The idea of intramuscular injections can be scary. The needle is bigger and the injection site is harder to reach than subcutaneous injections. Intramuscular injections are used for medications that are best absorbed in the muscle. The muscle is located beneath the skin and fatty subcutaneous layer. A larger needle is needed to reach the muscle and administer the medication in the correct place.
Here are some tips to help you feel confident and comfortable as you tackle this part of your fertility journey!
The Supplies You’ll Need
All the injection supplies should arrive with the medication from the pharmacy. Take stock of your supplies when you receive your prescription to make sure you have what you need. Your supplies should include:
22-25 gauge needles that are either 1 or 1.5 inches long
The most common IM injections during fertility treatment are the hCG trigger shot at the end of an IVF or egg freezing cycle and again in the form of injectable estrogen and progesterone during a frozen embryo transfer cycle.
Choose Your Injection Site
The injection site for IM injections is most often on the buttocks. The best way to determine a good location for the injection is to think of each side in 4 quadrants. The injection should take place in the upper outer quadrant.
Safe areas for intramuscular injections
Once you locate this area, feel for the hip bone and go below it by about 2 inches. It’s important to avoid injecting yourself near the midline on either side. This is because the main nerves and blood vessels travel down the middle and you are more likely to hit one of these structures if you inject towards the middle.
Ask your clinic if a nurse can draw circles where the acceptable injection sites are to help guide you when you’re at home doing your injections.
Prepare the Medication
Begin by washing your hands and setting your supplies on a flat surface. Then follow these steps:
Attach one of the provided needles to your syringe. The size of the syringe will vary based on the type and dose of your medication.
Next, clean the top of the medication vial with an alcohol swab and then insert the needle into the vial.
Invert the vial with needle inserted and make sure the needle tip is submerged in the medication.
Then draw back on the plunger of the syringe until you have your dose of medication in the syringe. Then remove the needle from the vial.
Pull back on the plunger to create an air gap at the top of the syringe.
Remove the needle and discard it in the sharps container.
Attach a new needle and prime it.
Priming the Needle pushes all 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.
The Injection Process
Whether you’re doing the injection yourself or having a friend or family member do it for you, there are a few simple steps to follow. The first step after identifying the right spot is to clean the area with an alcohol swab. Then let the area dry for 30 seconds or so.
After you prep the site, it's time to do the injection. You start by removing the cap from the primed 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.
Once you have the cap removed, return to the cleaned injection site. The best way to do the injection is to hold the skin taut and to insert the needle in a smooth, swift motion. This helps the needle get through the skin and makes for a more comfortable experience.
If you’re injecting the medication yourself, it can be helpful to stand with your back facing a mirror. When you’re ready to give the medication, twist around and use the mirror as a guide to better see what you’re doing.
Something that sets IM injections apart is the idea of aspirating. Once the needle is inserted, you will pull the plunger back to check to see if you are able to pull blood back into the syringe (known as a blood return). If you get a blood return, that means that the needle is in a blood vessel rather than in the muscle. Don’t panic! The quick fix for this problem is to remove the needle from the skin, recap it, and discard it in the sharps container. Then screw on a new needle and move your injection site an inch away from where you previously injected and start over.
If you get a blood return when you aspirate, it’s ok if a bit of blood mixes into the medication in your syringe. It’s still safe to use the contents of the syringe after you select a new injection site.
Inject the medication
After you aspirate to confirm your injection site is correct, it's time to inject the medication. Some IM fertility injections, like progesterone, are mixed in oil. Because of the thicker consistency of the oil, it can be hard to push the plunger down and get the medication out of the syringe and into the muscle. Make sure to take your time and push the plunger down gently as the medication goes in.
After all of the medication is in and the plunger has reached the bottom, slowly and carefully remove the needle. Discard the entire needle and syringe in the sharps container.
After the Injection
After you complete the injection, hold pressure on the site with gauze. Some people like to gently massage the area. This can be especially helpful with the oil based medication to help disperse the medication.
Don’t ice the injection sites of oil based medications like progesterone. Icing the oil will cause it to thicken and create knots in the tissue. Alternatively, you can apply gentle heat like a warm (not hot!), damp washcloth to the area after injecting. Always check the temperature before applying heat to your skin to avoid burns and skin irritation.
Giving yourself intramuscular injections can be an incredibly intimidating process. Knowing what to do each step of the way will help you feel confident and in control throughout the process.