How Many Injections are Needed for IVF Treatment? | By Dr Firuza Parikh

by Dr. Firuza Parikh

During the remarkable IVF procedure, eggs are fertilized with sperm outside the body, and the developed embryos are carefully placed into the uterus for potential pregnancy.

IVF treatment consists of giving different types of hormones to recruit a good number of eggs. The type and dosage depend on the woman’s AMH levels, age, hormonal profile, and her response in past cycles. Typically, there are two protocols: the antagonist protocol (or short protocol) and the long protocol.

In the antagonist protocol, hormonal injections begin on Day 1 or Day 2 of the period, and the GnRH antagonist is added by Day 6 or Day 7 of the period. This antagonist keeps LH levels under control and prevents spontaneous ovulation. In the long protocol, GnRH agonist is started either on Day 1 or Day 21 of the period and continued until the ovaries are suppressed. Following this, the GnRH analogue is continued, and hormonal injections are added as per requirements.

When at least 2 follicles measure 17mm or more, the trigger to mature the eggs is given. Typically, egg retrieval is carried out 34 to 36 hours later. The trigger can be with HCG injection or GnRH injections in the antagonist protocol, or a mixture of GnRH and hCG can also be given. However, only the hCG trigger is used in the GnRH long protocol.

How Many Injections are Needed for IVF Treatment? | Table Of Content

Why are Medications and Injections Important During IVF Treatment?

IVF injections help with obtaining good quality and quantity of eggs. These medicines allow your doctor to manage ovulation right from the start of the treatment process. Throughout this ovulation period, the doctor will keep a close watch through ultrasound scans and blood tests, mainly checking estradiol levels and the development of the eggs until they mature. These observations will assist the doctor in making the necessary dosage adjustments.

What Are The Different Types Of IVF Injections?

There are two kinds of injections: one type is made from the urine of women who have gone through menopause, and the other type is created with recombinant hormones. The injections from the recombinant source are purer, work better, and are more dependable.

Typically, the injections are gently put under the skin, like a small pinch. They can be given in the muscle. But most people prefer the under-skin way because it’s less uncomfortable.

Why Are Injections Given During the IVF process?

In IVF treatment, injections have several roles:

Ivf injections aim to help with the growth of a good number of high-quality and mature eggs, increasing the chances of success.
Injections are given to trigger ovulation at the right time. This precision is vital for the proper synchronization of egg retrieval procedures in order to optimize the IVF treatment.
Injections of GnRH agonists are also administered to suppress ovulation and to thin down the lining prior to preparing the uterine lining for FET – Frozen Embryo Transfer. This step is important to prevent potential issues with implantation and to increase the chances of pregnancy.

The number of injections required in IVF treatment varies for each person. The kind and amount of medication are chosen according to each patient’s own condition.

The doctor will choose the specific type of injections and the treatment plan based on factors such as your age, body weight, ovarian reserve, past success with stimulation, and whether you have a PCOS profile or poor ovarian response. It’s important to create a customized protocol for each individual.

What to Expect from IVF Injections

IVF injections are relatively painless as they are mostly administered by the subcutaneous route. While they might not be the most comfortable, they’re quick, lasting just a few seconds. There are two types of injections that are used during the IVF procedure:

Subcutaneous Injections: These involve using a small needle to inject medication under your skin. Common fertility medications like gonadotrophins are given this way. You usually inject in your belly or the front of your thigh, similar to how people with diabetes use insulin pens. The feeling is like a quick pinch and sometimes a slight tingle or sting when the medication goes in. Most IVF medications are taken like this, using an injection pen. Giving yourself a subcutaneous injection is usually simple.

Intramuscular Injections: These injections put fertility medication directly into a muscle with a slightly longer needle. Progesterone in oil and the hCG “trigger” shot might be given this way. You typically inject in the upper outer part of your buttocks. You can do these injections yourself or your partner can help. Some people find the needle for this injection a bit intimidating, but it usually feels like a mild pinch.

What Are the 5 Most Common Fertility Injections And When Are They Given?

HMG (Human Menopausal Gonadotropin): This drug contains two hormones, FSH and LH, which stimulate the ovaries to produce multiple eggs. It’s often used in treatments like IVF. You’ll take daily injections for about 7 to 12 days in the first half of your menstrual cycle.
FSH (Follicle follicle-stimulating hormone): Similar to hMG, FSH can also be used on its own to stimulate egg production. The injections are given in a similar way as hMG.
hCG (Human Chorionic Gonadotropin): This hormone triggers egg release (ovulation) from the follicles. It’s administered at a specific time in your cycle, guided by blood tests and ultrasounds. You might recognize hCG as the hormone detected in pregnancy tests.
GnRH Agonists: This medication temporarily lowers hormone production in the ovaries. They’re used to carefully control egg development during fertility treatments. They might be taken before starting a cycle, followed by other drugs to stimulate egg production. This approach prevents premature ovulation until hCG injection is given.
GnRH Antagonists: They are similar to GnRH agonists; these drugs block LH hormone release. However, they work immediately and usually require fewer injections. They also help with egg development.

