Tips for Easier Progesterone Injections

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.
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Six Questions to Ask Your Insurance Provider About Infertility Coverage

Understanding infertility benefits with your insurance plan can be a daunting and confusing process. Although Neway Fertility verifies infertility coverage for all patients, it’s best to call your insurance company to re-verify coverage details and ask any specific questions regarding your benefits.

Below are some of the most important things to ask when obtaining information about your coverage for infertility.

1.) Are there any specific requirements you need to meet before undergoing certain treatment cycles?

With some insurance companies, coverage for certain treatment cycles may not be immediate, even if your insurance provider tells you they cover that specific treatment.

For instance, in 2013 Aetna requires the majority of patients to undergo at least three cycles of injectable, medicated IUI cycles before they will begin covering IVF. These three cycles of IUI can be bypassed if there is a compelling reason proving medical necessity for IVF. (It can take a lot of appealing to get these cycles approved). We see similar limitations with insurance providers Oxford and GHI.

2.) Is your plan covered under state mandate?

There are currently 15 states that are required to offer infertility coverage to varying degrees. If your plan follows a state mandate, it is easiest to figure out what services you are guaranteed coverage. For example, a New York mandated plan offers coverage for all diagnostic testing and unlimited IUI attempts. IVF is not covered under NY mandated plans.

For a full list of states that have infertility mandates, as well as more detailed coverage information (including limitations and qualifications for coverage), please refer to the American Society for Reproductive Medicine (ASRM) website.

3.) Is there a maximum financial spend or a cycle limit for your infertility treatment?

Regardless of whether your plan is state mandated, you may have a lifetime financial spending cap or a cycle maximum for infertility services.

With regard to dollar max, it is important for you to know if this cap is only for infertility treatment cycles (IUI and IVF) or for any service (such as tests and procedures) related to infertility. This will provide a better idea of how long your infertility coverage might last.

For example, if you have a $15,000 lifetime maximum for infertility services that includes all diagnostic testing, surgeries, IUI, IVF and drugs, one cycle attempt could deplete this fund. If the $15,000 applies specifically to IUI and IVF procedures, you will most likely have coverage for more than one cycle. If you have a maximum spend, it is best to follow up with your provider occasionally to check on the dollar amount they have applied towards the max in their system.

Conversely, cycle limits are usually easier to interpret. Some plans will specifically define IUI and IVF attempts covered separately, while other plans will have a total cycle max for IUI and IVF combined. Insurance companies count only completed cycles towards these limits, so if your cycle is cancelled before the actual procedure, it will not count towards an attempt.

For any plan with a cycle limit, it is always beneficial to contact your insurance company after each cycle to follow up on your remaining allotted treatments. We have had patients who were mid-treatment and had their infertility limits changed by their insurance company without sufficient notification from the insurance. Changing from a cycle amount limit to a dollar amount max can alter your course of fertility treatments greatly.

4.) Does infertility coverage change if you’re a single woman or are in a same sex relationship?

Some plans and/or specific insurances have limitations if a patient has not been trying to conceive naturally for a defined amount of time. These insurance companies will require a certain number of self-pay cycles of IUI before they will begin coverage for infertility.

For example, many plans under Aetna and Oxford currently require single women using donor sperm or women in same-sex relationships to attempt 6 self- paid cycles of IUI before they will consider the patient as meeting the criteria for infertility. Additionally, even if your plan has coverage for IVF, an egg freezing cycle for single women wishing to cryopreserve for future treatment(s) may not be covered if the provider requires medical review of a cycle. Some insurance companies will deny coverage citing that the freezing cycle is not a medical necessity.

5.) Are there age limits on your plan?

This will be the case with many state mandated plans, but it is always good practice to ask this question. Many state mandated plans and some non-mandated plans will cut all infertility coverage off by the age of 45. This means anything that is submitted to insurance with an infertility diagnosis code once a certain age has been met will not be covered.

6.) Does your insurance require registration with an infertility program and/or authorization for treatment cycles?

