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IVF Injections: What To Expect & How To Deal With Them More Proactively

IVF injections are a necessary part of many fertility journeys. Whether you are undergoing fertility treatments yourself as an intended parent or donor, or you are researching what the process will be like for your egg donor, it’s important to understand what is involved.

How Does The IVF Treatment Work?

IVF, or in vitro fertilization, is a type of reproductive technology that helps people who are unable to get pregnant without assistance. People who struggle with infertility or other medical conditions, LGBTQ+ people, and single individuals can all benefit from IVF.

The first baby to be conceived with IVF was born in 1978. Since then, IVF has become a very common means to have a child. Science Daily estimates that over 8 million babies have been born as a result of IVF since 1978.

The Mayo Clinic defines in vitro fertilization as “a complex series of procedures used to help with fertility or prevent genetic problems and assist with the conception of a child.”

“In vitro” is Latin for “in the glass,” and it’s used to describe a medical experiment, study, or procedure outside a living organism. “In the glass” is a fitting term because the procedure takes place in a test tube or Petri dish.

So what does IVF treatment actually look like?

Each person’s course of treatment will vary depending on their unique situation, but the typical IVF process includes the following steps:

  • Baseline lab work and physical examination
  • Suppression/control of the natural menstrual cycle
  • Ovarian stimulation using injectable fertility medications
  • Oocyte maturation, triggered by a shot of the hormone hCG
  • Egg retrieval
  • Fertilization
  • Embryo transfer
  • Pregnancy test after two weeks

Normally, a woman’s body releases one or possibly two eggs during each menstrual cycle. Because several eggs are needed for a successful IVF cycle, the doctor will prescribe medication to help increase the number of eggs released. The more eggs retrieved, the higher likelihood that some will be successfully fertilized in the lab.

This medication, called follicle stimulating hormone (FSH), sends a message to the ovaries to grow more follicles containing eggs. Patients self-administer FSH injections on a daily basis for roughly two weeks. The fertility doctor is able to monitor follicle growth using bloodwork and ultrasounds, making adjustments to the dosage as necessary.

Once the doctor confirms that the follicles are responding as expected, the patient will be given specific instructions for administering the final trigger shot. This last shot helps the eggs reach full maturation, making sure they are ready for retrieval. The trigger shot contains human chorionic gonadotropin (hCG), which is commonly called the “pregnancy hormone.”

The hCG injection needs to be given at a very specific time, around 36 hours prior to the egg retrieval procedure.

Egg retrieval is a minor outpatient surgical procedure. The patient is typically given a mild sedative to prevent any discomfort. During the retrieval, the doctor inserts a very thin needle through the vaginal canal. Then, gentle suction is used to extract fluid from each follicle. This fluid is put into a test tube and examined by the embryologist to see how many eggs are present.

On average, between 10-20 eggs are retrieved. The procedure only takes about 20-30 minutes. Patients are expected to rest for around an hour before leaving the clinic and should avoid any strenuous activities for a day or two.

A few hours later, the embryologist combines the eggs with sperm from a male partner or donor and places them in an incubator to encourage fertilizations. Two to five days later, the embryologist will select the embryos that appear to be the healthiest. At this time, it’s also possible to conduct a genetic screening on the embryos.

The final step to IVF is the embryo transfer. During this procedure, the fertilized embryo will be inserted via a thin catheter. Most doctors recommend transferring a single embryo to reduce the risk of becoming pregnant with multiples. However, it is possible to transfer more than one in some cases.

Over the course of the next two weeks, the patient will likely be prescribed progesterone supplements to help encourage a healthy uterine environment for the developing embryo. Often, these are intramuscular injections. After two weeks, a pregnancy test can be taken in order to confirm if the embryo has successfully implanted.

Administering The IVF Treatment

Many people worry about how their IVF injections will work. How often should they be given? Will it hurt? Your fertility care team will be your best resource for specific instructions about how to administer your injections, but here is a brief overview of the process.

Pre-Cycle Injections

You may need to give yourself some injections to help control the timing of your ovulation during the menstrual cycle before your treatment period begins.

These often include one week of subcutaneous injections using the medication Lupron, a GnRH agonist that helps your doctor regulate and control your body’s normal hormone and egg development process. These shots are to be given once per day.

Alternatively, your doctor may want you to take birth control pills to help reduce the risk of ovarian cysts, regulate irregular cycles, or for other reasons. In that case, you will start giving yourself Lupron injections a few days before you are due to stop the birth control pills.

Stimulation

The next phase of IVF is the stimulation phase, which lasts about 8-12 days. You will continue giving yourself subcutaneous shots of fertility medications once per day. Your clinic will let you know if there is a preferred time of day to administer the injections.

Most often, you’ll be asked to give yourself the shots in the evening so the clinic can monitor how your body reacts the next day.. Try to schedule it around the same time each day by setting an alarm to remind you.

