In vitro fertilization (IVF) involves a lot of injectable medications. If you’re somewhat squeamish around needles, that may make you anxious or uncomfortable.
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“Most IVF medications are administered subcutaneously — into the layer of fat beneath your skin,” says fertility specialist Julierut Tantibhedhyangkul, MD.
Injecting medication this way isn’t as bad as it sounds. And it’s also not unique to fertility treatments — healthcare providers prescribe subcutaneous injections for many conditions, including diabetes, severe asthma and blood clotting disorders. But if you’ve never given yourself an injection, it’s natural to be nervous. Knowing what to expect can ease your anxiety so you can confidently begin your IVF journey.
Dr. Tantibhedhyangkul describes the step-by-step process.
How are injectable medications used for IVF?
IVF is a type of assisted reproductive technology, a way to help people get pregnant. It’s a delicate and multistep process to:
- Stimulate ovaries to produce eggs.
- Retrieve the eggs.
- Fertilize the eggs with sperm to create embryos.
- Transfer one or two healthy embryos into the uterus.
“Timing is critical for IVF,” Dr. Tantibhedhyangkul says. “And injectable fertility medication plays an important role.” It helps get your body primed and ready for the removal of the eggs and embryo transfer.
Types of IVF injections
Injectable medications play a role in almost every phase of IVF. While fertility drugs are available under many brand names, each type of medication achieves one of four goals:
- Increase egg production: Gonadotropins are drugs containing follicle-stimulating hormone (FSH), luteinizing hormone (LH) or a combination of the two. These hormones encourage ovaries to grow multiple eggs (instead of just one) during a single cycle. Gonadotropins are administered through a subcutaneous injection.
- Prevent early ovulation: Gonadotropin-releasing hormone (GnRH) agonists and GnRH antagonists are two types of medication that keep your body from ovulating — that way, an optimal number of eggs can develop to a large size before retrieval. Both hormones are given as subcutaneous injections but work differently to suppress ovulation.
- Cause ovulation: Once ovarian stimulation is complete and the eggs grow, the next step is taking medication to trigger eggs to finish the maturation process and encourages your body to begin ovulation. This drug is typically injected subcutaneously, but it’s also possible to do it as an intramuscular injection. Human chorionic gonadotropin (hCG) and Lupron (a type of GnRH agonist) are two commonly used medications to trigger ovulation.
- Prepare for embryo implantation: Progesterone supplements help prepare your body for embryo transfer. Without enough progesterone, the embryo may have trouble attaching to the lining of your uterus and growing after implantation. You can administer progesterone shots for IVF into a muscle, but vaginal progesterone is also an option.
How many subcutaneous injections does IVF treatment require?
Infertility specialists prescribe different IVF medications in various ways, but the process is typically the same. The exact medications needed and the amount of time one needs to administer injections usually depends on age and what’s causing infertility.
“Most people use injectable medications for eight to 15 days,” says Dr. Tantibhedhyangkul. “In some less common situations, they may need to self-inject for three or four weeks.”
Do your injections at the same time each day. Most medications only need to be injected once daily, but some might require two or more daily injections.
How to give yourself a subcutaneous injection
Most medications you take during the early stages of IVF involve subcutaneous injections. If you’ve never given yourself an injection, familiarizing yourself with the steps can relieve some anxiety.
You typically inject subcutaneous shots into your stomach or thigh, says Dr. Tantibhedhyangkul. Your nurse may provide an illustrated guide explaining where to target your injections.
Choose your injection site and begin the steps:
- Clean the site: Wash your hands and clean the injection site with rubbing alcohol. Allow your skin to dry.
- Prepare the syringe: Carefully remove the needle cover. Hold the syringe with the needle tip pointed up and tap on the side to get rid of any air bubbles. Push the plunger gently until a small drop of medication appears on the needle tip.
- Insert the needle: Flip the syringe so the needle points toward your skin at a 90-degree angle — it should be parallel to the floor. Pinch your skin and firmly push the needle through the surface. Once the needle is fully inserted, let go of the pinched skin.
- Press the syringe: Depress the syringe until all the medication fully ejects.
- Remove the needle: Use gauze or a cloth to apply gentle pressure to the injection site.
- Dispose of the needle: Throw it out in a glass jar or another puncture-proof container.
Common side effects of subcutaneous fertility shots
Subcutaneous injections don’t typically cause serious side effects. Any minor side effects occur at the injection site and may include:
- Bleeding, which is easily controlled by applying pressure with a piece of gauze immediately following injection.
- Bruising, which you can avoid or minimize by injecting the medication into a different spot each day.
- Soreness, which should subside when you apply ice to the site.
Tips for making IVF at home easier
If you’re uncomfortable or unable to self-inject your IVF medications, Dr. Tantibhedhyangkul recommends taking these steps to make the process easier:
- Discuss the instructions with your IVF nurse, who can show you the best places to inject IVF medication.
- Do the first injection in the office with your IVF nurse.
- Ask a friend or family member to give you your medication.
- Watch instructional videos online to learn how to self-inject medication.
“Fertility specialists and nurses want you to succeed,” Dr. Tantibhedhyangkul encourages. “Look to them for resources and support throughout the process.”