If In-Vitro Fertilization (IVF) was a movie, the medications would be the villainous sidekicks. Not the main menacing bad guy, but the annoying, unwanted plot necessity (picture the hyenas in The Lion King). We all know that they are essential to the journey, but you still wish you could get to the end of the movie without ever encountering them.
How did medication get the “bad guy” label? Maybe you’ve heard injection horror stories from a friend or colleague, or you’ve seen posts on social media of people making weird cakes with their used syringes. As a result, you grit your teeth, prepare yourself for the worst, dive in, and give yourself your first injection…
And then you realize that it’s not that bad.
As the days progress, you go from feeling relief to, believe it or not, a sense of empowerment.
Huh? How could that be?
Well, let’s dig into how injections work and what they actually do.
What Are Ovary-Stimulating IVF Injections?
Let’s back up a little. Depending on the type of medication, fertility meds come in many forms: pills, patches, nasal sprays, or injections. Oral medications are usually the first step for those proceeding with fertility treatments (for instance, ovulation induction or IUI), but they are not strong enough to provide the response that we desire during an IVF cycle. Once you make the decision to move forward with IVF, we need to use injectable medications that directly stimulate the ovaries to produce multiple dominant follicles.
Quick reproductive lesson: Follicles are fluid-filled sacs that contain eggs that look like black circles on an ultrasound. Women naturally produce only one dominant egg per cycle, therefore, out of those “black circles,” only one keeps growing while the others are reabsorbed into the body.)
IVF ovary-stimulating injections are subcutaneous, like insulin injections, and utilize a small needle that goes under the skin into the fatty layer. We teach you how to administer them in the abdomen and, since the exact puncture site doesn’t need to be precise, most women can administer them themselves, even if they have never given themselves an injection in the past.
Most women feel good, emotionally, on the medications as their estrogen levels are elevated (low estrogen levels caused by some of the oral medications can cause legendary mood swings). Since your ovary is expanding beyond its usual size to accommodate the multiple follicles, it is normal to have bloating and water retention during the cycle. Also, even expert injectors (and I am one, I must say) can cause slight bruising at the injection site as it’s difficult to avoid the tiny, superficial blood vessels with the needles.
Do IVF Medications Deplete My Egg Supply Faster Than if it Were a Regular Month of Ovulating?
This is an incredibly common question that I get asked all the time. It’s a good one, because as you know, women are born with a finite amount of eggs. Every egg counts!
The short answer, though, is no. Here’s why:
Each month, a woman recruits a bunch of follicles from her ovaries. The number of follicles recruited differs per woman and can even be different in the same woman month to month. In a normal (unstimulated) menstrual cycle, one of the follicles becomes dominant around day 5, uses all of the hormone called follicle-stimulating hormone (FSH).
The other follicles cannot continue to grow without it. Therefore, they stop growing, die off, and get reabsorbed by the body. But here’s the important part: they are still withdrawn from your egg supply.
If we give a woman the proper hormones before dominant cycle formation, then we can salvage the as many of the other follicles as possible by giving them the FSH as well (the hormone I just previously mentioned that is necessary for follicular growth) that they need to mature and be fertilizable.
We also give the patient another hormone called LH, signaling the body to prepare for ovulation. These hormones are normal in a cycle, but usually devoted to one follicle. We up the ante and push the hormones into as many follicles as possible.
So long story short, we are not withdrawing additional follicles from your ovarian ‘bank’ that month – we are just allowing you to keep the change.
Why are IVF Injections Necessary?
This beginning part of IVF, with all the stimulation injections, is necessary for the in-lab part of the process.
We need to make many follicles (stimulated by your IVF injections) so that we can surgically retrieve them, combine them with sperm, make embryos that then make blastocysts (embryo at day 5-7, aka the best stage for implantation!), that then get implanted in the uterus.
Since there is a high rate of attrition from the eggs retrieved to the blastocysts available for transfer, we have to start with a lot to get the 1-2 blastocysts for transfer and some others to freeze or be analyzed for chromosomes, or both.
Need a refresher on the IVF Process?
How Much IVF Medication is Needed?
Your unique starting dose depends on many factors (such as your age, weight, and results of ovarian reserve testing) and might be increased or decreased during your cycle depending on your response.
No two people or cycles are alike, so your dose and medications may be different than your friend's, even if you are the same age.
Besides Ovary-Stimulating Medications, What Are the Other IVF Medications?
IVF stimulating medications aren’t the only thing you must take. Additional medications are prescribed so that you don’t ovulate prematurely – we don’t want to make a bunch of eggs only to have them be released into the fallopian tubes where we can’t retrieve them!
The “Trigger Shot”
Once the eggs are the perfect size, we give you a “trigger shot.” This causes ovulation to occur in 34-36 hours so that we can precisely time your retrieval to fall just before that window. This assures us that your eggs are as mature as they can be but haven’t ovulated yet.
Progesterone and Estrogen
If you are having an embryo transfer this cycle, we will prescribe progesterone injections and suppositories and estrogen pills for you to take at least until the pregnancy test.
Why? The cyst(s) that remain after ovulation are usually in charge of providing progesterone and estrogen, important implantation hormones that make the uterus thick and cozy for an embryo to implant there. Since we disrupted their functionality by giving you medication to prevent ovulation, we can’t rely on them to do their job... so we do it for them.
Should a pregnancy take place, you would continue taking these medications until the placenta starts to work in a few weeks.
The progesterone injections are intramuscular, and we show you how to administer these as well. Since they should be given in a large muscle (preferably the gluteal muscle, or butt), most women ask for help with these.
IVF Medications: When Fear Becomes Empowerment
Ok, back to the good part. One of the worst feelings during an infertility cycle is the lack of control that many women feel over their outcome. You have to rely on your fertility team and technology to help, and that can be frustrating, especially for those of us who believe if we “work hard, we can accomplish anything!” Unfortunately, fertility doesn’t always work that way.
But there are ways to feel empowered by this…
Injecting the medications at night and seeing the response in the next day or two (your estrogen level rise and those little black circles increase in size and number) is incredibly fulfilling. You feel like you are, well, actually doing something.
Many women report that they were surprised at how brave and resilient they became through the process, even if they were initially terrified by the thought of daily injections. I am not surprised as I encounter amazing and courageous women like you regularly.
What about the intramuscular progesterone injections? They can feel daunting, to say the least. Well, remember when I said that you might need someone to help you with them? Many partners, friends, or family members will ask how they can help. They, too, feel helpless. Allowing them to administer these for you gives them a way to support you, particularly if you are someone who doesn’t like asking for help.
Many partners have told me that they have found humor amid a stressful time while administering injections and others have told me that their collaboration during this part of the cycle deepened their relationship and commitment to each other.
In summary, do you want to take injections in your spare time for fun? Hell no. Are the injections as bad as most people make them out to be? No. In fact, there is a silver lining in that you can tap into your internal resources that you didn’t know you had until you were asked to do some hard stuff. Also, allowing someone to help you with the medications can enrich your relationship with them as they most likely feel strongly about helping but aren’t sure how.
Sometimes all it takes to switch from fear to empowerment is believing you can do this. Reading an article like is a helpful way to wrap your head around all that is to come with your IVF journey, and I applaud you for preparing as much as you are.
Undergoing an IVF cycle can be tough, but so are you.
What are the side effects of IVF?