Trigger Shot

The final shot of your treatment is known as the hCG trigger shot. This must be given at a precise time, typically 36 hours before your egg retrieval is scheduled. This injection is only taken once, and it is typically intramuscular.

Types of Injections Throughout The IVF Process

There are three basic types of injections used throughout the IVF process:

  1. Cycle suppressing medication
  2. Follicle stimulating hormones (FSH) to stimulate egg production
  3. Human chorionic gonadotropin (hCG) hormone to the eggs to mature properly for retrieval

The first two types are typically subcutaneous. The last is usually intramuscular.

Your fertility clinic will provide you with patient education on how to administer each type of injection. Often, they will demonstrate for you in person, allowing you to practice in the office before you head home with your supplies.

There are also several online resources, including instructional videos, that you can access to help familiarize yourself with how to give injections.

Subcutaneous Injections

Most of the medications you will need for IVF will be administered as subcutaneous injections. Many patients give themselves these shots, but you can also enlist the help of a partner or a friend.

“Subcutaneous” means under the skin.

Using a short needle, you will inject the medication into the fatty tissue that lies between the skin and the muscle. The hormones used for fertility treatments are commonly given in this way, as is insulin to help treat diabetes.

Because you need to inject the drug into fatty tissue, you will want to choose an area that has an ample amount of fat. Common places to administer a subcutaneous injection include the abdomen, the back or side of the upper arm, or the front of the thigh.

Here are some general steps for how to administer a subcutaneous injection:

  1. Wash your hands thoroughly with warm water and soap.
  2. Gather all of your supplies, including the needle and syringe of medication, alcohol pads, gauze, a safe puncture-resistant container to discard your used needle, and bandages.
  3. Find an appropriate injection site, free of any bruising, burns, swelling, or other irritation. Try alternating sides to avoid damage from repeat injections.
  4. Clean the injection area with an alcohol pad.
  5. Prepare your syringe by removing the cap and cleaning the rubber stopper with alcohol.
  6. Draw air into the syringe equal to the amount of medicine you’ll be injecting.
  7. Insert the needle into the rubber stopper of the vial and inject the air into it.
  8. Turn the vial upside down and pull back on the syringe plunger to draw in the correct dosage of medicine.
  9. Tap the syringe to release any air bubbles to the top, then slowly press the plunger to remove the air bubbles.
  10. Pinch your skin between your thumb and index finger, about 1.5 inches apart from one another.
  11. Insert the needle quickly and with control at a 90-degree angle.
  12. Push the plunger slowly to release the medication into the muscle.
  13. Pull the needle out and throw it away in the puncture-resistant container.
  14. Apply a piece of gauze with some light pressure to stop any bleeding and then cover with a bandage.

Intramuscular Injections

Intramuscular means “within the muscle,” so this type of medication is injected directly into the muscle. This allows the medication to be absorbed into the bloodstream more quickly than with subcutaneous injections. If you have ever received a flu, tetanus, or other vaccine, it was most likely an intramuscular injection.

When healthcare providers give intramuscular injections, they usually use the deltoid (shoulder) muscle), but this is less common with self-injection. To give yourself an intramuscular injection, the upper thigh is usually recommended. It’s easier to reach, and you are less likely to hit a bone, nerve, or blood vessel.

Your fertility care team will give you specific instructions on how to administer your intramuscular injections. Here are the general steps you should follow:

  1. Wash your hands thoroughly with warm water and soap.
  2. Gather all of your supplies, including the needle and syringe of medication, alcohol pads, gauze, a safe puncture-resistant container to discard your used needle, and bandages.
  3. Find the injection site by spreading your skin between two fingers.
  4. Clean the injection area with an alcohol pad.
  5. Prepare your syringe by removing the cap and cleaning the rubber stopper with alcohol.
  6. Draw air into the syringe equal to the amount of medicine you’ll be injecting.
  7. Insert the needle into the rubber stopper of the vial and inject the air into it.
  8. Turn the vial upside down and pull back on the syringe plunger to draw in the correct dosage of medicine.
  9. Tap the syringe to release any air bubbles to the top, then slowly press the plunger to remove the air bubbles.
  10. Insert the needle quickly and with control at a 90-degree angle.
  11. Push the plunger slowly to release the medication into the muscle.
  12. Pull the needle out and throw it away in the puncture-resistant container.
  13. Apply a piece of gauze with some light pressure to stop any bleeding and then cover with a bandage.

Why Injections Are Needed In The Process

Most IVF injections are administered via injection because that is the most efficient way to deliver the medications to your body. It’s important to follow all instructions given by your medical team.

IVF is a well researched medical treatment with a proven track record for success. While you may hesitate due to a fear of needles or a worry about the discomfort, most patients report that it gets easier as you continue along the process.

