Understandably, most of our patients dread daily progesterone injections. This is usually their first introduction to the world of intramuscular (IM) injections. These daily injections last until the tenth week of pregnancy.
Adequate progesterone supplementation is a crucial support medication. Progesterone vaginal tablets, suppositories, and gels are readily available, but progesterone IM injections continue to be a mainstay of many post-egg retrieval and frozen embryo transfer (FET) cycle regimens.
Now, as with most things, these injections require practice. Here are a few tips.
Progesterone in ethyl oleate
Progesterone is available in sesame oil, cottonseed oil, olive oil and ethyl oleate. We tend to order progesterone in ethyl oleate for our patients. Progesterone in ethyl oleate is less viscous, thus requiring a thinner needle (22 or 25 gauge.)
The negative aspect of progesterone in ethyl oleate is due to the fact that it is compounded select pharmacies and may require a separate medication order; it also has a shorter shelf life.
IM injection best practices
The IM needle size is one inch longer than the 1/2-inch subcutaneous needle and a little bit thicker. The length of the IM needle is important since the progesterone must be injected into the muscle and not into the subcutaneous layer (also known as the “fatty tissue”). The ventrogluteal or dorsogluteal areas are good sites for IM injections. Please ask a staff member to locate these sites for you.
Numbing the appropriate IM site with an ice pack is always recommended. Once the area is numb, you can withdraw the 1 ml (50 mg) of progesterone from the multi-dose vial with a 3 cc syringe and an 18 gauge or 22 gauge 1 1/2 inch needle.
Always check the syringe for air bubbles and expel air by holding the syringe with the needle pointed upwards. Tap or flick the barrel of the syringe until the air bubble floats to the top and press on the plunger gently. Stop once the air bubble is gone. You should have 1 ml of progesterone in the syringe.
Next, remove the 18-gauge or 22-gauge 1 1/2 inch needle and replace it with a 25 gauge 1 1/2 or a new 22-gauge 1 1/2 needle. The 25-gauge needle is thinner than the 22-gauge needle. Inject the needle into the alcohol-prepped site and gently pull back on the syringe. If you see blood, you are in a blood vessel. Do not panic. Remove the syringe, attach a new needle, and try again in different area. If you see air, however, you can inject the progesterone.
Aftercare is key
After disposing the used needles safely, apply a warm compress to the site. Massaging the site also works very well.
Please remember to keep the progesterone at room temperature, swab the rubber top of the vial prior to drawing the progesterone, rotate injection sites and – as always – contact Neway Fertility with any questions, difficulties or concerns.