The Role of Fertility Medications in The IVF Process?

Throughout your IVF cycles, your doctor will prescribe a range of fertility medications as part of your treatment plan. These medications help with the release of hormones that help stimulate egg growth and maturation while also regulating ovulation in your body. These medications enhance your fertility during important procedures like egg retrieval and embryo transfer, significantly increasing your chances of a successful pregnancy.

Before you begin taking any medication, your doctor will look into your medical history and your partner’s if relevant. They will also conduct thorough exams and tests. If the reason for fertility challenges is found, your doctor will design a personalized plan to improve your chances of success based on the diagnosis.

Types Of Fertility Medications

Fertility Medication: These contain follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which stimulate the ovaries to produce multiple follicles. The medication amount and ovarian response vary based on the treatment plan (ovulation induction or ovarian stimulation for IVF).
Fertility Medication to Prevent Early Ovulation: In some cases, medications are used to delay early ovulation. This is important in IVF cycles where equal growth of follicles is desired. By delaying the LH surge that triggers ovulation, more follicles have the chance to mature. These consist of GnRH antagonists and agonists.
Fertility Medication to Induce Ovulation: Women with irregular ovulation may benefit from medications that induce ovulation at a specific time. Once a mature follicle (at least 17mm) is present, these medications trigger ovulation within 24 to 36 hours.
Fertility Medication for Implantation Support: Fertility drugs can help prepare the uterus for a potential pregnancy after ovulation. Once ovulation occurs, a structure called the corpus luteum forms in the ovary and produces progesterone, which makes the uterine lining ready for pregnancy. If some women have low progesterone levels or are having a frozen embryo transfer, they might need extra progesterone support. This support can be done through injections, pills, or vaginal administration.

The treatment for oligospermia depends on the cause and your condition. If your low sperm count is due to certain medications or habits, stopping them can potentially help increase your sperm levels. Surgical options might be considered if you have conditions like varicocele or blocked sperm ducts. Your doctor might prescribe hormone supplements or antibiotics if needed. If you’re dealing with issues like erectile dysfunction, counselling could be recommended. In some cases, increasing sperm count might not be possible, and your doctor might suggest alternative ways to assist you in reproduction utilizing ICSI.

Medications like oral contraceptive pills or GnRH agonists can be used to treat conditions like adenomyosis, endometriosis or uterine fibroids.

How Many Injections are Needed for IVF Treatment?

When you undergo IVF treatment, you’ll receive medications through injections. These shots can be either under the skin (subcutaneous) or into the muscle (intramuscular). The number of injections can vary depending on many factors, including your ovarian reserve and age. You might need 1 to 2 injections each day, depending on your specific treatment plan.

These injections contain hormones like follicle-stimulating hormone (FSH) and luteinizing hormone (LH). These hormones help your ovaries develop mature follicles and eggs.

The number of injections you’ll need during an IVF cycle is influenced by your individual factors and treatment choice. Here are some factors you need to consider:

Your Age: Older women typically require more eggs for successful IVF, leading to the possibility of more injections.
Your Ovarian Reserve: The success of egg retrieval relates to your ovarian reserve. A higher reserve often means fewer injections are necessary.
Your Medical History: If you have a complex medical history or fertility issues, your doctor might recommend more injections for better results.
Your IVF Approach: The treatment type also matters. Using donor eggs could mean injections and tablets for hormonal replacement since fertilized eggs are used.

Side-effects of IVF Injections

If you’re going through IVF (In Vitro Fertilization), it’s important to understand that there can be some side effects and risks. Here’s what you might experience or need to be aware of:

Soreness or Bruising from Injections: When you receive injections during IVF to stimulate your ovaries, you might feel some soreness, see bruising, or experience tenderness at the injection sites. To minimize this, try different spots for injections when possible.
Nausea: Some people may feel nauseous during IVF, and occasionally, vomiting can occur, although it doesn’t affect everyone.
Breast Tenderness: Fertility medications used in IVF can make your breasts feel more sensitive, similar to how they might before or during your period.
Bloating: You might experience a sense of fullness and swelling in your belly, which is known as bloating. This happens because the hormones used in IVF are similar to those in your monthly cycle but in higher amounts.
Hot Flashes: Some individuals report getting hot flashes, which are sudden sensations of heat and sweating, due to hormonal medications, particularly those that suppress oestrogen.
Mood Swings: These medications can influence your emotions, leading to mood swings. You could find yourself feeling irritable, restless, or a bit down.
Fatigue: Hormonal changes and physical symptoms like hot flashes might lead to feelings of tiredness during IVF.
Allergic Reactions: In some very rare cases, people may have allergic reactions to the injections, resulting in itching or redness at the injection sites.
Ovarian Hyperstimulation Syndrome (OHSS): There’s a possibility that your ovaries might respond excessively to the hormones, causing symptoms like bloating, nausea, and weight gain. Most cases are mild, so they can be managed with rest and fluids, but severe cases might require hospitalization.
Mild Pelvic and Abdominal Pain: After egg retrieval, you may experience mild to moderate pelvic or abdominal pain, similar to cramps. Usually, over-the-counter pain medication can help, and it typically goes away within a day or two.
Pelvic Infection: While it’s very rare, there is a small risk of infection during IVF procedures. Some doctors prescribe antibiotics to prevent this.
Multiple Births: IVF boosts the chances of having more than one baby, especially if more than one embryo is transferred. This can lead to complications like preterm birth, high blood pressure, gestational diabetes, and also the need for a C-section.
Emotional Stress: IVF can be emotionally challenging. Not every cycle results in a pregnancy, which can be disappointing. The process itself can make the lack of conception and pregnancy loss more painful, even though IVF doesn’t increase the risk of miscarriage.