Every injection your doctor prescribes serves a particular purpose, designed to help prepare your body for a successful fertility journey. If you have any questions about particular steps or medications during treatment, don’t hesitate to reach out to your medical team.

Are These Injections Painful?

IVF injections are no more painful than the needle stick you feel with your average blood draw or vaccine. You may experience minor bruising or swelling. The injection site may be slightly tender to the touch for a few hours following the injection. Rarely, an infection or blood blister may develop at the injection site.

That being said, everyone’s experience is different. Patients report a wide range of reactions to their IVF injections, ranging from barely noticeable to quite disruptive. The latter can be especially true for people who have a phobia of needles. See here for tips about overcoming a phobia of needles: Techniques to Help You Overcome a Fear of Needles | Cedars-Sinai

Potential Side Effects

While the injection itself causes relatively minor discomfort, the medications can cause some unpleasant side effects. The most common side effects of IVF medications include:

  • Mood swings
  • Hot flashes
  • Bloating
  • Cramping
  • Headaches
  • Nausea
  • Breast tenderness
  • Blurred vision

A serious side effect to watch out for is called Ovarian Hyperstimulation Syndrome, or OHSS. This happens when the hormones taken for IVF cause the ovaries to swell and leak fluid. Mild symptoms of OHSS include:

  • Weight gain
  • Abdominal pain
  • Nausea and vomiting
  • Diarrhea
  • Bloating

Severe symptoms of OHSS require immediate medical attention. If left untreated, blood clots and dehydration can occur, along with other potentially life-threatening symptoms. Call your doctor if you experience any of the following after your IVF injections:

  • Rapid or excessive weight gain
  • Trouble breathing
  • Decreased or difficult urination
  • Abdominal pain and/or tightness
  • Trouble swallowing and/or keeping down fluids
  • Swelling in the lower extremities
  • Weakness

How To Make Injections Easier

There are a few things you can try to make your injections easier and less painful. Most patients report that the injections are not as bad as they feared! After the first one, it becomes easier to tolerate.

Don’t Stress or Struggle

Practice some relaxation techniques prior to the injection. Deep breathing, calming music, aromatherapy, and simply distracting yourself can all help. Remain as relaxed as possible, and try to reduce the tension in your muscles.

Many patients find it easier to have someone else give them the shots so they can look away. Often, the anticipation is worse than the actual pinch of the shot!

Try a Heating Pad or Icing The Injection Site

For subcutaneous shots, try applying ice to the skin for 15-30 seconds. This should numb the area enough to reduce any pain caused by the needle.

For intramuscular shots, a heating pad may help relax the muscles. Try applying heat to the area for approximately 10-15 minutes before the injection.

Numb The Injection Site or Apply Pressure

You may apply an anesthetic gel or cream on the injection site. Some over-the-counter numbing agents include Anbesol (typically used for sore gums), Aspercreme or other OTC lidocaine. If over-the-counter numbing agents don’t work and you still experience discomfort, ask your doctor about prescribing something a bit stronger.

If you apply any topical creams, be sure to wipe the area clean using an alcohol pad before giving the injection.

Another tip: try pinching your skin and pulling it taut at the injection site. When you separate the skin from your muscle just a bit, it can “distract” the nerves, making the pain less noticeable.

Consider Other Injection Sites

Avoid injecting your medication into the same spot each time. Repeat injections in the same place can cause a build-up of bruises, swelling, or other damage. Different areas of your body may also be more or less sensitive. Try the thicker areas of your abdomen, your upper thigh, or ask a partner or friend to try your upper arm, hip, or buttocks.

Experiment With Positions During Injection

Changing the position of your body may alleviate some discomfort. Try standing, lying down, reclining in a chair, or sitting comfortably.

Use Finer Needles

You may be able to use a thinner needle for your injections. Subcutaneous injections are typically given with a 27, 28, or 30 gauge needle. The higher the number, the thinner the needle, so 30 is the thinnes. Ask your medical team if it’s possible to try a thinner needle.

Your trigger shot will be an intramuscular injection, which requires a larger needle. Thankfully, this is only needed once during a cycle!

Preparation Is Key Before Getting Through The Process

IVF injections are a necessary part of the fertility treatment process. Be sure to gather as much information as possible from your medical team so you know what to expect.

For most patients, the discomfort is a minor and temporary inconvenience on the road to pregnancy. Being aware of what is involved at each stage of the process will help you prepare for the journey, both mentally and physically.

Want to know more about starting your own fertility journey? Consult with our experts now!

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Eloise Drane
Eloise Drane, Founder

"I believe that we are all placed on this earth for a purpose. Each one of us has a specific calling in this world and although it is different for everyone, we are here to serve one another. My purpose is to help women who wish to become surrogates and egg donors and the hopeful parents who wish to partner with them. I fell very lucky to be living my purpose."