IVF Injections Guide

While some people can start their families the natural way, others need a little help to do so. One way individuals get help is through assisted reproductive technologies like in vitro fertilization or IVF. IVF is a fertility treatment where eggs are combined with sperm outside of your body in a lab. The process involves many steps and different medications, including injections. 

Key Takeaways

• IVF uses hormone therapy injections that are given over some time to prepare eggs for fertilization.
• Many of the injections used during an IVF treatment can be done at home by the patient.
• Subcutaneous injections are given in the area beneath the skin surface, like the stomach or front thigh. 
• Intramuscular injections are delivered directly into the muscle, usually in the top outer quadrant of the buttocks.

What is IVF?

In vitro fertilization, or IVF, is a fertility treatment where sperm and an egg are fertilized outside of the human body and inside a lab. After fertilization, the embryo is allowed to mature for some time before it’s transferred into the uterus. The embryo then implants itself in the uterine wall and starts to grow. 

IVF is recommended when dealing with: 

• There are blocked or damaged fallopian tubes,
• There’s infertility relating to sperm quality or quantity
• Uterine, fibroids, endometriosis, or polycystic ovarian syndrome (PCOS)
• Advanced age (40 and above)
• Unexplained infertility
• Recurring miscarriages
• Tubal ligation

At facilities like Ivy Fertility, treatment is customized based on each individual’s needs. The whole process can last between four and six weeks, and healthcare professionals will monitor your health and adjust your dosage as you progress through the cycles. 

What to Expect Before Starting IVF

IVF can be a long and arduous journey. Before starting the cycle, it's important to prepare your mind and body for the journey ahead. 

• The fertility clinic will take you through different tests, such as ultrasounds and blood tests, to check your body. You will also go through ovarian reserve testing to find out how many eggs are available in the body. 
• A sonohysterography test will be done to check the lining of the uterus.  
• If you are going through IVF with a male partner, they will go through a semen analysis to check the amount of sperm, how they move, and how they are shaped. 
• You will both be screened for infectious diseases like syphilis, hepatitis C, human papillomavirus, and HIV. 
• Test the depth of your uterus by practicing embryo transfer. This also helps to decide the technique that will work well during the process.
• Your fertility clinic will ask for a plan in case you have any extra embryos.

IVF Medication Used

The medications used in IVF are used to stimulate the ovaries to produce many follicles (fluid-filled sacs in the ovaries) which contain eggs. Healthcare professionals start giving the medication at the beginning of the menstrual cycle. The medication is administered once or twice a day for about 7–14 days, depending on the medication protocol. Here are some of the most common medications used during the IVF process.

GnRH Agonists

Gonadotropin releasing hormone (GnRH) is a hormone produced in the brain that indirectly stimulates ovarian function. Gonadotropin-releasing hormone (GnRH) GnRH agonists are synthetic forms of gonadotropin-releasing hormone (GnRH), which stimulates the ovaries and, at the same time, suppresses the production of any new gonadotropins. In other words, GnRH agonists control the development and maturation of eggs during the IVF cycle and help prevent premature ovulation. The most commonly used GnRH agonist is Lupron, but other forms include Zoladex and Synarel.

GnRH Antagonists

GnRH antagonists bind to the receptor for gonadotropin releasing hormone in the pituitary gland, preventing the natural luteinizing hormone surge and ovulation. GnRH antagonist medications are given later in the cycle than Lupron, and they prevent natural ovulation to ensure the maximum number of eggs can be retrieved during the IVF cycle. Protocols that use these medications may require fewer injections. An ultrasound is done to measure follicular growth to see when to start these medicines. Common drugs include Antagon, Ganirelix, Orgalutran, and Cetrotide.

Progesterone

After egg retrieval, progesterone is given to prepare the uterine lining for implantation. It helps to ensure the uterine lining is at optimum thickness. Popular types of progesterone include Endometrin, Crinone gel, and Prometrium tablets. 

FSH Injections

Follicle stimulating hormone injections are given to stimulate the growth of follicles in the ovaries. If FSH injections are not enough, human menopausal gonadotropin (hMG), which combines FSH and LH, is given.

hCG Injections

Human chorionic gonadotropin (hCG) injections are given to enhance the success of pregnancy. They are given after embryo transfer and play a key role in preparing the uterine lining. 

Antibiotics

Some healthcare professionals prescribe oral antibiotics like doxycycline to help control any bacteria that may negatively affect embryo implantation.‍

How IVF Works

Each IVF cycle has four main stages, but these stages vary depending on the clinic.

Downregulation

Fertility specialists recommend starting your IVF cycle by suppressing the natural menstrual cycle to prevent ovulation. This process is known as downregulation. When done before IVF, downregulation reduces premature ovulation and enhances ovarian stimulation, which is the next stage. In this stage, you’ll have to give yourself daily injections of gonadotropin-releasing hormone (GnRH) antagonists for about two weeks.

Ovarian Stimulation

During this stage, you’ll be required to take hormonal injections to encourage more follicles to mature. The more follicles produced, the more the eggs can be retrieved. This means that instead of having just one egg (like in a natural cycle), you may produce many eggs. The type of medication and dosage will depend on your medical history, age, AMH (anti-mullerian hormone) level. 

The fertility specialist will monitor either daily or every few days how your ovaries are responding to the injections. They will measure the size and number of growing ovarian follicles. Follicles that are greater than 14 millimeters contain a mature egg, while those that are less than 14 mm are more likely to be immature and won’t fertilize.

Sperm Collection

If you’re going through IVF with a male partner, the fertility clinic will ask for a semen sample on the morning of your egg retrieval. If not, the clinic will use sperm from a donor. This is usually previously collected sperm that has been frozen. The semen is then washed/ prepared for the fertilization process.

Egg Retrieval

When your eggs are almost ready, a “trigger shot” is given to finalize the maturation of your eggs in preparation for egg retrieval. This trigger shot exactly 36 hours before your scheduled egg retrieval.  Egg retrieval has to be timed perfectly to avoid egg loss during ovulation, and you’ll receive anesthesia to ensure that you’re comfortable during the procedure. 

The eggs are removed using a needle to remove eggs from your ovaries. The retrieved eggs are then put in a controlled environment in preparation for fertilization. After egg retrieval, the clinic will update you on the number and quality of the embryos that have started to develop.

Fertilization

In this stage, the retrieved eggs are fertilized with the sperm using traditional insemination, where healthy sperm is mixed with eggs in a petri dish in the laboratory or through intracytoplasmic sperm injection, where sperm is injected into each egg separately. The combined mixture is given 20 hours to fertilize. In most cases, 70% of mature eggs will fertilize. If successful, the fertilized egg will become an embryo.

If there are extra eggs or you don’t want all eggs fertilized, you can ask the clinic to freeze them for future use.

Embryo Transfer

After fertilization, the embryos are placed in an incubator to see how they are developing. They will then be cultured and observed again every day. When the embryo reaches the blastocyst stage of development (typically five days after fertilization), it is transferred into the uterus. During transfer, the embryos are carefully injected into the uterus two to five days after egg retrieval. A blood pregnancy test is done 2 weeks later to confirm pregnancy. 

However, in some cases, the embryo takes a bit longer to develop, and it can be transferred much later, such that it reaches this stage on day 6 or even day 7 after fertilization.

You will discuss with your fertility specialist how many embryos to implant as well as how many embryos you would like frozen for later use.

The Bottom Line

IVF injections encourage many eggs to mature simultaneously. The length of the IVF cycle, as well as the dosage and type of injection, are tailored to your body based on your age, medical history, hormone levels, and your response to previous IVF cycles.