The hormones needed for the IVF procedure are mainly gonadotropins. These hormones are mainly in injectable form. Many patients do not realize that mixing fertility medication and administering an injection can play an important role in the success of fertility medication treatment. The following guidelines are designed to help patients administer the necessary injections related to infertility treatment safely, successfully and with minimal discomfort.

Before You Begin Fertility Medication

Before beginning the injection process, make sure your hands, materials and work area are all clean. This is important because you will be handling needles syringes, which must remain sterile. If you think that the needle may have been accidentally touched by unwashed hands, please change the needle.  A needle can become contaminated if it touches anything other than the inside of the ampoule or needle cap. Fertility injections are administered by subcutaneous route or intramuscular route.

Subcutaneous Injection

Subcutaneous injections are administered through a shorter (usually ½ inch) needle that delivers medication to the tissue just under the skin, usually on the back of the arm, abdomen or top of the thigh.

Intramuscular Injection

Intramuscular injection is administered by a longer needle (usually 1 or 2 inches) so that it can deliver hormone deep into the muscle. These injections are given to mid-thigh or buttock. While this guide is designed to take you step-by-step through the entire injection process, please be sure to consult your doctor or sister if you have any questions or concerns relating to this or any other aspect of your treatment.

Getting Ready For Injecting Fertility Medication

To complete an injection successfully for fertility medication, you will need the following materials, which you should collect  in advance:

• Soap and water/alcohol
• Clean towel
• Mixing needle
• Syringe
• Ampoule(s) / vial(s)
• Gauze pad/alcohol swabs
• Injection needle
• Disposal container

Choose a comfortable location for your injection? It is very important for you to identify a comfortable place to administer your injection It is important to find a proper spacious place to keep all your injection materials within easy reach. Wash your hands with soap, and clean the area of injection with alcohol to prevent any chance of infection.

Attach mixing needle to syringe? Your fertility medication kit includes a mixing needle, which is usually the largest needle. Firmly fix the mixing needle to the syringe. To prevent contamination, only touch the outside of the barrel and handle of the plunger.

Ampoules and Vials

Your fertility medication will come in two types of containers: ampoules or vials. Although the mixing procedures are similar for both, be sure to follow the instructions  for the specific type of container you use.

Ampules

For this step, you will need:

• Ampoule(s)
• Gauze pad/alcohol swabs
• Mixing needle
• Syringe
• Disposal container

How to Open the Ampoule(s) for Injection?

The first step is to remove the liquid from the top of the ampoule.

• To do this, hold the ampoule in left hand between your index finger and thumb and tap the ampoule with your right hand.
• Look for the dot on the ampoule and face it away from yourself.
• Place a square of gauze or an alcohol swab over the top of the ampoule. Snap the top away from you.
• Remove the cap from the needle by pulling straight without twisting.
• Insert in the ampoule and withdraw 1 ml of diluent from the ampoule.
• Turn the syringe over so the needle is pointing upward. Tap the syringe barrel so the air bubbles travel to the top.
• Expel the air and excess diluents from the syringe by depressing the plunger. The measurement should read 1 ml.

Mix Fertility Medication

• Now, inject 1ml of diluent into the ampoule of powder medication.
• With the needle still in the ampule, roll it between your finger and thumb until the solution is clear.
• Draw all of the mixed fertility medication back into the syringe; you may have to tilt the ampoule slightly. You have now mixed one ampoule of medication.
• If you are prescribed one ampoule of medication, replace the mixing needle with an injection-sized needle

For The Vials

For this step, you will need:

• Vial(s)
• Gauze pad/alcohol swabs
• Mixing needle
• Syringe

Open the vial(s)

To open, pop off the plastic tops. Clean the top of each vial with a gauze pad/alcohol swab to prevent contamination.

Mix Fertility Medication

• Attach the mixing needle to the syringe by twisting it firmly. Draw 1ml of air into the syringe by pulling the plunger back to the 1ml mark. Inject it through the rubber stopper into the vial of diluent. With the syringe still in the vial, pull the plunger to withdraw more than 1ml of liquid.
• Remove the needle from the rubber stopper. Turn the vial upside down. Tap the syringe barrel to get the air bubbles to travel to the top. Check the measurement. The uppermost ridge of the plunger should be at 1ml.
• Inject the diluent into the vial of powder medication. With the needle in the vial, roll it until the solution is clear. Turn the vial upside down. Pull the needle below the liquid line and withdraw the solution, making sure to draw out all of the mixed fertility medication. You have now mixed one vial of medication
• If you are prescribed one vial of medication, replace the mixing needle with an injection-sized needle.
• If you are prescribed more than one vial, inject the contents of the syringe directly into the second vial of powder. Inject the solution slowly into the vial. As before, roll the vial with the needle still in place, until the solution is clear. Turn the vial upside down. Draw the mixed fertility medication back into the syringe. Use this same procedure for mixing the remainder of your medication.
• Recap the mixing needle. Replace the mixing needle with an injection-sized needle for injection.

For this step, you will need:

• Injection needle
• Gauze pad/alcohol swabs
• Syringe
• Disposal container

Prepare for Injection

Once you have chosen the site for your injection, cleanse the area with an alcohol swab, cleaning around in a circle of about two inches in diameter. Remove the needle cap by pulling it straight off. While holding the syringe straight up, tap the side so any air bubbles travel to the top. Push the plunger slowly until you see one or two drops of fertility medication come out of the top, which ensures that all of the air is out.

To Administer a Subcutaneous Injection

You are now ready to administer your subcutaneous injection. First, hold the syringe like a pencil in your dominant hand. With the other hand, pinch the injection site. Insert the needle into the pinched skin. Because the medication is being deposited into fatty tissue, the needle can be inserted at either a 45-degree or a 90-degree angle. Depress the plunger quickly and steadily. Now, remove the needle and syringe. You have successfully completed your injection.

Place the needle and syringe into the disposal container without recapping the needle.

To Administer an Intramuscular Injection

You are now ready to administer your intramuscular injection. With your dominant hand, hold the syringe like a pencil. With the other hand, stretch the skin of the injection site. This will help the needle to go in easier. To minimize discomfort, insert the needle at a 90-degree angle with a smooth, dart-like motion. With one hand, stabilize the syringe, while you gently pull back on the plunger. It is normal to feel resistance or to see a small air bubble. Although it is rare, you should watch to see if there is any blood. If there is no blood, the needle is properly placed in the injection site. Slowly and steadily depress the plunger. Quickly pull out the syringe and throw it in the disposal container. With a gauze pad, apply pressure to the injection site. Massage the area to disperse the medication and ease any discomfort. If you think you need an adhesive bandage, place one on. You have successfully completed your injection.

If there is blood, you have two options. First, you may remove the needle and apply pressure with a gauze pad to the injection site. Remove the used needle from the syringe and discard it. Replace it with a clean needle and re-inject at a nearby location. A second option is to pull the needle back slightly (about ¼ inch) and redirect it away from the vein. Gently draw it back again in the new site and, if no more blood is seen, inject as usual.