IVF injections: when, where, how, who and arrrrrggghhh!

URGGGHHHHH IVF INJECTIONS.

Unless you’re somehow reading this a century from now and scientists have found a way for you to avoid IVF injections, needles will play a big part in your trying-for-a-baby life. (And if you’re reading this a century from now, why aren’t you just receiving messages telepathically like everyone else around you? And aren’t all babies grown out of computers anyway these days? I digress.)

Here’s the short, sharp shock you need to know before you start IVF: sometimes, you might be giving yourself up to three injections a day. Every day. For weeks.

But before you throw your hands in the air and yell, “Screw this, I’m getting a puppy”, I swear it's not that bad. Daily injections aren't on anyone's bucket list, but you'll be remarkably impressed by how quickly it all feels so ordinary – if you allow it to, that is.

That out the way, let's focus on some of the practicalities…

I'm terrified of needles… how can I cope with IVF injections?

Most IVF injections don’t hurt – or if they do hurt, it’ll only be for a second or two. There are just three types of injection that might noticeably sting:

• The hCG trigger is usually a subcutaneous injection but can sometimes be prescribed as an intramuscular one.
• You might be prescribed blood-thinning injections after egg retrieval. These burn for a couple of seconds when the medication is going in, and can also cause a fair few bumps and bruises (which disappear in time).
• After embryo transfer, you’ll be put on “progesterone support” to encourage the lining of your uterus to remain thick and cushiony. Progesterone can be prescribed as subcutaneous injections (which go just under the skin), suppositories, vaginal gel or intramuscular injections (which go into the muscle and are absorbed more quickly). It’s the intramuscular injections that can ache.

Here are a few tips on how to reduce any pain:

• Try not to tense up. Tensing the muscles can make injections hurt more than they would otherwise.
• For intramuscular injections, apply a heating pad to the injection site for about ten minutes beforehand: it can help to relax the muscle.
• Dab a gum/ulcer gel (such as Anbesol) onto the injection site a few minutes beforehand (but be sure to wipe it away before you actually inject). It should numb the area slightly so you won’t feel the needle going in too much. This method won’t work so well with the blood-thinners, because those sting from the medication itself going in – not the needle.

But remember: most injections don’t hurt at all. So dive right in and you'll get used to them in no time.

Who should give the injections – me or my partner?

There are pros and cons to each. When it came to our own IVF experience, my husband took on the role of Chief And Only Injectioner: I found it too weird to try to do it myself. But then a few months in, he went away on a business trip and it was just me, a box of syringes and John Humphrys (on the radio, obvs. I miss you, John).

I probably took a deep breath because that’s what people do, and went in. And… my poor husband was suddenly out of a job. Giving myself the injection was about a trillion times less stressful than when he got involved, and it was also pain-free (whereas when he did it, it would sometimes sting a bit because he got the angle wrong).

But for all future injectioning occasions, we made a pact that we’d always be together – even though I could do it myself. Why? Because we’d grown to love those mornings and evenings when we’d get together in the living room and have nice little chats while he stabbed me multiple times in the stomach. From then on, I stabbed myself, but the little chats remained. It also helped him feel part of the IVF experience more.

That’s just my experience, of course, but I hope it helps you figure out what you want to do.

How do I (or my partner) learn the art of giving IVF injections?

Your clinic or hospital will teach you what to do. (And if they don’t offer it, ask: there’s absolutely no way they’ll expect you to know what to do automatically.) If you want a refresher session, ask: they’ll be more than happy to help.

You can also cement your learning with YouTube videos – although you should always run these past your doctors to make sure they approve of the instructions.

One Duff reader emailed me to say she found some great advice (on giving subcutaneous injections) on the Great Ormond Street Hospital site. While the advice is aimed at injecting children, most of it applies to adults too: https://www.gosh.nhs.uk/conditions-and-treatments/procedures-and-treatments/giving-subcutaneous-injections. As my reader said, “There was something calming about being reminded that there are sick kids needing their parents to do this many times a day, which helped me get a grip!”

What time of day should I do the injections?

For most stimulation medication, this isn’t usually a decision you get to make: doctors will ask you to inject stimulation drugs every evening. That’s because your scan appointments and blood tests will always be during the day, so they can adjust your dosage before your next jab that night.

When it comes to other types of injections, there are time-gap-related limitations. For example, you might need to give yourself two jabs of Lubion (oestradiol) each day after embryo transfer. Those jabs need to be spaced a certain number of hours apart, so it makes sense to do one in the morning and one in the evening.

What should I do if I miss a dose, or if half leaks out the syringe as I’m injecting?

Please don’t double up on your injections the next day, or try to inject yourself with half of another syringe. Instead, speak to your hospital or clinic as soon as you can (even if it means waiting until the next day), and – most importantly – don’t panic! There’s a good chance your missed dose/underdose won’t make a difference if you don’t make the mistake frequently.

The one time it’s really important you don’t miss a dose is the trigger injection. That injection is timed to precede egg retrieval by about 36 hours, so it’s kind of a big deal if you forget about it. If you miss the slot by a few minutes, don’t worry: you’ll be fine. If you realise after a few hours, call the hospital/clinic: they may well tell you to take the injection at a later hour, then move your egg retrieval back by the same number of hours.

Want to know more about the trigger injection? Read my article on the IVF process from start to finish or download the summary below: