« School of Injections »: guide for autonomous medication administration

You are about to enter an important phase of the treatment: stimulation or support of the cycle. We understand that the idea of giving yourself an injection may evoke fear and uncertainty. This is a completely normal reaction: 9 out of 10 patients experience the same feelings before their first injection.

However, modern medications and needles are designed to be used by non-professionals. The needles for subcutaneous injections are so fine that the injection is often imperceptible.

Consider each injection not as a complex medical procedure but as a small, safe step towards achieving your dream. This process is your personal contribution to the success of the program, whether it involves a conventional in-vitro fertilization (IVF), a donor egg IVF, or a double donation IVF. This guide has been written to serve as a reliable reference and to answer all your "how" and "why" questions.

1. Preparation: golden rules for safety and comfort

Before starting any injection, create a calm environment. Do not rush. Follow this detailed checklist:

1. Space setup: choose a well-lit place. Wash your hands carefully with soap and dry them with a clean towel. Prepare a clean surface (a table covered with a clean cloth or a disposable towel).
2. Visual check: take out the medication. Check that the name on the packaging matches the one on the doctor's prescription. Check the expiration date and the integrity of the packaging.
   • Tip: examine the solution in the light. It should be transparent, without deposits or flakes (unless otherwise indicated in the instructions).
3. Material: place all the necessary materials in front of you so you don't have to look for them during the procedure :
   • the medication (injector pen, vials, or ampoules with solvent);
   • Sterile syringes and needles (a thick needle for mixing, another thin for the injection, if the medication needs to be prepared).
   • Alcohol wipes (preferably take more than needed: 2 or 3).
   • Container for disposal (special container or any sturdy plastic bottle with a cap).

Important: temperature affects sensations. If the medication has been stored in the refrigerator, take it out at least 15 to 20 minutes before injection. Injecting cold medication can cause a burning sensation and discomfort.

2. Subcutaneous injections (in the belly)

This is often how medications to stimulate follicle growth (Gonal, Puregon, Ovitrel, Menopur) and blood thinners (Clexane, Fraxiparine) are administered.

Site selection for injection: your target area is around the navel, about 2-4 cm to the right, left, or below.

• Rotation rule: change the injection site daily. For example: today on the right side of the navel, tomorrow on the left. This helps prevent the formation of bruises and nodules.
• Avoid: do not inject into scars, moles, stretch marks, or areas where blood vessels and bruises from previous injections are visible.

Step-by-step technique:

1. Preparation: wipe the chosen area with an alcohol wipe in circular motions. Very important: let the alcohol dry completely (10 to 15 seconds). If you insert the needle into damp skin due to alcohol, you will feel a strong tingling sensation.
2. Pli: Using two fingers (thumb and index), firmly pinch the skin to form a fold. This is necessary to lift the subcutaneous fatty tissue above the muscle. The medication must enter precisely into the fatty layer.
3. Needle insertion:
   • Remove the needle cap. Hold the syringe firmly, like a pen.
   • Take a deep breath and, as you exhale, insert the needle at the base of the fold with a quick and precise movement. Do not insert the needle slowly while "pushing" the skin, as this causes more pain.
   • Inclination angle: For short needle syringes (insulin): 90 degrees (perpendicular). For regular syringes, if the needle measures over 1 cm or if you are very thin: 45 degrees.
4. Injection: without releasing the fold, slowly and gently press the plunger until it stops. A sudden injection of the medication can damage tissues and cause pain.
5. Pause: once the plunger is fully pressed, count slowly to 10 while continuing to hold down the injector pen button or the piston. This ensures that all the medication is distributed in the tissues and that the last drop does not leak out.
6. Removal: first remove the needle with a quick motion at the same angle used for injection, then release the skin fold. It is not necessary to apply a cotton pad, rub, or massage the injection site as this could cause a hematoma.

3. Intramuscular injections (in the buttock)

Typically, oil-based solutions (e.g., progesterone) or some forms of ovulation triggers (HCG) are administered.

How to find the right spot: Mentally divide the buttock into 4 equal squares (a cross). The injection should be strictly in the upper outer square (the one closest to the waist and thigh). This is the safest zone ("safety zone") where large nerves (sciatic nerve) or large blood vessels are not present.

