How many injections are needed for IVF treatment?

The answer is that it varies from person to person — but we promise it's not as bad as you’d imagine. If you're nervous about giving yourself daily hormonal injections, knowing what to expect can help ease your anxiety and make you feel more confident about your IVF journey. Keep reading to learn more about IVF injections.

How an IVF treatment works 

For each cycle, there are several stages of IVF, which include:

• suppressing natural hormone production

• hormone treatment to increase egg supply

• egg collection

• combining eggs and sperm (fertilisation) 

• transferring the embryo back into the womb. 

For most people, a round of IVF typically lasts between four and six weeks, but each patient is different, and the treatment can vary depending on the clinic and the individual. 

Types of medications used

When undergoing IVF treatment, you'll likely need to self-administer hormonal injections in various stages, depending on your specific treatment plan. The fertility medications used during IVF generally include: 

• Gonadotropin-releasing hormone antagonists (Cetrotide, Buserelin): Your fertility specialist may recommend starting your IVF journey by suppressing your body's natural cycle to temporarily "switch off" your ovaries. This makes them more sensitive to the hormones used to stimulate them later. You’ll have to give yourself daily injections of gonadotropin-releasing hormone (GnRH) antagonists for about two weeks.

• Follicle-stimulating hormones (Gonal-F, Menopur, Bemfola, Meriofert): Follicule-stimulating hormone (FSH) and luteinising hormone (LH) are types of gonadotropins that help your ovaries produce more eggs. This means more eggs can be collected and fertilised, giving the clinic more embryos to choose from. You’ll self-administer daily FSH and LH injections for around 10 days, but the treatment length can vary from person to person.

• Human chorionic gonadotropin (Gonasi, Pregnyl, Ovitrelle): Once the ovaries have been stimulated, the next step is to take a medication that contains human chorionic gonadotropin (hCG) to prompt the body to begin ovulation. This medication is often called a “trigger shot” because it triggers the ovary to mature and release an egg.

• Progesterone (Gestone, Prontogest, Agolutin): After the egg collection, your doctor may prescribe daily progesterone injections to help prepare your body for embryo transfer. Progesterone helps your uterine lining get ready for the embryo implantation process and supports the attachment and growth of the embryo. You'll be taking progesterone injections every day for about eight weeks. 

IVF medications come in different forms, and when they're prescribed as self-administered shots, they're usually subcutaneous injections — injections that you can give yourself with a tiny needle just under your skin. You can choose where to do it, whether in your thigh, tummy, or upper arm. Don't worry, you'll be taught very clearly how to give yourself these hormonal injections by your fertility nurse and with guidance from the Apricity app. 

Determining the right dosage

The dosage of your IVF injections depends on a few factors, including age, body mass index (BMI), and ovarian reserve. 

Your fertility specialist will determine the best IVF drug protocol and dosage to include in your treatment plan. Since every person is different, they'll tailor your medication plan to fit your unique needs. Your fertility specialist will regularly monitor your reproductive health and adjust the dosage of your medication as needed.

Some women are prescribed lower hormone doses of IVF, for example, if they're at risk of ovarian hyper-stimulation syndrome (OHSS) or have a history of cancer and can't take certain hormones. 

Three main approaches to IVF that involve no or fewer drugs: 

• Natural cycle IVF: This is a procedure that doesn't involve any fertility drugs. In this process, the single egg released as a part of the regular menstrual cycle is retrieved and combined with sperm, just like in conventional IVF. It's important to note that the National Institute for Clinical Excellence (NICE) doesn't currently recommend natural cycle IVF.

• Mild stimulation IVF: With mild stimulation IVF, you receive a lower dose of fertility drugs over a shorter period than standard IVF. This means you can avoid any potential  side effects from the drugs and complete your treatment quickly. PCOS, a reduced ovarian reserve, and male infertility are some of the most common reasons for needing mild IVF.

• In vitro maturation (IVM): IVM involves removing immature eggs and maturing them in the lab without hormone therapy. IVM is only available if you've opted for Intracytoplasmic Sperm Injection (ICSI). While IVM is a newer technique, it currently has fewer successful births than IVF. 

How many injections are required for IVF treatment?

How many injections are needed for IVF treatment may vary from person to person and depends on the IVF drug protocol your fertility specialist recommends and how your ovaries respond to treatment. Usually, injections are required for 8-14 days before egg collection, and you may also be prescribed different medication to inject following an egg transfer.