Some insurance providers require a holder to contact specific departments before you even begin infertility treatment. Failure to do so means benefits will either be cut in half or not afforded. Neway Fertility will notify you if your plan requires you do to so. Below are insurance providers that require registration from nearly all patients:

• Aetna with the Aetna Infertility Program – 800-575-5999
• Oxford with Optum Health Managed Infertility Program (MIP) – 877-512-9340
• Empire United Government Plan with the infertility program – 877-769-7447

Depending on your plan, you may also require prior authorization for certain treatment cycles that we obtain in our office. Based on insurance, your cycle may not be covered if authorization is denied.

Of the insurance carriers we currently work with, Aetna and Oxford require authorization for all IUI and IVF cycles. GHI requires authorization for all IVF cycles. The Empire United Government provides authorization to patients for IVF cycles when the patient calls and registers with the infertility program.

Being informed before you begin treatment, staying on top of your insurance company and keeping yourself updated of your coverage can reduce the risk of unpleasant surprises and additional costs during your treatment. While we follow up with insurance coverage information frequently, it’s always best to re-verify the information by calling your provider’s member services.

If you’re unsure about coverage or any additional information you’ve been provided, please feel free to contact our office and we’ll work to find an answer.

For a full list of insurance programs that we currently participate, please see our Insurance & Forms page.

Understanding PGD and the Role of Genetics, Environment

Pre-implantation genetic diagnosis (PGD) is the process used in reproductive science to profile the genetic makeup of embryos before they are selected and implanted as part of the in vitro fertilization (IVF) process.

Most often, couples carrying – or who are at a higher risk of being the carriers of – a genetic disorder use PGD so as not to pass on a specific genetic abnormality to their offspring. Cystic fibrosis, sickle-cell disease, Huntington’s disease, Duchenne muscular dystrophy, fragile X syndrome and a host of other life-threatening conditions can be detected through PGD.

PGD allows us to avoid devastation from these diseases, as we can select embryos that will have the best chance of avoiding genetically inherited abnormalities.

As a reproductive endocrinologist, it’s my obligation to provide information and guidance to my patients considering the PGD embryo biopsy. Ultimately, each patient must decide whether to use genetic testing based on his/her unique social, religious and environmental circumstances.

Great strides in the field of genetics have been made since PGD’s beginnings in 1989. While we are able avoid some diseases with the use of PGD, less is known about how to control diseases that may be linked both by genetics and environmental factors.

Understanding your genes

More than 10 years have passed since the Human Genome Project successfully mapped the properties of approximately 25,000 genes, which comprises a majority of all human genetic information. This feat has equipped scientists with a “blueprint” to better understand the physical and functional properties of single genes.

Defining the properties of human genes was an important first step of understanding biological codes and how they dictate development from an embryo to a human.

The major challenge, now, is to discover the sources of what exactly makes that coding go awry. Scientists are looking at what triggers a gene – which may exist as seemingly normal for many years – to malfunction and manifest in the body as cancer, for example.

A common misconception about genes is that they dictate who and what you are: that’s only part of the story. Genes only tell you what your capacity for being is. In actuality, it’s the environment – and influencers within the environment – that humans are exposed to that activate or turn off genes.

It may not necessarily be the case that you have an abnormal gene by inheritance, rather it’s that you have a gene that is inadvertently shut off or turned on at a point in time that triggers disease.

While some people are genetically predisposed to illnesses like cancer, environmental and behavioral factors play a much more significant role in the presence of a disease in the body.
Consider the environments that we live in

While PGD has given scientists the ability to screen for genetic abnormalities – and select embryos that will not carry a genetic mutation – we know very little as to the environmental conditions that make genes mutate into a disease such as breast cancer.

Research has shown that smoking can cause lung cancer and heart disease can be the result poor diet and lack of exercise. There are very clear behavioral modifications that individuals can control that will help them prevent the development of these diseases, entirely separate from their genetic profiles.

We know that the environments that we live in greatly alter our personal health, but will science help us to better understand the necessary steps to live a healthy, fulfilling life? Time will tell. For now, PGD has a proven value in alleviating human suffering that can be highly beneficial to appropriate candidates.