Step-by-step technique:

1. A needle preparation: Make sure to use the right needle. It should be long (usually 3 to 4 cm, often with a green or black hub) to ensure it penetrates the subcutaneous fat layer and reaches the muscle. A short needle may leave the medication in the fat layer, leading to inflammation.
2. Position:
   • Alone: Stand in front of a mirror, profile view. Shift your weight onto the leg where you DO NOT plan to inject. The muscle of that leg should be completely relaxed (shake the leg to check). Tensed muscles make injection more painful.
   • With a partner: the ideal position is lying on your stomach. This allows maximum relaxation of the muscles.
3. Injection:
   • Disinfect the area with alcohol.
   • Stretch the skin at the injection site with the fingers of your free hand (this reduces nerve ending sensitivity). Do not pinch a fold!
   • Hold the syringe like a javelin. With a decisive movement, insert the needle perpendicular (at 90 degrees) over 3/4 of its length.
4. Verification (aspiration test): Hold the syringe with one hand and gently pull the plunger back with the other. If no blood appears in the syringe, it means you haven't hit a blood vessel. You can administer the medication. (If blood appears, remove the needle, replace it, and inject elsewhere).
5. Administration: Oil-based solutions are thick and difficult to administer. Press the plunger very slowly.
   • Tip: Before drawing the medication, warm the oil ampoule in your hands or under hot water until it reaches body temperature. Warm oil becomes more fluid and easier to inject.
6. Removal: Press the injection site with a clean alcohol wipe and quickly withdraw the needle. Immediately after, you can gently massage the injection site in circular motions to speed up absorption and prevent a “bump”.

4. Medication storage: refrigerator or room temperature?

Proper storage ensures medication effectiveness. Temperature fluctuations can damage hormone structure. Always check the instructions on the packaging!

Where to store? Read the instructions carefully

Refrigerator (+2...+8 °C)

Gonal-F, Puregon, Ovitrelle, certain forms of HCG.

Store them on the middle shelf. Never place medications against the back wall (they could freeze) or in the door (constant temperature changes during opening damage the medication).

Room temperature (up to +25 °C)

Menopur, Cetrotide, Ogalutran, oil-based progesterone.

Avoid direct sunlight and heat sources. Note: oil-based progesterone crystallizes in the refrigerator, precipitates, and can no longer be drawn into the syringe.

Important regarding injector pens (Gonal-F and similar): many injector pens need to be refrigerated before first use. However, after the first injection (once you have performed the initial injection with the pen), they can often be kept at room temperature for a limited time (generally 28 days). This is convenient if you need to take the medication to work. Always check this point in the specific medication's instructions.

5. "Emergency situations": answers to common fears

Q: I forgot to take my injection at the usual time. Is everything lost?

• A: Don't panic. For most stimulating medications, a delay of 1 to 2, or even 3 hours, is not critical. Take the injection as soon as you remember and resume your usual schedule the next day (or gradually shift the time).
• Critical exception: This rule DOES NOT apply to the ovulation trigger (injection strictly prescribed 35 to 36 hours before retrieval). The timing for this injection is calculated to the minute. If you are more than 30 to 60 minutes late, call your doctor immediately or the clinic’s helpline, as the procedure may need to be postponed.

Q: After removing the needle, a drop of medication leaked out.

• A: This is entirely normal and expected by the manufacturer. There is always a small volume ("dead space") in the needle. It is not necessary to try to inject a second dose or worry about reduced effectiveness. You received the required volume.

Q: A drop of blood, a bruise, or a small bump appeared.

• A: You accidentally touched a small superficial capillary. It’s not very aesthetic, but it’s completely harmless and does not affect the absorption of the medication. Press the area with a dry sterile gauze for 2 to 3 minutes. The bruise will fade on its own, like a normal contusion. You can apply a heparin-based ointment (Traumeel, Lioton), avoiding the next injection site.

Q: I see an air bubble in the syringe. Is that dangerous?

• A: For subcutaneous injections (in the belly), small bubbles of air are harmless. Trying to remove them completely might cause you to lose some of the expensive medication.
• For intramuscular injections, it’s better to let the air escape. Tap the syringe with your finger to bring the bubbles to the top and gently press the plunger until a drop of medication appears.

When should you call the doctor?

Do not hesitate to seek help if:

1. You experience a systemic allergic reaction: skin rash all over the body (hives), face, lip, or eyelid swelling, breathing difficulties. In this case, call emergency services.
   • Note: slight redness and itching at the injection site (about the size of a coin), disappearing after 30 minutes, are considered an acceptable local reaction (especially with Cetrotide/Orgalutran).
2. You have confused doses (injected a significantly higher or lower amount than prescribed).
3. You forgot or delayed the ovulation trigger injection significantly.