Oftentimes, these medications are given by injection into the fat just under the skin (subcutaneous) or in the muscle (intramuscular). You may choose to do your own injections or ask a friend, partner or spouse to give them to you. Your health care provider will give you specific instructions about the medication and injections. In the course of treatment, patients may be required to receive up to 90 shots per cycle. Injections will be used to administer several types of medications that are critical to your treatment protocol, specifically if you are doing an ART cycle such as Ovulation Induction (OI) or IVF. Medications that might be prescribed for you by your reproductive specialist include:
- GnRH Agonists (Leuprolide Acetate, Lupron®) and GnRH Antagonists, (Ganirelx Acetate or Cetrotide®).
These medications are often used in conjunction with IVF. GnRH agonists and antagonists work by suppressing natural hormone production to prevent ovulation from occurring prematurely. These medications are given by subcutaneous injection.
- Gonadotropins, Follicle Stimulating Hormone (FSH): Bravelle®, Follistim®, Gonal-F®; Follicle Stimulating Hormone & Luteinizing Hormone (FSH&LH): Menopur®, Repronex®; Luteinizing Hormone: Luveris®; hCG: Novarel®, Profasi®, Ovidrel®).
These medications stimulate your ovaries to develop and mature follicles and ultimately eggs. They are usually given subcutaneously but may also be given intramuscularly. Although these medications must be prepared a bit differently prior to administration, the actual injections are the same.
Bravelle®, Menopur® and Repronex® are all supplied in vials. Using the supplied needle-free reconstitution device (Q-cap) and a syringe, the liquid is mixed with the powder to prepare the medication for injection.
Follistim® and Gonal-F® are pre-mixed medications administered using a pen device.
Luveris® is sometimes used in conjunction with FSH injections to assist with follicle development.
Novarel®, Profasi®, Ovidrel®, commonly referred to as hCG, this medication is given to induce the final maturation of your eggs, and if an egg retrieval is not performed, will also stimulate ovulation.
- Progesterone. A hormone, progesterone is naturally produced after ovulation. Should a pregnancy have taken place as a result of your ART procedure, the progesterone will prevent your uterine lining from shedding, thus preserving your developing embryo or embryos. As the pregnancy progresses, the production of progesterone will be taken over by the placenta. For some patients, especially those undergoing IVF, insufficient quantities of progesterone are often produced. In these circumstances, progesterone supplementation will be prescribed. This medication may be given by intramuscular injection or vaginally (as a gel, suppository, or insert). Your health care provider will prescribe the medication considered best for your particular situation. Progesterone supplementation is generally begun around the time of an egg retrieval or ovulation and may be recommended well into your first trimester of pregnancy until your pregnancy produced sufficient hormonal production to maintain itself.
Crinone® is a vaginal gel.
Endometrin® is a vaginal insert.
Generic progesterone is a vaginal suppository.
Psychological and Emotional Benefits
Most patients learn to tolerate the physical and psychological discomfort associated with the routine of daily injections, and incorporate it into their lifestyle during the course of their treatment. Some individuals find that their preference is to self inject their own medications. This can give a sense of control over the experience and also adds scheduling flexibility, as it is suggested that you receive your medications at around the same time each day. Other women prefer to have someone else administer their medications to them. This can be done by a partner, a healthcare professional, a neighbor or a good friend. For many in this situation, the first person they will turn to for support with the injection process will be their own spouse or partner.
Despite the fact that only one of you will be getting the actual injections, if you are trying to conceive and are part of a couple, all of the procedures and routines required affect both of you. How you will build this routine into your daily life should be discussed, decided and agreed upon. Often individuals will find that they are uncomfortable asking their partners to give them their injections and choose not to initiate the conversation. And sometimes, a spouse may feel uncomfortable providing an injection to their partner.
However, by talking it through, you may find that you are creating a strong bond that will give you both strength to get through your days of fertility treatment together. You may also avoid feelings of isolation if the tasks required for conception are shared.
