Going through in vitro fertilization (IVF) can be overwhelming. Understanding the process, the medications, potential side effects, and accepting that medical intervention, needles and in some cases, the help of a gestational carrier is necessary to build your family – it can take a toll. In this blog, we’ll provide an overview of IVF, what purpose the medication serves, plus some tips for taking the medications and any concerns you should be on the lookout for.
A healthy female typically produces a follicle that contains an egg every month. These follicles grow in your ovary and when released, it’s known as ovulation. If you’re pursuing IVF, however, you are prescribed injectable medications that aim to increase the number of follicles that will develop over a single cycle. More eggs mean a greater likelihood of multiple embryos. The goal, of course, is to ultimately increase your chances of IVF success.
You will be carefully monitored through blood work and ultrasounds during this time. This is to observe the follicle size and your estradiol blood level to monitor the estrogen in your system. When your doctor determines that your follicle is at a size indicating the eggs are mature, they will be retrieved using a laparoscopic technique. Follicles are viewed using ultrasound and then a very thin needle is inserted into the follicle to retrieve each egg. Based on how well you respond to the fertility medications, the number of eggs retrieved can vary. Any mature eggs are then fertilized with the partner’s (or a donor’s) sperm.
After the egg retrieval you are contacted with the fertilization results, or the number of eggs that became an embryo. Depending on your treatment protocol (if you’re doing a fresh or frozen transfer), embryo(s) are transferred to your uterus or your surrogate when your physician feels the time is ideal. If you are using a surrogate, she would have her own set of medications for the cycle.
Bravelle,® Follistim,® Gonal-F,® Menopur® and Repronex® are the most commonly used brand names of injectable medications. These are known as gonadotropins, which means, “any of a group of hormones secreted by the pituitary which stimulates the activity of the gonads.” All these medications are used to stimulate the ovaries to produce multiple follicles. Your doctor will prescribe the ones he or she feels will be the most helpful for your situation and diagnosis. However, it’s worth noting that these medications are very similar and can be used interchangeably.
Every individual and/or couple is responsible for the administration of these medications. Your clinic will teach you how to give these injections (or if you prefer, your partner can administer it).
Some commonly reported side effects to gonadotropins are the following:
• Mood swings
• Discomfort at the injections site
• Ovarian hypersensitivity (which is why you’ll be closely monitored)
Once you know what medication you’ll be taking and how to inject yourself, here is a list of things you’ll want to have on hand to prepare:
• A Band-Aid (or two, just in case)
• Antibacterial soap
• Cotton balls and alcohol or alcohol swabs
• Vials of medication
• Vials of diluent
• Syringes and needles (use the type and size recommended by your reproductive endocrinologist)
• Sharps container to dispose of used needles
How to prepare yourself and the area to take an injection:
• Choose a flat surface in your home to set up
• Clean the surface with alcohol and let air dry
• Wash your hands with antibacterial soap
• Set up your medication and supplies on the flat surface
In order to help minimize any pain or discomfort, the following tricks and tips are often recommended:
• Apply ice to the injection site 30 to 60 seconds before to help numb the area
• Make certain that air bubbles are removed from the syringe before injecting
• Wait until alcohol on skin has evaporated
• Mix up the site where you inject your medication to prevent one area from getting sore
• Inject medications when they are at room temperature (especially for progesterone in oil)
• Use a quick dart-like motion when putting in the needle
• Avoid changing direction of the needle once it’s in
• Warm compresses can help soreness of injection afterwards
All of the above are suggestions and do not replace any instructions you’ve been given by your reproductive endocrinologist, nurse or medical team.
Once the injection(s) are complete, discard any used needles, syringes and vials into your “sharps container”. This container is categorized as “medical waste” so it can be disposed of properly. Let your clinic know when the container is full.
Some other important things to note regarding injectable medications:
• The needles used for the injections must be sterile
• Do NOT reuse any needles
• Do not leave any needles lying around or dispose of them in your regular trash
Injections are usually done over a span of 10 days. If you prefer, you can hire a nurse to give your injections or a friend or relative can be taught.
Once the ultrasound and estradiol levels confirm mature follicles (eggs), your reproductive endocrinologist will determine when you are ready to receive the next injection, called human chorionic Gonadotropin (hCG). This is to induce ovulation for your egg retrieval.
The final stage is when the embryo(s) are transferred. You or your surrogate may be prescribed progesterone in oil (PIO). Progesterone in oil helps thicken the uterine lining to help the embryo and allow it to develop.
As always, if you have medical concerns, you should speak to your doctor. If you have questions around surrogacy, you’re always welcome to contact the team at ConceiveAbilities!
Written by Jennifer (Jay) Palumbo
Jay is a writer, a healthcare and family building advocate, CEO of Wonder Woman Writer LLC, a comic, and thyroid cancer survivor, a wife and mother of two extraordinary boys. Check out her Instagram and LinkedIn.
All Things Conceivable is a blog dedicated to sharing the knowledge and expert opinions of the dedicated team at ConceiveAbilities, a Chicago-based egg donation and surrogacy agency.