The 4 Types of IVF Injections and Their Differences

3 different syringes

A normal IVF treatment cycle typically requires you to have between 13 and 20 injections and they don’t all do the same thing. In fact, there are four different types of IVF injections.

1. Injections to Stimulate Your Ovaries

An IVF treatment cycle starts by stimulating your ovaries, so they make multiple follicles which contain eggs. The injections that do this are called Gonadotropins.

These are the most common IVF injections which are administered once a day for about 10 – 14 days. You’ll be regularly monitored via blood tests and ultrasounds to ensure you don’t become overstimulated and to ensure you’re being stimulated enough. Your dose may have to be adjusted accordingly.

These injections are administered into the lower abdomen subcutaneously which means that they deliver the medication to tissue just under the skin. Since it only needs to pierce the skin, the needles they use are quite short and thin. In precise terms they’re ½ inch long needles or 27 gauge – which is a way of measuring needle size.

I have developed my own system of measuring needle size: Ah, Ahhhhh and Oh my god they can’t be serious.

And they’re self-administered. Meaning the doctor or nurse isn’t going to inject you, you’re doing it yourself. This can be quite scary of course, as most people are not ok with the idea of injecting themselves, but I assure you, you will get used to it. The first time, you’ll be nervous and take about 25 minutes but soon you’ll be able to do it and shout at your kids to keep out the bedroom at the same time.

Fortunately, these injections often come in a multidose pen format and although there are various types, they’re all basically the same: a container with all the medication you probably need for one treatment cycle, in the shape of a pen with a dial at the top to adjust the dosage, a plunger above that for pushing out the medication and a place at the bottom to attach a needle.

For every injection, you’ll dial the correct dosage, attach a new needle from the package, insert it into your body and push down on the plunger. When you take out the needle all you need to do is discard it and put the pen back in the fridge. It’s that easy. Eventually.

While these injections don’t hurt that much and are fairly easy to administer, with so many of them and the fact that you’re not a professional injection giver, your whole lower abdomen may end up bruised and sore, making it difficult to find a new injection site easily.

Using ice before and after the injection (with before meaning before the alcohol swab) numbs the area and helps to reduce the risk of inflammation. Alternating between the left and right sides of the abdomen will also help reduce the bruising as long as you remember which side you’re up to.

2. Injections to Block Ovulation

With all the extra eggs in your ovaries, the last thing you want is for ovulation to occur too early. The injections that do this are called Antagonists.

These injections are administered from around the time the first ones end, once a day for 3 – 4 days. As there may be some cross over, you may end up taking 2 injections per day, one of each type. You’ll still need regular monitoring via blood tests and ultrasounds so that the doctor will know when you’re ready for the egg retrieval process.

These injections are also self-administered subcutaneously in the already bruised lower abdomen. They can be a bit more painful not only because of the previously mentioned already bruised lower abdomen, but because the needles are slightly longer and wider, and because there’s more content to inject.

These injections don’t come in pen format, but they do come packaged with everything you need. There are two types of these packaged injections. The first is a syringe with a needle attached and which is already filled with the medication that you’ll be injecting. Simply open the package and inject yourself.

The second type is a little more complicated, but only slightly so. It comes with a syringe, two needles – a larger mixing needle and a smaller one for injecting, a vial of solution and powder. You have to attach the larger needle to the syringe and use it to mix the powder with the solution and then suck the mixture into the syringe. You then switch to the smaller needle (phew) and inject yourself.

3. Injection to Trigger Ovulation

This is a one-time injection that triggers ovulation when the follicles are ready. It’s often referred to as ‘release’ as it releases the egg from the wall of the follicle. It’s administered sometime after the first two types of injections and your doctor will tell you precisely when.

This injection is also self-administered subcutaneously into your almost-finished-being-abused lower abdomen and comes in similar type packages to the previous types of injections.

This injection is also slightly more painful than the first type of injections you’re taking but not more than the second.

The good news is that some IVF treatment cycles do not require any of these first three types of injections. If you’re only transferring frozen eggs that were extracted in a previous cycle then there will obviously be no need to stimulate your ovaries, supress ovulation and then trigger it. You may not even need the fourth type of injection.

Yes, they are easier cycles.

But, whenever you’re starting from scratch, you’ll need all three types of injections.

4. Progesterone Injections

Sometimes progesterone in oil is injected to strengthen the lining of the uterus and help optimize chances of transferred embryos being implanted. It’s also sometimes given to prevent the worsening of Ovarian Hyperstimulation Syndrome (OHSS) symptoms. The dosage and frequency will be determined by your doctor, but a common schedule is every 2 – 3 days from just before the egg retrieval until week 20 of a pregnancy.

These injections are intramuscular which means that the needle is inserted more deeply than with subcutaneous injections so that they reach the muscle. This means that the needles used must be longer and thicker. 1 – 2 inches long or 25 gauge.

The injections are administered to the mid-thigh or buttock and so unless you’re a contortionist are quite difficult to do yourself. You’ll need someone else to administer it for you, a nurse, friend or partner.

By the time you get around to progesterone injections, you’ll be so used to injecting yourself, you’ll wonder why your husband has that look on his face when you tell him he’s going to be injecting you. Just give him a little reassurance and tell him he’ll get used to doing it after a while. If that doesn’t work tell him that if you have to spend time running to the nurse to have it done, he will be picking up any slack that causes. Works for me.

Usually, progesterone solution comes in a vial and has to be sucked into the syringe through a needle. The fluid is very thick and oily and has to be withdrawn by a wide needle. You’ll be using a thinner needle for the actual injection, but because of the thickness of the fluid and the fact that you’re injecting it into the muscle, you need to use a needle that’s longer and thicker than the needles used for the other three types of injections.

This means that these types of injections can be a bit more painful than the others. They’re not super painful and you’ll definitely be able to manage, but if your partner is injecting you, you may want to keep that to yourself.

Extra Injection Related Paraphernalia That You’ll Need

Apart from the injections themselves, you’ll need a few other things to make this part of the treatment cycle as smooth as possible. To help you, here’s a short checklist of all the things you’ll need:

SoapAlways wash your hands before injecting yourself
IceYou can use ice to numb the injection site before administering the injection and before wiping the site with alcohol and after the injection. It numbs the area and reduces the risk of inflammation.
Alcohol and Gauze pads or Alcohol swabsYou must clean the injection area with alcohol
The syringes or injection packagesIt’s always useful to have spare syringes for when they inevitably fall on the floor and become contaminated and unusable
Disposal containerYou can’t just throw used needles in the bin. They have to be kept out of harm’s way. I use an old plastic drinks bottle.

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