smoothly. The ice obviously works to numb the area but it can also affect how fast the oil absorbs, so after the injection I took about a 20 minute walk and then came home and sat on a heating pad. I highly recommend taking a walk after doing the injection! Some nights it was raining and I couldn't get out and I was much sorer the next day. I also found that I bruised worse when I went a little too far in the center of my cheek than if I stayed out near my hip.

Caroline said...

Definitely essential oil for progesterone! I love that it's chemical free and balances the hormones the all-natural way :) Use a few drops every day

Suz said...

I'm going to be doing the PIO too!!! And I also got cute band-aids. I think it makes the shots hurt less if I get a "reward."

Aubrey said...

Like you I've tried both, and really prefer the oil injections. I heat up a rice pad or use a heat pad on the injection site after and I have no problem with soreness. Good luck!

Kandie Walker said...

My RE doesn't give the option, PIO shots only! They are not fun. The first two nights I thought it wasn't as bad as everyone says but after a while you get so sore and lumpy. We iced the spot for a few seconds before, then husband rubbed the spot and I sat on a heating pad. It helps the medicine to spread. When we were out and couldn't do all that the medicine seemed to form a knot. I applaud you for making your choice! Suppositories would be so much easier but I would be the same way having read what you read. I'm so excited for you and love reading your posts!

Brittnie said...

I had to do the PIO shots and they were awful. I mean awful. I have a high pain tolerance and these were NO JOKE. Lots of tears shed. . . so good choice!!

Brittnie said...

Ok just saw that you switched to the shots. GOOD LUCK!! Which oil did they give you?

Anonymous said...

I use crinone, my doctor says just as effective as the shots, not messy like people think it is. Our insurance also covered all of the crinone as well so cost wasnt a factor.

Amanda said...

My assumption is that Crinone hasn't been around long enough so the FDA required the memo to save their butts if it comes back later... that being said, it's definitely a scary warning!

I REALLY worried over this decision. The fact that progesterone levels can't be verified with Crinone really bothered me... I've had low progesterone in the past and I HATED hearing that I should just trust that the levels were high enough... I wanted to see the numbers! I always heard about PIO... I just assumed I'd do the shots when my time came like everyone else. Then I heard that my clinic had switched to crinone (nothing else) for IVF but was doing PIO for FETs. So I did Crinone for the IVF and planned to need PIO for the FET. But then they changed again and said crinone was their med of choice now for all cycles. It was literally a change from January to March... I think more and more clinics are beginning to favor crinone.

I found this blog VERY interesting about the debate: http://theunexpectedtrip.wordpress.com/2014/03/28/progesterone-in-oil-and-crin-one-further-education/

Ashley Sanderson said...

I did the PIO injections until I was 12 weeks. Only a handful of the shots hurt. My suggestion, ice your bum before the shot, and sit on a heating pad after. Made a world of difference for me!!! :)

Cristy said...

This is such a topic of dispute. The published research says that Crinone is equally effective at PIO. But, the only pregnancy that didn't result in miscarriage for me was the one I was on PIO. And I know that I had to be bumped up on dosage because the recommended dose wasn't enough (we could measure that, where as with the Crinone we couldn't).

I think you need to go with what feels best. After my two miscarriages and a failed FET, the PIO was the best option for me. Plus I didn't spot at all where as with Crinone I had constant spotting and vaginal irritation.

Finally, you can order concentrated PIO (100 mg/ml) so you can reduce your injections down to 1 cc daily. Saved my butt. Let me know if you want information on the pharmacy I ordered this from in case your's doesn't have this option.

shay said...

with my fresh transfer i was allowed to do the crinone - but for the FETs i had to do the PIO. which yes was a PITA but you get used to it. try sitting on a heating pad 10 min before and after. i found i didnt need to after a while, though i do still have scars from the needles and its been over 3 months since i did them. i was allergic to the sesame oil but they were able to switch me to ethyl oleate which was actually a thinner medium. so if you are allergic (my allergy didn't show up til week 3 or 4) there are still options. Also, not to be gross, but when i did the crinone, it was GROSS. like i won't go into detail but i felt like i had a permanent yeast infection. Barf. So for a little prick of pain every night, i'd take that over the suppositories...