Bad Genes End with Me

Dr. Jesse Hade was interviewed on HuffPostLive by host Nancy Redd about pre-implantation genetic diagnosis, and how this and other genetic screening tests could help men and women who are carriers of genetic diseases to start families without passing on problem genes to their children


Three Babies Born This Fall in the Tri-State Area Thanks To Groundbreaking, Low-Cost Fertility Treatment – Natural Alternative to Traditional IVF

New York City – October 21, 2013 – Neway Fertility, a leading NYC fertility clinic specializing in natural fertility treatments, today announced that three healthy babies have been born in the tri-state area thanks to IVM – a groundbreaking fertility treatment that requires little to no drugs and is a fraction of the cost of traditional IVF. This includes the first-ever IVM babies (twins) reported to be born in New York.

IVM (in vitro maturation) is an alternative to traditional IVF that offers a virtually drug-free, minimally invasive, and low-cost treatment for infertility. IVM is ideal for women with hormone-sensitive issues like PCOS (polycystic ovarian syndrome), who cannot tolerate the high doses of ovarian stimulation drugs required by IVF. It’s also an option for anyone interested in pursuing a more natural course of treatment for infertility.

The recent births are the result of a research study that Neway is conducting for women with PCOS and infertility, offering free IVM treatments to up to 20 women. A total of five out of seven women have become pregnant through the study so far, with three babies born to date, and three due in 2014. The first two couples to give birth to healthy IVM babies include:

  • Cecilia and Talya, a same-sex couple from Brooklyn, NY, who welcomed twin girls on October 11. Cecilia, who carried the twins, has PCOS, and was unable to conceive through other methods. She underwent 5 failed IUIs before trying IVM. The IVM treatment was successful on the first round.
  • Manpreet and Sarbdeep, from Carteret, NJ, welcomed a baby girl on September 25. Manpreet was so pleased with her IVM experience that she called Neway from the delivery room to tell them she was almost ready to schedule her next treatment!

Neway is one of only a handful of US clinics pioneering successful IVM treatments. IVM has already seen great success around the globe, with more than 4,000 live births worldwide – more than 1/4 of them under the direction of Neway’s founder and technical director, fertility pioneer Dr. Jin-Ho Lim. Dr. Lim brought this innovative technique to Neway Fertility and trained an expert staff, led by top fertility specialist Dr. Jesse Hade, to help women in NYC and across the country realize their dreams of having a baby.

“With IVM, the eggs are retrieved and matured outside the body. IVM is a different technology from the traditional Natural cycle IVF, which uses only one or two oocytes matured in the body. This allows us to achieve a high success rate without subjecting women to high doses of infertility drugs, extensive blood tests, or constant ultrasounds. The eggs can be immediately implanted, or frozen for later use,” explained Dr. Lim. “This is truly a breakthrough for women who are looking for more natural options, or simply don’t have the option of using a conventional IVF approach.”

“The first time Dr. Hade and Dr. Lim told us about IVM, we were hooked. No weeks of heavy meds? No risk of hyper-stimulation? No need to take a second mortgage to cover the cost? IVM was the answer we had been looking for,” said new mom Talya. “The Neway staff gave us unparalleled support and encouragement, giving us back the hope we had lost after a year of trying to conceive. We are so grateful for this magical experience.”

New moms Cecilia, Talya, and Manpreet are available to share their experiences with IVM, along with Dr. Lim and Dr. Hade, who can describe the procedure and how it’s changing the practice of treating infertility.

About Neway Fertility
Neway Fertility is a leading NYC fertility clinic offering the full range of fertility treatments, with an emphasis on natural approaches. Neway was founded by Dr. Jin-Ho Lim, a pioneer in natural fertility and founder of the groundbreaking Maria Fertility Network in Asia. Dr. Lim established a world-class facility in Manhattan to bring his innovative treatments to the US, training an expert team led by top fertility specialist Dr. Jesse Hade, MD, F.A.C.O.G. Neway leverages innovative techniques and a personalized approach to deliver some of the highest success rates in the country for everything from traditional IVF, to natural alternatives like IVM, mild IVF, Natural cycle IVF, and Natural cycle IVF/M, to IUI, genetic testing, embryo screening, egg freezing, egg donation, and more. Visit for more.