It’s important to know about potential side effects. These can vary from person to person and might include:

It depends upon the number of injections, the daily dose and the days that the injections given depend on the age, the body weight, the ovarian reserve and the response in previous cycles.

All in all, there usually are no side effects. Some women may suffer from mood swings, a feeling of bloating, heaviness in the abdomen, enlargement of the ovaries, nausea and occasionally ovarian hyperstimulation. All these can be minimized by counselling and choosing the right type of medication.

What to Expect from IVF Injections?

IVF injections are medications that help your ovaries make eggs for pregnancy.

Throughout the ovarian stimulation, the doctor will monitor the growth of the follicles, the rate of growth, the number of follicles and the timing of the trigger injection in order to mature the maximum number of eggs. Here’s what you might notice during this process:

Changes in Body and Appetite: These shots can affect your weight and your hunger. Some medicines may make you gain weight quickly. If that happens, talk to your doctor. The weight gain is usually due to water retention. It clears up within a few days of the egg retrieval.
Emotional Changes: These injections can sometimes make you feel more emotional, like having sudden bursts of feelings. IVF treatment can be overwhelming, so you might feel emotional and find it hard to focus on your usual activities.
Digestive Issues: You might experience constipation because of the injections, which increase the levels of progesterone in your body. To help, eat a healthy diet with fibre and drink lots of water. You may require a mild laxative.
Stress and Anxiety: IVF injections and fertility treatment, in general, can be frustrating and cause stress and anxiety. Talking regularly to your doctor and trying stress-relief activities like meditation. Yoga can help ease these feelings.

Some common side effects you could and may experience include:

Headaches
Night sweats
Hot flashes
Abdominal pain
Bloating,
Nausea
Upset stomach and discomfort
Changes in cervical mucus
Temporary visual disturbances (blurred vision)
Dizziness and frequent mood swings
Tenderness in the breast
Skin redness, soreness, or bruise at the injection site
Irritability and restlessness
Overstimulation of ovaries, termed ovarian hyperstimulation syndrome (OHSS)

Which Time is Best for IVF Injections?

For the sake of convenience, the injections are usually administered in the evening as this is the time that the woman returns from work or is less busy. Although a new study indicated that morning time gave better success, it is a very small study and hence not statistically significant.

How to Make IVF Injections Easier?

Here are some tips to make your IVF journey easier:

Talk To A Therapist: To understand the IVF process, instead of Cognitive Behavioral Therapy (CBT), consider general counselling with a psychologist.
Ask Questions: You should be given the chance to ask as many questions as possible. No question should be ignored or avoided. Also, it’s best to provide you with realistic estimates of success. You should never feel that your questions are silly or stupid. Asking lots of questions should always be encouraged.
In Case Of Any Pain: You might experience some pain at the injection site, and some women may notice a bump, redness, or irritation. These issues usually resolve on their own. For abdominal injections, you could sometimes see bruising and a bluish-purple discolouration around the injection site. You can wear loose clothing and apply an ice pack. Taking an antihistamine tablet might help, too. Reassurance is often sufficient to resolve these problems.

FAQs

How can one make the IVF process easier?

General counselling by a psychologist and an efficient understanding of the IVF process will make the process easier.

What conversations/questions should the patients ask their doctors?

The patients should be given the chance to ask as many questions as possible. No question should be ignored or avoided. Also, it is best to give realistic estimates of success to the patient. The patient should not be made to feel that her questions are silly or stupid. Asking os questions should always be encouraged.

What are the things to do after getting the injections to reduce the pain

Some women may complain of pain at the site of injections. Some may experience a bump or a wheal and redness and irritation. Those usually settle soon. Abdominal injections may sometimes cause bruising and a bluish-purple discolouration around the site of the injection. Loose clothing and an ice pack application usually help. An anti-histaminic tablet can also help. Reassurance is mostly able to solve these problems.

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