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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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I completed my first egg stim and retrieval cycle in January and I had all these same concerns! I have a fear of needles and have fainted in the past with shots. Also, my clinic did NOT do any overview of the injections, so I was just relying on videos from my pharmacy and my anxiety was high! In the end it was not that big of a deal. The sub-cutaneous needles are small and I barely felt them. I had a bit of a struggle on the first day figuring out how to depress the pen for one of my meds and had a pharmacy tech on the phone until I got it. According to people on Reddit, the Menopur injections were supposed to burn, but I didn’t feel that (I followed recommendations to let the Menopur sit for 10 minutes after mixing it, iced my injection area, and injected very slowly).
In the end, the hardest part was just managing the logistics of daily injections at precise times. I was able to work from home for the whole cycle, which helped a lot.
To add more details for what the injections involve: I had Gonal-F from day one in the evening, which came pre-mixed in an injection pen. A couple days in I added Menopur, which I had to mix a liquid and a powder and draw into a syringe (video helped make this all clear). A couple days after that I added in Cetrotide in the mornings to prevent early ovulation (also had to mix that one myself). Then 36 hrs and 24 hrs before the egg retrieval I had to do a couple shots of different meds to trigger final egg maturation. Egg retrieval day was determined 2 days prior based on ultrasounds and blood work. And for me was Day 12 of the stimulation cycle.