hi my name is dr sarah bjorkman and i am a board-certified ob gyn and also a reproductive
endocrinology and infertility specialist you may have followed us through our last
pregnancy and postpartum and all of the things and now as we are trying for baby number two
find found ourselves unable to get pregnant and are now doing ivf so the ivf doctor has now become
the patient and i thought it would be helpful to go through ivf medications how to give them
how to draw them up and so come along with me as i give myself my meds tonight
the next injection we are going to demo and talk about is probably the least favorite of all ivf
medication injections and that is progesterone in oil this one is pretty un-fun and you may have to
do it if things go well for many days to weeks um so let's talk about this really quickly so
progesterone um if you had a fresh transfer if you had if you're doing a fresh transfer basically we
just sucked your ovaries dry so they don't work exactly like we expect so we need to give you
progesterone back to help develop that endometrial lining so it's nice and receptive and ready for
that embryo to implant same kind of concept in a frozen embryo transfer to get ready for a frozen
transfer um we are kind of taking over that whole cycle getting your lining ready for an embryo
transfer so again we have to give progesterone back usually for five days before your transfer
to get that endometrial lining nice and ready for embryo so progesterone is a pretty thick liquid
which makes it a little slower to inject so you're going to get a vial and you're
going to use this vial for multiple days so the dosage is 500 milligrams per 10 ml
or 50 milligrams per ml and there are 10 mls in each vial so that's 10 doses
per vial this can be stored at room temp until its expiration date
some things that you may have seen on tick-tock um a lot of people at least you know on tick-tock
tips for making this better they'll like put this in their armpit to warm it up or they'll
roll it roll it in their hands to warm it up our pharmacist said don't do that because then
you are warming this liquid every single time um and that isn't great for it if you want to
pull up your single injection and then roll that syringe itself in between your hands fine
don't put your multi-dose vial in your armpit um you can ice your hip again to
make this less painful because progesterone and oil is again an intra muscular injection
so it's a longer needle we need to get it all the way into the muscle and we're
doing that again in the ventrogluteal injection site it's kind of on your hip
there's again you can ice before if that helps get it in a little numb there's different shot
blocker things you can use to kind of distract um when you inject again you're going to put
the needle all the way in drop it back a tiny little bit um and then inject all the way till
all that liquid is gone one two three pull out the progesterone and oil can be a little bit itchy
so if there's a little bit of that on your skin you're gonna wanna make sure that you wash it off
the number one side effect of this is sore hips like you're just your glute
really gets sore to numb after a while so what our pharmacist recommends is a
three to five minute massage right after you do the injection to really help get that into the
muscle um and then she you know recommends you move have whoever's giving you that shot move
all the way up to your neck do a nice full body massage not necessary but recommended
doesn't help with the medication but no it does not massages are always good
but think of that as you're injecting kind of this glob of thick liquid into your muscle think of it
like a glob of jelly you want to massage it around into that muscle so it really gets spread out um
afterwards you want to move that leg do a little bit of hip glute leg exercises jazzercise
walk hula hoop anything just to get it into that muscle to help with soreness then afterwards ice
heat whatever um feels better for you we usually do a rice sock heat it up in the microwave and
hold it there sit on it on my hip and that's been helpful i would recommend pro tips alternating
right hip left hip right hip um just to kind of take it easy and not continually beat up one hip
right after the other that being said sometimes one hip will get more sore than the other and it
is okay to do two on two in a row on the same hip or three in a row if you've got a really sore hip
other final notes with progesterone progesterone in oil is not one of those injections that is
critically important that you give it at exactly the same time every night like it is with those
gonadotropins and some of the other medications we talked about it is a great idea to give it at the
same time every night set an alarm do whatever you need to to have a routine of giving it at the same
time but this is more a plus or minus four hour window and you would still be okay all right so
progesterone you are going to start five days before your embryo transfer you then continue
that progesterone for until your pregnancy test which is usually nine to ten days after transfer
so i always tell patients that that is 15 days of an injection
that kind of sucks where you don't know if you're pregnant or not if you are not pregnant you will
be able to stop this injection and if you are pregnant then you have to continue which
again sucks but you're doing it for a very important reason to support that early pregnancy
and it becomes just a little more worth it when you know hey i'm suffering with a purpose now
um that for how long it depends on your protocol for your clinic um it very very much varies some
people supplement with vaginal progesterone as well some do it every third day some do
it every day some do it up to eight weeks some to ten some to 12. um so again that is going
to be very protocol dependent so make sure you know your end date with your progesterone which
i sure already am counting down to being able to stop this so shall we yeah let's do it all right
so kurt's gonna get everything ready um and we'll talk him through what we're gonna do
so the first thing we're doing here is you when you open your progesterone there is a little cap
that flicks off and now you want to sterilize the top of this um rubber stopper every time you do it
you are going to open your syringe and some you may get a syringe that has a needle on
it your drawing needle you may have to put your drawing needle on it it's usually a thicker and
shorter needle so this draws up faster you also want to get your injection needle ready
which again is just longer one and a half inch needle instead of the shorter drawing needle
so drawing needle um sometimes it's nice to push just a little bit of air in makes it a
little easier to draw it back out again the dose is 50 milligrams per milliliter so if you need a
50 milligram injection you need 1 ml if you're doing 75 you would need 1.5 ml of the liquid
again this you got to tip it upside down and take your time drawing back because it's a thick liquid
that takes a little bit and so as you're drawing this you'll notice this draws up a lot more slowly
than the other medications just because it's so thick in that oil so just give it a little time
and if you get more than you need you can always give it back to the while
okay we're gonna change our needle right yep removing the drawing needle and changing out
for the injecting needle okay now what's next the fun part the not fun part um so in terms of
location on your hip um my clinic tends to draw a big purple circle that you can keep marked on your
hips that i usually keep retracing um sometimes it washes off and your nurses in your clinic
are going to be happy to redraw that for you or you can just you know look at a picture of what
the ventral gluteal spot is and get very good at hitting that you can also after a while just see
where you injected last and go in that general area so alcohol swab okay i can feel where hip is
i know where i'm going here cleaning again it's kind of over that hip bone kind of in the
front half of that hip but you don't want to hit the bone not hitting the bone exactly so again
sterilizing the spot just wanting to make sure it's clean injection site three circles is plenty
okay here we go
okay good oh i can't wait what kind of things do i need to think about while i'm doing this
you're going to inject you're going to pull back to make sure that you don't get any blood return
and then you just slowly push okay until it's gone hold two three okay oh i can't wait hey poke
okay man no blood return drawing back
and then slowly pushing i'm all the way in with this needle into the muscle
tingly okay and out tapping the needle and then massaging that oil in let's go
so that was a progesterone injection and that was kind of wraps up um our little med teaching video
again some of the meds you take may vary based on your protocol and what your clinic uses the
one um resource i want to share with all of you is a website called freedom freedommedteach.com
it is an amazing amazing resource that has instructional videos for every single ivf med
from drawing up switching needles getting ready i mean absolutely everything based on
the ivf med um so we will link that here i mean just everything alphabetically cetratide
estradiol valarate phallus nymph ganorelics general im injections general sub q injections
gona left lupulide luperolite trigger menipur novarel literally every ivf med you might need is
at this website with great step-by-step videos to help you if you are find yourself about to do that
injection and you're like oh i don't remember what they showed me at clinic i really want someone to
walk me through this again freedommedteach.com is an awesome awesome website so that
is all we have make sure you subscribe guys and we will see you in the weeks to come bye
we're doctors but not your doctors anything we've said in this video
is for education or entertainment purposes only it is not medical
advice any specific medical questions you have should be directed to your provider