When it comes to how many injections to expect per day during IVF treatment, most fertility medications only require one daily injection, but some may require two or more. The number of IVF injections you'll have to self-administer will also depend on your age and the cause of your infertility.

Managing IVF injection side effects

Like most medications, the hormonal injections you give yourself during IVF can have some side effects. These can include: 

• Abdominal pain, bloating, and nausea

• Changes in the cervical mucus

• Headaches

• Hot flashes and night sweats

• Mood swings

• Tender breasts

• Light bleeding, bruising, or soreness at the site of the injections.

It's completely normal to experience some temporary side effects, but don't worry, they won't cause any future complications. If the side effects are getting in the way of your day-to-day life, your doctor can adjust the dosage, suggest changes, and give you some helpful guidance on easing the side effects. Remember, you're not alone in this journey; your fertility team is there to support you every step and can answer any questions you may have on the dos and don’ts during IVF stimulation.

As part of this, they will also keep a close eye on you to make sure there are no signs of ovarian hyperstimulation syndrome (OHSS). This is a potential side effect of the IVF injections used to increase your egg production.

If you do experience any symptoms of OHSS, such as bloating, abdominal discomfort, nausea, vomiting, shortness of breath, or lightheadedness, don't hesitate to reach out to your doctor. 

Tracking progress and adjusting dosage

Even though you'll self-administer your IVF injections, that doesn't mean you'll be alone. Your clinical team will keep a close eye on how you're progressing at each stage of your treatment. They'll run blood tests, do ultrasounds to check how things are going, and adjust your fertility medications if needed. 

Your Apricity advisor will always be available to answer any questions. We understand that IVF injections (and their side effects) can be a daunting experience, so we're here for you every step of the way. If you're feeling nervous or need reassurance, don't hesitate to contact your Apricity advisor. 

References

1. (2020, June 30). Fertility treatment 2018: Trends and figures. Human Fertilisation & Embryology Authority. https://www.hfea.gov.uk/about-us/publications/research-and-data/fertility-treatment-2018-trends-and-figures/#storage 

2. Kakkar, P., Geary, J., Stockburger, T., Kaffel, A., Kopeika, J., & El-Toukhy, T. (2023). Outcomes of Social Egg Freezing: A Cohort Study and a Comprehensive Literature Review. Journal of Clinical Medicine, 12(13), 4182. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10342811/ 

3. Mesen, T. B., Mersereau, J. E., Kane, J. B., & Steiner, A. Z. (2015). Optimal timing for elective egg freezing. Fertility and sterility, 103(6), 1551-1556. https://pubmed.ncbi.nlm.nih.gov/25881876/

4. Cascante, S. D., Blakemore, J. K., DeVore, S., Hodes-Wertz, B., Fino, M. E., Berkeley, A. S., ... & Grifo, J. A. (2022). Fifteen years of autologous oocyte thaw outcomes from a large university-based fertility center. Fertility and Sterility, 118(1), 158-166. https://pubmed.ncbi.nlm.nih.gov/35597614/

5. Maslow, B. S. L., Guarnaccia, M. M., Ramirez, L., & Klein, J. U. (2020). Likelihood of achieving a 50%, 60%, or 70% estimated live birth rate threshold with 1 or 2 cycles of planned oocyte cryopreservation. Journal of Assisted Reproduction and Genetics, 37, 1637-1643. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7376799/ 

6. (2018, December 20). Press release: Age is the key factor for egg freezing success says new HFEA report, as overall treatment numbers remain low. Human Fertilisation & Embryology Authority. https://www.hfea.gov.uk/about-us/news-and-press-releases/2018-news-and-press-releases/press-release-age-is-the-key-factor-for-egg-freezing-success-says-new-hfea-report-as-overall-treatment-numbers-remain-low/

7. Kasaven, L. S., Jones, B. P., Heath, C., Odia, R., Green, J., Petrie, A., ... & Nagi, J. B. (2022). Reproductive outcomes from ten years of elective oocyte cryopreservation. Archives of Gynecology and Obstetrics, 306(5), 1753-1760. https://link.springer.com/article/10.1007/s00404-022-06711-0 

8. Cimadomo, D., Fabozzi, G., Vaiarelli, A., Ubaldi, N., Ubaldi, F. M., & Rienzi, L. (2018). Impact of maternal age on oocyte and embryo competence. Frontiers in endocrinology, 9, 327. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6033961/