Monday, November 24, 2008


It wasn't so much the actual stabbing or any kind of fear of needles or even the welts and bruises. But when I began waking up so many times every night in pain - whenever I rolled over, or my husband flopped his arm against me - I decided I just couldn't take it any more.

So, against my superstitious better judgment, I am switching from the PIO to progesterone suppository. I know there is a sort of hard-core IVF badge-of-honor tradition to the agony of the PIO injections. And sure, I get that after all it takes to even make it to this point, I should be willing to do whatever I have to in order to support a positive outcome. But waking up whimpering in pain six nights in a row has done me in.

It really wasn't so bad at first. Even though that needle is long, you don't feel anything past the surface nerves anyway. It's the swelling - and possibly a mild allergic reaction - that was my undoing. I could massage with a hot washcloth until I was sure there were no lumps of oil coagulating in my muscle, but there wasn't much to be done about the general swelling. I rotated sides, of course, and used different spots each time. But after a few weeks there just isn't any undamaged tissue left to puncture. The last few days I have had large pink spots on each hip, swollen tissue that is so sensitive that I have to wear soft elastic-waist pants and pretend I am just on my way to a yoga class all the time.

I know the suppositories have a bad rap - they leak, they itch, they ruin your panties. They can cause irritation that can lead to bleeding - and, thus, panic - and progesterone levels can't be reliably measured with a blood test since the effect is so localized. I was hoping to talk to my doctor about Claudia's secret sub-Q progesterone alternative, but since my appointment was canceled I decided I just couldn't go another week without a switch.

I've read a lot of studies that show no difference at all between intramuscular and intravaginal progesterone. Then there are studies showing that one is better, and studies proving that the other is better. There are even studies suggesting that no supplementation at all (past a positive beta) is just dandy. It's ultimately impossible to make the right decision based on all this vague information. Even though I used to be paranoid about changing anything or doing anything that might possibly cause some kind of disaster, I've been worn down by exhaustion and worry and the business of trying to stave off hope. So, I don't know. But I'm damn glad that I'm not icing my ass while I type this.


Nikki said...

My RE here had me on the progesterone suppositories for the last 3 IVF cycles. He also told me there was no difference in terms of effectiveness.

Panty liners are great to help with the leaking, and just simple washing with water is great with the itch ;-)

(One time I complained to the nurse about the itching, and she said I could choose to switch to PIO instead. I decided that the itching was better than daily shots in my butt!)

Good luck!

Claudia said...

I think the use of progesterone past a positive beta is largely a cover-your-ass move, anyway. You'll be fine on the suppositories. Hang in there!

Lost in Space said...

Both of my RE's have given me the option to choose between PIO and suppositories. Both agree the only real difference is the range they use to make sure you have enough.

Don't beat yourself up. For the record, I have chosen suppositories every time. (;

Midlife Mommy said...

I've used supposities exclusively n all my cycles since I started up again in 2007. I've never had any of the bad side effects you mention, except for the leaking, but I do use long panty liners, sometimes the lightest incontinence ones (because they are loooong). My protocol requires progesterone for 100 days after a positive test (and it was the same when I was using PIO with my 2004 pregnancy, though the doctor did let me choose between PIO and suppositories back then as well, and I alternated weeks).

Sky said...

Lorraine, CCRM prescribes PIO injections and suppositories in addition. But I have been told that if you can't tolerate the PIO injections, it's fine to switch you over to suppositories. Besides which, I've read women on PIO suppositories who've had miscarriages as well as those exclusively on suppositories who've had successful pregnancies.

And, frankly, being in pain and therefore unable to get a good night's sleep is far worse for a healthy body (to support a healthy pregnancy) than anything else.

And I agree with Claudia that beyond a positive beta, I think using prescription progesterone is not only a "cover-your-ass move," it helps us patients believe we've done everything we could to keep the pregnancy going. Wouldn't it be nice if we had THAT MUCH control?! We'd all be pregnant for goodness sake!

So go stick those suppositories up your woo hoo - the baby's outcome will not be affected by it. :)

chicklet said...

My clinic doesn't do PIO shots - they do suppositories, which i gotta say SUCK. Panty liners and constant changing of those panty liners is critical, or you really will ruin your underwear. Plus you'll be "sitting in it" which is just plain nasty.

Jill said...

My RE doesn't feel there is any clinical difference b/t PIO and Prog supps. So, I think you should do whatever makes you feel best!

the Babychaser: said...

The endometrin suppositories were really effective, and well worth the mess.

I had such a bad reaction to the PIO shots that even now, eight months after my last shot, I still have numb patches and react badly to anything other than the lightest touch. (I even had that moment you described, where my husband's arm flopped over in bed and I woke up howling in pain.) It's better than it used to be, and I'm sure the nerves will heal eventually, but I'm never doing a PIO shot again. I don't care how much more expensive the suppositories are (and they really are!), it's worth it.