IVF Injections: A Beginner's Guide to Giving Yourself a Shot

It is 9 PM. You are standing in your bathroom. On the counter is a small vial, an alcohol swab, and a syringe. The nurse at the clinic showed you how to do this in about 90 seconds — while you were already overwhelmed with information about protocols, timelines, and costs.

Now you are alone, and the needle looks a lot bigger than you remember.

If this is you: you are not weak, you are not dramatic, and you are not the only one. Almost every woman doing IVF goes through this moment. The first injection is the hardest. After a few days, most women report that it becomes routine — annoying, but manageable.

This guide walks you through everything: what the injections are, where they go, how to do them step by step, tricks for managing the fear, and what to do if something goes wrong.

Two Types of IVF Injections You Need to Know

Subcutaneous (SC) Injections — The Common Ones

These go into the fatty layer just beneath the skin. Most of your IVF injections are this type.

Feature | Details

**Where** | Lower abdomen (belly), 2-3 cm to either side of the navel; alternately, front of the thigh

**Needle size** | Very thin — 27-30 gauge, about 12mm long (similar to insulin needles)

**Pain level** | Mild pinch. Most women rate it 2-3 out of 10 after the first time

**Common SC medications** | Gonadotropins (Gonal-F, Menopur, Follistim), GnRH antagonist (Cetrotide, Orgalutran), trigger shot (Ovidrel)

Intramuscular (IM) Injections — Less Common but More Intimidating

These go deeper into the muscle. You may need these for progesterone support after embryo transfer.

Feature | Details

**Where** | Upper outer quadrant of the buttock (gluteal muscle)

**Needle size** | Thicker and longer — 21-23 gauge, 25-38mm long

**Pain level** | More noticeable — 3-5 out of 10. The muscle can feel sore afterwards

**Common IM medications** | Progesterone in oil (Gestone), some trigger shots (hCG intramuscular)

Step-by-Step: Giving Yourself a Subcutaneous Injection

Read this entire section before your first injection. Then follow it step by step.

Before You Start

1. 1Wash your hands thoroughly with soap and water. Dry them.
2. 2Gather everything you need: Medication vial or pen, syringe (if using a vial), alcohol swabs, cotton ball, sharps disposal container (or a thick plastic bottle like a Bisleri bottle with cap).
3. 3Check the medication: Confirm the name, dose, and expiry date. If the liquid looks cloudy, discoloured, or has particles (and it should not), do not use it.
4. 4Bring the medication to room temperature if it was refrigerated. Cold medication stings more. Take it out 15-20 minutes before injection time.

Preparing the Injection

If using a pre-filled pen (like Gonal-F pen):

1. 1Attach the needle to the pen as shown in the pen instructions
2. 2Dial the prescribed dose
3. 3Hold the pen with the needle pointing up and tap gently to move air bubbles to the top
4. 4Press the plunger slightly until a tiny drop of liquid appears at the needle tip (this removes air)

If using a vial and syringe:

1. 1Clean the top of the vial with an alcohol swab
2. 2Draw air into the syringe equal to the dose you need
3. 3Insert the needle into the vial and push the air in (this makes it easier to draw the liquid)
4. 4Turn the vial upside down with the syringe still inserted
5. 5Pull the plunger slowly to draw the correct dose
6. 6Check for air bubbles — flick the syringe gently to move them up, then push the plunger slightly to expel them
7. 7Remove the needle from the vial

If mixing powder + liquid (like Menopur or Cetrotide):

1. 1Draw the provided liquid (diluent) into the syringe
2. 2Inject the liquid into the powder vial
3. 3Swirl gently (do not shake) until the powder dissolves completely
4. 4Draw the mixed solution back into the syringe
5. 5Change to the injection needle (if a separate one is provided)

The Injection

1. 1Choose the site: Lower abdomen, about 2-3 cm to either side of the navel. Stay at least 3 cm away from the navel itself. Alternate sides each day (left today, right tomorrow).
2. 2Clean the area with an alcohol swab. Let it dry for 10 seconds (injecting through wet alcohol stings).
3. 3The ice trick (optional but recommended for the first few days): Hold an ice cube wrapped in a thin cloth against the injection site for 30-60 seconds. This numbs the area significantly. Remove the ice and inject immediately.
4. 4Pinch a fold of skin between your thumb and index finger. This lifts the fatty layer away from the muscle.
5. 5Insert the needle quickly and smoothly at a 45-90 degree angle into the pinched skin fold. One smooth motion — do not hesitate or go slowly. Quick insertion hurts less than slow insertion.
6. 6Release the pinch once the needle is in.
7. 7Push the plunger slowly and steadily to inject the medication. Take about 5-10 seconds.
8. 8If using a pen: Hold the pen in place for 10 seconds after pushing the plunger all the way to ensure the full dose is delivered.
9. 9Withdraw the needle quickly in one motion.
10. 10Press a cotton ball or gauze gently against the site. Do not rub — rubbing can cause bruising.
11. 11Dispose of the needle in your sharps container immediately. Never recap a used needle.

Step-by-Step: Intramuscular Injection (Progesterone)

If you need intramuscular progesterone, this is harder to self-administer (because it goes in the buttock). Many women have their partner do this one.

How to Find the Right Spot

Divide the buttock into four quadrants (mentally draw a cross). The injection goes in the upper outer quadrant — the area farthest from the spine and above the centre of the buttock. This avoids the sciatic nerve.