Other benefits of sharing the injection process may include an increased sense of ownership and responsibility for the cycle by both people involved, and also the opportunity to share the outcome, either good or bad, together. Sharing the experience can help alleviate feelings of self blame, or of blame towards your partner if things don’t work out the way you both had hoped.
In addition, you may find that you experience a stronger appreciation for your partner, and they towards you, if you both go through this together.
For many people, a positive element of couples injection is the opportunity that this experience provides to create a story for their future children about their origins. The “I used to give mommy her medications saga” can be funny, emotional, even poignant, and may become part of your child’s cherished history about themselves.
When you’re ready to begin, you may find that a large, overwhelming box will arrive from your pharmacy filled with a daunting array of medicines, syringes, and needles. The hopeful images of “our baby” can be jarringly replaced with the clinical reality of ART. Some patients feel overwhelmed or anxious when faced with the responsibility of handling and administering expensive and crucial medications1, but here are some basic instructions to keep in mind.
Whether you choose to self inject or have someone else give you your medications, it will be important for you to follow the dosing instructions given to you by your doctor. Begin your injection preparation by gathering all the supplies that you will need for your injection, such as the medication(s), syringe or pen device, alcohol pads, etc. Choose a clean, flat surface to prepare your injection.
Visually inspect your medications. Make sure that the liquids are clear; they should never be cloudy or contain obvious particles. Check the expiration date, too. The person giving the injection should thoroughly wash their hands with lots of soap and warm water. When the medication is prepared for injection (that is, mixed or assembled), choose the injection site and gently wipe that area with alcohol. Allow the site to dry for a few seconds prior to injecting. Alternating the injection sites may help to keep any one area from becoming too sore or tender. Also, always be sure to follow intra-muscular injections with safe, healing, non-erotic touch in order to support physical healing, as well as intimacy and connection.
After your injection, be sure to properly dispose of your needles and supplies in a proper sharps container or in an unbreakable plastic container that can be sealed tight.
Although the pen devices are reusable, never reuse needles.
A possible goal the two of you might share for this experience is the creation of a sense of intimacy, when the act of conception is no longer a private one. There are a number of techniques that may help you to achieve this goal.
If you decide that couple injection makes sense for both of you, set the stage. Your medications and tools need to be sterile, but the atmosphere does not. If possible, schedule the taking of your medications in comfortable surroundings, such as your own home. Try to arrange injection time around an activity you both enjoy, such as cooking dinner together, or watching a movie. Have something planned each day to look forward to immediately following the injection procedure. Maybe this is the time to take a bubble bath together, or simply sit down to a lovely meal and talk about your day.
It is important to try to maintain a sense of humor and understanding of each other during this process. If you are on the receiving end of the needle, it is possible that your partner may accidentally hurt you while giving you an injection, and that may make you feel temporarily upset, or even angry. These feelings may be made even more intense by the mood swings brought on by the medications themselves that many people go through during the fertility process. It is important that you both try to remember that the intention you share is to become parents together, and this is simply the means to an end that you both want very much.
Whether you choose to self inject, or proceed with this process as a couple, many people will feel a build-up of tension in the hours leading up to injection time. As with most things, the more information you have, the less anxiety you will feel. Make sure that you are thoroughly trained by a healthcare professional at your doctor’s office about the how-tos of giving injections, and use this video as a guide. Ask your doctor to provide you with their after hours telephone number in case you need additional support. Often, pharmacies have immediate assistance numbers posted on their websites that you can use if you have additional questions or concerns.
As long as you follow your doctor’s directions and also strive to maintain a high level of cleanliness for the injection procedure, there is no right way or wrong way to receive your medications. It is important that you do what feels right and comfortable for you during the course of your treatment. This is your journey, and while much of it may feel out of your control, it is very much up to you how your medication protocol will be handled.