IVF Injection Technique: A Practical Guide to Making It Easier

Nobody feels calm the first time they look at a needle and realize they have to inject themselves. Or have someone inject them. The good news is that most people who've been through IVF will tell you the same thing: it gets easier. Not because the needles disappear, but because you learn what you're doing, you build a small ritual around it, and your hands stop shaking quite as much.

This guide walks you through the two main injection types used in IVF, the medications you'll most likely encounter, and practical techniques to make each injection as comfortable as possible.

Subcutaneous vs intramuscular injections

IVF protocols use two types of injections, and they are quite different experiences.

Subcutaneous (SQ) injections

Subcutaneous injections go into the fatty tissue just beneath the skin, typically in the lower abdomen, about two inches from the navel, or in the outer thigh. These use short, thin needles (usually 25 to 27 gauge, half an inch or shorter). Most stimulation medications are given subcutaneously.

Common subcutaneous medications include:

• Gonal-F (follitropin alfa): An FSH medication that stimulates follicle development. Comes as an auto-injector pen or multi-dose cartridge. See our IVF medications guide for full details.
• Menopur (menotropins): Contains both FSH and LH. Given via syringe after mixing powder with diluent.
• Cetrotide or Ganirelix (GnRH antagonists): Prevent premature ovulation. Come as pre-filled syringes.
• Lupron (leuprolide acetate): Used in various protocols for down-regulation or trigger. Small volume, thin needle.
• Ovidrel (choriogonadotropin alfa): The trigger shot. Pre-filled pen.

Intramuscular (IM) injections

Intramuscular injections go into muscle tissue, most commonly the upper outer quadrant of the buttock (gluteal muscle) or the outer thigh. These use longer, wider needles (21 to 22 gauge, 1 to 1.5 inches). They can feel more daunting but are manageable with the right technique.

Common intramuscular medications include:

• Progesterone in oil (PIO): Used for luteal phase support after egg retrieval or during frozen embryo transfer preparation. Sesame, olive, or ethyl oleate oil base. Daily injections, often for 10 to 12 weeks in successful cycles.
• Some trigger protocols: hCG (Pregnyl, Novarel) is sometimes given intramuscularly.

Subcutaneous injection technique

1. Wash your hands thoroughly with soap and water for at least 20 seconds.
2. Gather your supplies: medication, needle, alcohol swab, gauze or cotton ball, sharps container.
3. Prepare your medication according to your clinic's instructions. For powders that require mixing (like Menopur), follow each step carefully.
4. Choose your injection site. Rotate sites to avoid tissue buildup. Most people alternate sides of the lower abdomen.
5. Clean the area with an alcohol swab and let it dry completely. Injecting while the site is still wet with alcohol stings more.
6. Pinch a small fold of skin between your thumb and index finger. This is especially helpful for people with less abdominal fat.
7. Insert the needle at 45 to 90 degrees, depending on the needle length and your tissue depth. Your clinic will advise on the angle for your specific needle.
8. Inject slowly and steadily. Rapid injection is more uncomfortable. Count to 5 as you push the plunger.
9. Remove the needle at the same angle you inserted it, then apply gentle pressure with gauze. Do not rub.
10. Dispose of the needle immediately in your sharps container.

Intramuscular injection technique

1. Warm the oil before drawing it up by holding the vial in your hands for a few minutes, or placing it in warm water (not boiling). Cold oil is thicker and harder to inject.
2. Draw up the medication with the larger needle provided, then switch to a fresh needle for injection. This gives a sharper needle point.
3. Locate the correct site. For the upper outer buttock: imagine a line from the top of the hip bone to the crease of the buttock. Inject in the upper outer quarter. Your clinic may have you mark the site.
4. Clean the area and let it dry.
5. Relax the muscle. If using the buttock, standing with your foot turned inward helps relax the gluteal muscle. Having your partner inject is often easier for IM sites you cannot see easily.
6. Insert the needle quickly and firmly at 90 degrees. A confident insertion is less uncomfortable than a hesitant one.
7. Aspirate gently (pull back on the plunger slightly) only if your clinic instructs this. Many current guidelines no longer recommend aspiration for IM injections.
8. Inject slowly, counting to 10. IM injections involve more volume and take more time.
9. Remove and apply gentle pressure. Massage the area lightly for 30 to 60 seconds to help distribute the oil and reduce discomfort.

Tips for reducing pain and anxiety

Ice or heat beforehand. A cold pack on the injection site for 30 seconds can reduce sensation. Some people prefer a warm compress to relax the tissue. Try both and see which works for you.

Room temperature medications. If medications have been refrigerated, letting them sit at room temperature for 10 to 15 minutes before injecting can reduce stinging.

Distraction helps. Play music, watch something, have your partner talk to you. Keeping your brain occupied elsewhere really does reduce how much you feel.

Breathe out as you inject. Exhaling through the injection moment reduces muscle tension.

Site rotation is important. The same spot injected repeatedly becomes bruised and tender. Keep a loose mental map of where you've injected and move to a new area each time. TrackMyIVF's injection site tracker can help you rotate systematically.

For progesterone in oil: Moving and warming up gently after the injection helps distribute the oil and may reduce the knot-like lumps that can form with repeated injections. Sitting on a heating pad for 10 minutes after is a common technique.

If you are doing injections alone

Injecting yourself, especially for intramuscular sites, takes practice and courage. Many people find the outer thigh easier to reach for IM injections when they are doing them alone. Auto-injector pens for subcutaneous medications make self-injection significantly easier.

If you're struggling, reach out to your clinic's nursing team. Most clinics offer in-person injection training, or you can ask a nurse to walk you through it again over a video call. There is no shame in needing more support.

When to call your clinic

Contact your clinic if you notice:

• Significant swelling, warmth, or redness at an injection site that doesn't improve
• A lump that is growing larger or unusually painful
• Signs of allergic reaction: hives, difficulty breathing, facial swelling
• You accidentally missed a dose or injected the wrong dose

Bruising and minor soreness are normal. Severe pain or signs of infection are not. Your care team wants to hear from you.

You are doing something genuinely hard. Every injection is an act of determination and love. That matters.

TrackMyIVF is not a medical device and does not provide medical advice. Always follow your clinic's specific injection instructions and consult your nurse or physician with any questions.