The Injection

1. 1Clean the site with an alcohol swab
2. 2Warm the progesterone vial in your hands or in warm water for 2-3 minutes. Progesterone in oil is thick — warming it makes it flow more easily and reduces injection-site soreness.
3. 3Hold the syringe like a dart
4. 4Insert the needle at a 90-degree angle in one quick, firm motion — all the way in
5. 5Pull back slightly on the plunger (aspirate) — if blood appears, withdraw and choose a new spot. If no blood, proceed.
6. 6Inject slowly. This medication is thick and takes 10-15 seconds.
7. 7Withdraw the needle and press with gauze
8. 8Massage the area gently for 30-60 seconds. This helps distribute the oil and reduces lumps.
9. 9Apply a warm compress for 5 minutes after — this reduces soreness significantly

Managing Needle Anxiety: What Actually Helps

Needle phobia affects approximately 20-25% of adults. It is real, it is physiological, and it is not something you can just "get over" by being brave. Here is what helps:

Physical Tricks

• Ice the area first. This genuinely reduces pain.
• Do not look at the needle. Look at a fixed point across the room, or watch something on your phone.
• Breathe out while injecting. Take a slow breath in before you insert the needle, then breathe out slowly as you push the plunger. This activates the parasympathetic nervous system and reduces anxiety.
• Have your partner distract you. Even just talking to you about something unrelated helps.
• Sit or lie down if you feel lightheaded. Fainting from needle anxiety is common and not dangerous — but falling is.

Mental Tricks

• Reframe the injection: This is not a medical procedure being done to you. This is you choosing to build your family. You are in control.
• Count to 3 and go. Do not give yourself more than 3 seconds between "ready" and "inject." Waiting builds anxiety.
• Reward yourself. Seriously. Have a small treat after each injection — a piece of chocolate, your favourite show, whatever. Create a positive association.

If Anxiety Is Severe

• Ask your clinic if a nurse can come to your home for the first few injections (some clinics in metros offer this)
• Your local pathology lab (SRL, Dr. Lal, Metropolis) may offer a nurse visit service for ₹200-₹500 per injection
• Some women hire a trained nurse for the full stimulation phase (approximately ₹500-₹1,000 per visit, ₹4,000-₹12,000 total)
• If your partner is willing, teach them to do it — many couples find this works well

Common Problems and What to Do

Problem | What to Do

**Small amount of blood at injection site** | Normal. Press with cotton for 30 seconds.

**Bruising around injection site** | Common, especially with blood-thinning medications. Not harmful. Alternate sides.

**Hard lump at injection site** | Common with IM progesterone. Apply warm compress for 10-15 minutes. Massage gently.

**Medication leaks back out after removing needle** | You lost a small amount. Do NOT re-inject. The loss is usually minimal and does not affect the dose meaningfully. Mention it to your doctor.

**You missed a dose** | See the section below.

**Air bubble in the syringe** | A tiny bubble (1-2mm) is harmless subcutaneously. For peace of mind, tap the syringe and push the bubble out before injecting.

**Needle bent during injection** | Remove it. Use a new needle and a different injection site.

**Redness, swelling, or warmth at the site that worsens over 24 hours** | May indicate infection. Call your clinic.

What If You Miss a Dose?

Do not panic. Here is what to do based on how late you are:

How Late | What to Do

**Less than 2 hours late** | Give the injection immediately. Continue your normal schedule.

**2-6 hours late** | Give the injection. Call your clinic to inform them — they may want to adjust timing or add an extra monitoring scan.

**More than 6 hours late** | Call your clinic before injecting. They will advise based on where you are in the cycle and which medication it is.

**You forgot an entire day** | Call your clinic immediately. Do not double up the next dose unless specifically told to.

Context matters: Missing a dose of gonadotropin early in stimulation is less critical than missing one on day 8-10 when follicles are nearing maturity. Missing the trigger shot is the most time-sensitive (see our separate trigger shot guide).

Setting Up Your Injection Station

Make this process as smooth as possible by having a dedicated setup:

What you need in one place:

• Medications (refrigerated ones come out 15-20 minutes before)
• Syringes and needles
• Alcohol swabs
• Cotton balls
• Ice cube tray (in your freezer)
• Sharps container (a thick plastic bottle works — label it)
• Your medication schedule (printed or on your phone)
• A timer or alarm set for your daily injection time

Where to do it: Bathroom or bedroom, somewhere with a flat surface for supplies and good lighting. The same place every day creates a routine that reduces anxiety.

When to do it: Pick the same time every day. Most doctors recommend evening (8-10 PM) for gonadotropin injections. Set a phone alarm. Consistency matters more than the exact time.

Questions to Ask Your Doctor

1. 1"Can you show me how to give the injection — slowly, with me practising on a dummy first?"
2. 2"Can I use the pen injector instead of vials and syringes?" (Pen devices are easier for beginners.)
3. 3"Is there a non-injection alternative for progesterone?" (Vaginal pessaries are available.)
4. 4"What should I do if I miss a dose or inject at the wrong time?"
5. 5"Is there a nurse visit service your clinic provides for patients who are anxious about self-injection?"
6. 6"Can my partner attend the injection teaching session so they can help at home?"

A Final Word

You will be okay. The first injection is the worst — not because of pain, but because of fear. By injection #3 or #4, most women say it becomes mechanical. Annoying, sure. But no longer terrifying.

You are not doing something to yourself. You are doing something for your family. That is brave, not scary.

And if you need help — from a partner, a nurse, a friend, a YouTube video — ask for it. There is no medal for doing this alone.

Medical Disclaimer: This article is for informational purposes only and does not replace the specific instructions given by your fertility clinic. Injection techniques, medication preparation, and dosing must be followed as directed by your prescribing doctor. If you experience unusual symptoms — severe pain, swelling, redness, fever, or signs of allergic reaction (hives, difficulty breathing) — seek medical attention immediately.