IVF Injections Guide

Some couples find it challenging to get pregnant and several factors can affect how easy or hard it can be to start a family. One way individuals get help is through assisted reproductive technologies or fertility treatments 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 inside a lab. Once fertilization is done, the embryo is given some time to mature before it’s transferred into the uterus. The embryo 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. 

The IVF Process

IVF can be a time-consuming and emotionally taxing journey. Before starting the cycle, it's important to prepare your mind and body for the journey ahead. 

• You will undergo various tests Including, blood tests, ultrasound scans, laparoscopy, infectious disease screening, and genetic screening. The male partner will also be done for a semen analysis to test sperm quality. 
• You will go through a sonohysterography test to check the lining of the uterus.  
• 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

Different medications are given during an IVF cycle. These medications can be in oral or injectable form. Medications are given at the beginning of the menstrual cycle. The medication is administered once or twice a day for about 7–14 days, depending on your doctor’s protocol. Common drugs given during IVF include the following.

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 levels are not enough, human menopausal gonadotropin (hMG), which combines FSH and LH, is given.

GnRH agonists

Gonadotropin releasing hormone (GnRH) is a hormone produced in the brain that indirectly stimulates ovaries. Gonadotropin-releasing hormone (GnRH) GnRH agonists are the synthetic forms of GnRH, which stimulate the ovaries and, at the same time, suppress 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. Popular GnRH agonist drugs include Lupron, Zoladex and Synarel.

hCG injections

Whenever you take a preganancy test, one of the things that highlights whether you’re pregnant or not is the Human chorionic gonadotropin (hCG). 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. 

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 to prevent natural ovulation. Natural ovulation is stopped 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.

Antibiotics

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

How IVF Works

Steps in the IVF cycle largely depend on the fertility clinic you choose to go with. However, there are some similarities that patients have to undergo. 

Downregulation

Downregulation refers to suppressing the natural menstrual cycle to prevent ovulation. This is recommended by fertility doctors and is important in ensuring only good-quality eggs are fertilized. 

you’ll have to give yourself daily injections of gonadotropin-releasing hormone (GnRH) antagonists for about two weeks.

Ovarian stimulation

This is a key stage in the IVF cycle. The patient is given 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. 

You will be monitored regularly to see how your ovaries are responding to the injections. The size and number of follicles will be measured. Follicles 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.

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. At the same time, the male partner will be asked 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.

Fertilization

The retrieved eggs are then fertilized with the sperm using traditional insemination. Here, 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.

Embryo Transfer

After fertilization, the embryos are placed in an incubator to see how they are developing and when they reach the blastocyst stage (typically five days after fertilization), they are 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.  You can choose to implant one or more embryos. 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.

The Bottom Line

If you're having problems getting pregnant, your doctor may recommend IVF to you. The IVF injections are part of the process and they encourage many eggs to mature simultaneously. However, each fertility clinic may have its own drug protocol.