Katie said...

I had to do both the injections and the suppositories. The injections were definitely more painful and the big needle scared me but after everything you've gone through you are far tougher for any side effect :) and it made it much easier to handle knowing I was pregnant!

~ Megz ~ said...

PIO worked much better for me to keep levels in good range-

Ashley said...

For my ivf we used prometrium suppositories, but for my pregnancy I didn't end up needing them at all. I've heard the shots are horrible!! Good luck!! Are your levels low?

Chelley N said...

I HATE progesterone suppositories. So messy and gross. I'd much rather shoot myself up, but maybe I'm weird? Ha!

Amanda Raye said...

I used crinone but used it in the morning because it I absorbs better if you're up and moving after inserting it. My son is perfectly healthy. I tried not to get upset about those warnings because they were on all the fertility medications.

Stacey said...

I prefer the injections because the "leaky" factor suppositories always makes me think I may be bleeding. Maybe it's miscarriage PTSD. :-(

Beth and Harrison said...

I did PIO and no, they aren't fun but it was bearable and so worth it of course. There are tips and tricks you can do to make it easier like heat and massage. Warm up your muscle and the injection to make it go in easier, use a heating pad after (the heating pad will become your best friend) to help it dissolve into the muscle and massage, massage,massage! Helps it disperse and limits knots. I never found them all that painful during the injection but it's the pain the next day or in the days that follow that heat and massage will help with. Don't know how much your PIO is costing you but I have an unopened vial you are welcome to!

Laura said...

I took Crinone for the first trimester. The studies I could find showed similar defects with either suppositories or PIO

Lex Morton said...

So this post freaked me out a little and I ran to my meds to see what I'll be taking. On Monday I'll start progesterone suppositories. I don't have any warning label... Hopefully that's a good thing?

Holly said...

As much as I feared the needles, I knew 100% that it was getting in me. The suppositories freaked me out cause I know a little can leak out. My clinic didn't give me a choice but when she told me I was going to do the PIOs I cheered (she said it was a weird reaction). Ice your butt for 2-3 minutes before and then after the shot have your husband give you a little bun massage :)

Anonymous said...

I used PIO when I was pregnant with my twins six years ago. My doctor gave me no other options. Could you switch to morning shots?! I didn't have near the "knotting up" in my butt by keeping active after doing the injection.

Infertile625 said...

I used crinone with this pregnancy and all is well. I started 3DPO and stopped around 10weeks. I can't say I would have still used it had I seen that warning. But since I didn't, I used it and have not experienced those risks. But you do what you are comfortable with. P. S. Love the hello kitty bandaid

Aramis said...

As a needle phobe, I'm glad my RE always went with some version of suppositories. I've tried them all, I think, and they are all messy in their own way. I'm on Prometrium (vaginally) right now and it's not too bad.

B&B said...

My RE didn't even recommend injections. I tried both suppositories, but I got a terrible yeast infection from the crinone so switched to the other. I didn't have any other issues. I say whatever you're most comfortable with is the best option :)

Sunflower said...

I used Crinone, since being single I had nobody to give me the shots and I did not think I could do it myself. I recall reading that warning, completely freaked out and then did some research on it. From what I recall in the studies published it was a really small percentage of risk and I felt comfortable with proceeding with it.

Chalk Girl said...

MY doctor prescribed PIO. And the shots were a pain, but I was fine. I only needed them for a few weeks, as I recall, after getting pregnant. And I was so darn happy to BE pregnant that I almost didn't mind them. So my advice is to go with the PIO; you don't want to F around at this point, and you'll be done with them soon!

waiting and wishing said...

I've used three kinds of progesterone- the first was oral (prometri.um I think) and it made me SO exhausted- I'm sure I blogged about it, it was hilarious. That was before seeing my RE, once we started seeing her, I used a locally compounded progesterone from my pharmacy for my iui cycles and moved on to endomet.rin for my IVF cycles. I liked the endometr.in the best of the two suppositories- it was a bit less messy and came with an applicator which I was a big fan of. My clinic doesn't seem to use a lot of PIO unless you need multiple types of progesterone support.

dubliner in Deutschland said...

injections every night? ouch!

