By Megan Kukic
Note: Administering fertility injections is one of the most stressful components of the fertility journey. The pain aside, the constant pressure of thinking you are going to “mess up” adds so much to the injection experience that it can become one of the most dreaded parts of fertility treatment.
To help, registered nurse, fertility patient, and founder of 412 Fertility, Megan Kukic, provides patients with some tips, tricks, and techniques designed to help make the process a little easier and allow you to be more confident when you administer your next shots.
The first night I needed a fertility injection, I told my husband I wanted him to do it so he could be “a part of the experience”. While that was true, I was also not looking forward to stabbing myself with a needle. I had him watch the video on how to administer a subcutaneous injection. We set our alarm in case we got sidetracked. He was ready and confident, and I was confident in him. All was well. When the alarm went off, I went to the refrigerator and pulled out the medication. I started wiping my stomach with an alcohol prep pad when he asked, “Can’t you just do it?!”
The truth is that I could do it. I had been a registered nurse for years prior to this moment. I had administered more injections throughout my career than I could ever recall. Not to mention that I was working as an RN in a fertility clinic at the time. Although I had the background, training, and skill, the thought of having to inject myself was a totally different experience.
If you find yourself not looking forward to starting fertility injections, I can assure you that you are not alone. Many patients experience the same fears related to injections: What if I do it wrong? It’s going to hurt. How am I supposed to know what I’m doing? I can assure you that knowing how to prepare, what to expect, and how to make it less painful is all going to help you feel more confident when you get to this stage of your fertility journey.
Understanding Fertility Medications
While there are numerous medications your reproductive endocrinologist could place in your protocol, they will most likely fall under two categories: subcutaneous (SubQ) or intramuscular (IM) injection. Injections for IVF stimulation, ovulation induction, and most triggers are given subcutaneously. IM injections are typically used for medications like Lupron for suppression, Progesterone in oil (PIO) for embryo transfer, or occasionally HcG trigger for egg retrieval.
Getting Started
The basics for fertility injections remain the same: wash your hands, clean the site with an alcohol wipe, let the alcohol dry, inject slowly, remember to breathe, and rotate left and right sides daily. A personal favorite is to listen to your favorite music as you prepare and administer your medications. You could also repeat affirmations, do a meditation, or whatever else might make you feel relaxed and ready to begin. Give yourself time to prepare so that you don’t feel rushed through the preparation process. I also recommend having a treat waiting for you as a reward to yourself – you deserve it.
There are some tips, tricks, and techniques that are specific to SubQ vs IM injections.
Subcutaneous (SubQ) Injections
SubQ refers to the layer of fat beneath the skin. Most fertility injections will be given in this fatty layer of the abdomen.
When choosing the injection site, it is recommended to inject ~1-2 inches away from the belly button.
My favorite tip is to think of your belly button as a nose and then inject where dimples would be when smiling. Avoid injecting directly above or below the “nose”, but rather a smidge below and to the side.
Once you find your intended injection site, ice the area as you prepare your medications. This will not only help with comfort, especially if injecting Menopur. Icing also constricts small blood vessels/capillaries beneath the skin, which can help prevent bleeding and bruising.
Using your non-dominant hand, “pinch an inch” of the skin you want to inject. This allows the fatty layer to be pulled away from the abdominal muscle, ensuring appropriate injection technique.
Intramuscular (IM) Injections
Intramuscular is exactly what it sounds like: into the muscle. Most clinics will recommend using your glute due to how large of a muscle it is. Because the needle needs to reach the muscle, you will notice these needles are a bit scarier. It is easier to have someone administer these to you, but it is possible to do them on your own!
If you divide one buttock into fours, always use the upper, outer quadrant. Think of where the top, outer corner of a pant pocket would be.
Pro tip: locate iliac crest (where back dimples are on lower back), then locate greater trochanter (golf ball-size bone on the side of upper thigh – press hard to find this).
Draw an imaginary line from iliac crest and greater trochanter.
Inject where this point meets.
Although an IM injection can technically be injected anywhere in the glute muscle, these techniques help to avoid the sciatic nerve and prevent additional discomfort.
You want your glute to be as relaxed as possible when injecting. If you prefer to stand, place all your weight on the side you are not using for injection. You can also lie down if that’s more comfortable. Instead of pinching the skin like we would for SubQ injections, we want to use our non-injecting hand to hold the skin taut between the thumb and pointer finger.
Progesterone in Oil (PIO) Injection Tips
PIO injections are the most common fertility injections that are given intramuscularly. Some tips specific to these injections include:
If using lidocaine or numbing cream, place a quarter-size amount on the intended site, do not rub in, and cover with Tegaderm or saran wrap up to an hour before your injection time. Simply wipe with a paper towel and clean the area with alcohol prior to injecting.
Some people prefer using a heating pad prior to injection, others prefer an ice pack, some prefer nothing at all. It truly depends on the person. Try each and see which feels best. If icing prior, I do not recommend icing for more than five minutes.
Once the medication is drawn into the syringe, place the prepared syringe in your bra or underneath your arm. Using body heat warms the oil for easier injection.
Heating and massaging the area after injection are key. Whether it’s a warm shower, a warm washcloth, or a heating pad, heat will be so helpful. A massage gun is also recommended.
If you’re able, perform some squats/lunges after the injection. I know, exercising after an injection is probably the last thing you want to do, but people swear by this to help prevent lumping!
Lumps in the injection area are common but are avoidable by proper heat, massage, and movement after each injection. Be sure to avoid re-injecting into major bruising/lumping.
Common Side Effects and What to Look Out For
With any injection - SubQ or IM - redness, bruising, and mild irritation can be normal. However, if you become concerned about any reactions, please do not hesitate to contact your medical team. If you have any questions related to your medications, you can not only reach out to your medical team, but you can also reach out to the pharmacy you ordered your medication from.
Pharmacists are great resources for any medication question and are typically easy to get ahold of. This is a gentle reminder that you are your greatest advocate and that it is better to ask for clarity than wonder with uncertainty.
About Megan
Megan Kukic is a registered nurse and fertility patient. She worked in the operating room of a fertility clinic before launching her own business, 412 Fertility Services, in March of 2023. 412 Fertility is an injection administration and medication teaching service specific to fertility patients. Her goal is to use her education and training as a nurse and her compassion and understanding as a fertility patient to guide patients through the injection process of their journeys.
More about Megan and her business can be found at 412fertility.com and on Instagram.