IVF medications are predominantly Subcutaneous Injections. We know that sometimes these medications can feel complicated and overwhelming just to prepare, and that’s before you even think about doing the actual injection.
Here are some helpful tips and instructions to help prepare you to tackle your injections from night one!
First, check the box when you receive your medications. Make sure everything that was ordered is actually there. Once you’ve confirmed you have everything, determine how each medication is stored and place them in their appropriate location.
Each IVF medication has its own preparation process, which definitely comes with a learning curve. Some medications come in multi-use pens and others come as a powder that must be Reconstituted. Getting the hang of the process for each medication can be both time-consuming and frightening. This detailed guide can help you to feel more comfortable as you begin each new medication.
Prepare the Needle
To keep things simple, start with one medication at a time. Take out the items necessary for the injection. This usually includes a few alcohol swabs, gauze, the medication itself, any mixing needle or device, a syringe, an injection needle, and a sharps container. Once everything is set out on a flat surface, begin by washing your hands. Then prepare the medication based on your prescribed dosage. Once the medication is prepared, attach the injection needle.
Subcutaneous injections are most commonly done using ½ inch needles. The needles are short and thin in order to deliver the medication to the tissue just below the skin, where it will be best absorbed.
A mixing needle (longer one) and injection needle (shorter one).
Some fertility medications come with what’s known as a Mixing Needle, a much longer needle used for preparing the medication. Once the medication is prepared, swap the mixing needle out for the injection needle. Be sure to confirm that you're using the correct needle for your injection!
Once the injection needle is attached to the syringe, it’s time to prime the needle. Priming the Needle pushes all of the air out of the syringe and brings the medication to the tip of the needle prior to injecting. In order to do this, turn the syringe so the needle is pointing upwards. Then, leaving the needle cap on, very gently press up on the plunger of the syringe. Continue to press the plunger until a tiny drop of medication appears at the top of the needle.
To uncap the needle, hold the syringe parallel to the floor and gently pull the cap off the needle with your elbows out. Pulling the cap off this way can help prevent accidental needle sticks.
Inject the Medication
Once the needle is primed, it’s time to select your injection site. Subcutaneous injections can be done on the abdomen, upper thigh, or back of the upper arm, as long as you have enough fatty tissue available. The most common place to do fertility injections is the belly.
Choose an injection site that…
is a place you can “pinch an inch” of skin and fat (if you can pinch the tissue between your thumb and forefinger, then there’s enough subcutaneous tissue to inject and absorb the medication)
is at least 2 fingers apart from where you inject your other medications the same day
if using the abdomen, is at least 2 finger widths away from and is on either side or just below your belly button
Sometimes people feel nervous and can get lightheaded while preparing their injections. We're always concerned about safety first, so please be sure to sit down before proceeding with your injections!
Once you're comfortably seated and ready to administer the medications, pinch the tissue and wipe it with an alcohol swab. Then take your primed needle and, in a smooth, gentle motion, put the needle into the skin you’re pinching. You can slowly release the pinch as you press the plunger to inject the medication.
After you finish pushing the medication, leave the needle inserted for about 10 seconds to ensure all the medication has made it to the tissue. Then carefully remove the needle and place it into the sharps container immediately. No need to recap the needle. Then hold gauze on the injection site for a minute or two to stop any bleeding.
After Your Injections
After your injection is complete, it's normal to experience some tenderness and bruising at the injection site. No need to worry! The bruising is a result of breaking small blood vessels during the injection. It doesn't pose any risk to you and doesn’t alter the effectiveness of the medication. Alternating injection sites can help to prevent having to give your injections on top of bruises from previous nights, but if needed, it's perfectly safe to inject medication into a spot that still looks bruised.
Giving yourself injections can be very challenging! Check out this list of tips that patients find helpful:
Take refrigerated medications out of the fridge for 15 minutes (like Follistim, Menopur, Gonal-f). Taking the chill off the medication for a few minutes can make it less painful to inject.
Menopur is known for stinging a bit more than other medications. This doesn’t mean you've done anything wrong, but is helpful to be aware of.
The attached needle on Ganirelix syringes can be hard to puncture the skin with. Make sure you use a swift motion with a bit of pressure when injecting this medication.
Some patients find that icing the injection site for a minute or two beforehand makes the medications sting less.
Try using a ShotBlocker. It's a small, inexpensive product that some people find makes the injections less painful. It doesn’t work for everyone, but you can give it a try!
Q-caps provided to mix Menopur can also be used to mix Cetrotide.
Some people find it helpful to have another person do the injecting for them, but it isn’t necessary. Many fertility patients self-inject! So if you’re doing this by yourself don’t worry. You got this!