How long will you have to keep taking the progesterone for?
Is it just the first trimester?

Congratulations on the pregnancy
by the way! Excited for you!

Anonymous said...

I was terrified of PIO, but out hasn't been as bad as I feared now that DH has perfected his technique.

Elisha Kearns said...

After I did IVF I was given the suppositories to use...I wasn't even aware of the PIO shots. However since being in the blogging community and hearing about them...I will admit they terrify me!

Emily said...

Hands down PEO (progesterone in ethyl oleate). Exact same thing as PIO, except the medium is same consistency as water. It injects so easy and I had no adverse side effects, lumps, bruising, nothing. Hold a vial of PEO next to a PIO vial and you'll see what I'm talking about. BIG difference! Uses smaller needle than PIO too.

I liked that I knew it was all going straight into the body and none was "falling out" like it did with suppositories. Plus, I was so tired of sticking crap in my lady parts and wearing pantyliners. Only compounding pharmacies carry PEO, and my insurance didn't cover because it was a compounded med, but it was well worth my short trip locally to pick it up and to pay OOP $100 for it.

Emily said...

Oh and P.S. PEO comes in two different concentrations, just like PIO...50mg/mL & 100mg/mL. If they have you doing 2 CC of the 50 mg, then you could switch to 100mg/mL and reduce your dosage to only 1 CC...half the fluid to inject. Just something to ask about, perhaps to make it easier on you.

Suzanne said...

I prefer the PIO. I never thought they were that bad pain-wise and WAY less messy. :)

rainbeforerainbow said...

I used crinone without issue. It makes me crazy that there haven't been more studies done on this, considering the number of women who use progesterone supplements in early pregnancy.
As it says, this was not a study that determined Crinone causes birth defects. There were simply a couple of women who had babies with birth defects and they had also used Crinone. No evidence of causation. I felt comfortable using it.

Darcie K said...

My personal preference is PIO and here's why: because all of my positive pregnancy tests were when using PIO. Obviously, not all (3) of those ended in THB, but I kind of held on to that as being part of the right concoction for a successful THB for us. And, I used PIO with Wyatt :) Obviously, this is a very personal, not scientific reason.

The main reason I prefer PIO over supps is because it was just easier and, ummm cleaner, IMO. This is one of those where both options kind of suck, but you have to choose the best to two evils lol. I hated supps, ESPEICALLY when I had to add in oral on top of them. I did all my PIO shots myself and preferred it that way. Oh ya, and for $ reasons, PIO was WAAAAAAY cheaper than the prometrium supps! Like WAY cheaper!

It's a totally personal decision. My RE was like yours. He left the option up to me.

Moondancerjen said...

You are missing a heating pack in that picture! It really helps with the pain of the injection and helps the oil go in smoother. Make sure you massage the spot after your injection well too.

I've experienced both forms of progesterone and I preferred the PIO. It was the one I used on our successful cycle! I found it much easier to just do it once a day instead of 3 times a day with Endometrin. I mean, how do you sneak off the bathroom in an office to do that exactly? Plus so much came out, I felt uneasy about the actual amount I was getting. Not to mention that my hormones were CRAZY on the suppositories. Besides the lumpy butt from PIO injection welts, it was definitely a better more convenient option for me. Plus, IT WORKED!

Definitely would use it again next time.

acoursetothefinishline said...

I used suppositories, though offhand I can't remember which ones. They were a little messy but I had no other complaints, and our twins were both born healthy!

Hapa Hopes said...

I had always used PIO and did fine with them, but during the cycle that actually worked I had some weird reaction to it for some reason. We switched to Crinone and I liked it... for the most part. It does tend to... ahem... goop up in there and you've gotta scoop it out every once in awhile. After everything we've been through at this point, though, what's a little goo scooping? ;) Our little one turned out just fine.

dogmomchasingthestork said...

I totally agree! When I was reading the warning I was like "oh she needs to switch to PIO!!!!!" Scary! And that is CRAZY awesome about how you got your boy! I meant to comment the day you posted it but life got crazy!

erika said...

