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I’m getting ready to start a stimulation cycle with IVF. I am having serious anxiety about the injections. What do they involve? Do they hurt? What if I mess it up?! Please explain it to me like I’m five.
—Nervous About Needles
Needle injections add another layer to the many physical and emotional stressors of IVF. A survey study presented at one of the major national meetings in our field addressed this last year. Nearly 20% of the 102 survey respondents reported delaying IVF treatment due to fear of needles.
The injections given for ovarian stimulation in IVF are subcutaneous, meaning you are injecting the medicine into the fat tissue layer that is just below the skin. Most patients give themselves injections in the lower abdominal region just below the belly button. The needles are thin, which does make them less painful than shots that need to go into muscle, like a vaccine. However, you will probably feel a small pinch when you insert the needle and some burning when injecting the medicine. It is very common to also have some temporary redness or bruising around injection sites, especially after several days of these same shots! Any persistent redness or reactions should be brought to your doctor’s attention.
Your clinic will likely give you a hands-on demonstration of how to use your medications and administer them. There are also great online resources with videos of how to mix, draw up, and inject the various fertility medications. Specialty fertility pharmacies often have support resources available for patients to review medications and administration, as well.
For those with severe needle phobia, some exposure therapy prior to your cycle may help. I’ve had patients purchase “dummy abdomens” specifically designed to help patients practice giving subcutaneous injections. Even more exciting is the idea of using subcutaneous catheters, like those that are used for insulin pumps, to eliminate injections from IVF altogether. A small cohort study to prove this concept showed no difference in results compared to patients giving themselves the traditional injections. The subcutaneous catheter was placed on the patient’s abdomen at the beginning of the IVF cycle and was used to administer all of the medications. While this procedure is not yet widely available, this is an exciting development to someday help make IVF less painful and more patient-friendly.
Most patients are worried about making errors in the dosing of their medications. Fortunately, many of the medications are designed to be single-use or have a “dose dial” on a pen to help patients administer the correct dose. If you do realize you gave an incorrect dose with one of your injections, your clinic can help guide you on whether you need to take additional medication or be monitored with blood work and an ultrasound sooner. One of the more frequent “mistakes” we see is a patient realizing they have run out of medication, so make sure to keep up with your supply as the cycle progresses.
By the end of the cycle, most patients feel like injection professionals. Wishing you the best of luck!
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