Oh God. I am asking these same questions, and on top of that, my insurance doesn't want to cover Crinone or Endometrin, so it's like $600 for one of those, or like $10 for the PIO. I have been doing PIO for three weeks and don't really mind the shots, but it requires that my husband not travel for work so he can give me the injections, which won't be practical for another seven weeks! But I didn't know that about the risks of the other two. Stressful stuff. Thanks for posting!

Sarah Beth said...

Wow! That was the warning? My RE said PIO and nothing but- yes it hurt, yes it was a pain and my hubby and I would get anxiety before every shot but well worth the peace of mind. Beware though - I iced before every shot and I now have two diiscolored patches of skin on my back side where we iced... I now call them battle scars and well worth it! Thanks for posting.., interested in reading all the comments now!

Lisa {Amateur Nester} said...

So, I've done all three of these at one point or the other. Honestly, if I had to choose just one I'd go for the PIO every time. Crinone was so nasty (can we say leakage?) and expensive! Endometrin was slightly less nasty and slightly less expensive. I think the PIO was the cheapest of them all and I didn't have much trouble with the injections. Once I got over the scary needle, they weren't that painful. Plus, no nasty leakeage!

Aubrey said...

Ugh, the dreaded PIO injections! I swore my rear end was going to be bruised and sore for years ;)

Monica Z said...

I'm new to your lovely blog. First of all, congratulations! Such an amazing story, best of luck to you. I'm approaching our 3rd cycle soon. Ugh! Both previous cycles have resulted in no day 5/6 embryos to transfer. Hopefully 3rd time is a charm. First cycle I didn't mind the progesterone in oil shot at all. Second cycle, I absolutely hated it. Hurt like heck. Not sure what the difference was. But I know warming the med up in your hand first and applying heat 15 min after helps. Also a little leg movement and massaging the area helps the med get absorbed. Good luck and Congratulations. Thank you for sharing your journey!

Lauren said...

I definitely agree, go with your gut! I preferred the sore behind to the messy inserts. Here's a tip for the PIO, warm the oil vial in between your hands first to thin the oil then inject slowly and heat to the area not ice, ice will thicken the oil, heat will keep it thin. Hope it helps ;-)

Anonymous said...

Shots not that bad... Needle looks scary but just warm up pio first under hot water to thin it ( i would stick it on my bra to heat up😳) then put all your weight on one leg while standing. Relax as shot goes in opposite cheek ( clenching hurts!) Then massage area. You'll get used to it!

Miya said...

Love reading through all of the comments and experiences while I prepare to make the the same decision many of you are sharing.

I used PIO during my first IVF and fresh transfer. That cycle resulted in a healthy Baby Boy who is now gearing up to turn 3. Luckily I only had to endure the nightly needle for about 8 weeks into pregnancy.

Since then I've had 4 failed FET; all using Crinone Gel. At first I was delighted to know that I had an option (wasn't sure why my Dr didn't give that option to me during my fresh transfer). After multiple yeast infections, the discomfort of using the gel and the constant worry that too much of the gel is coming out and not absorbing, I will opt for PIO for my 5th FET.

For those of you who are trying to decide - I'm sure you'll do what works for you and everything will work out fine - data shows that there's no difference between the two options.

For me, although I'm not looking forward to the fat needle, it's my husband who will be administering the shot. I am actually looking forward to him being part of the baby making process again :-)

Krista said...

Which oils did you use? I'm dying here from the pain. Panaway?

Anonymous said...

I am about 4 weeks into PIO. My hubby and I have figured out a system. EMLA cream 1 hour before the shot, cover with plastic wrap and wait. With the EMLA cream I cannot even feel the shot going in. We heat the vial for a few minutes in a heating pad to warm the oil. After the shot I walk a mile (about 20 minutes) and rub the injection area. Walking a mile after has made a huge difference. I am not sore at all the next day. When I was not walking after, I was extremely sore and could barely sit down. two nights I got ambitions and walked more than a mile and was sore the following day. One mile seems to be my sweet spot.

Blogging tips