Ask any woman who has been through in vitro fertilization (IVF) what the hardest part of the treatment is. No doubt, she’ll tell you that it was dealing with all the injections and hormones.
When it comes to IVF, there are a lot of needles. After all, the goal of the procedure is to stimulate the ovaries so that they will produce several mature eggs that can be harvested for fertilization by sperm and implanted in the woman’s uterus. How that happens is different for every person—no two treatment plans or expected outcomes are alike.
For me, a 35-year-old woman dealing with egg quantity issues, that meant taking enough hormones to generate 12 to 15 good-sized follicles (18 to 22 millimetres in size). I was told that I’d need to inject myself with one needle with varying hormones twice a day, as well as take a variety of pills. As my eggs matured, I’d have to add one more needle to my night-time routine. My regimen was incredibly strict, and most of the shots had to be given at the same time every day.
It was a daunting process—one I thought I’d never manage—but I got through it. Here are a few key things that helped me through those challenging, stressful weeks.
1. Getting my husband involved
When I was told I’d have to inject myself with multiple needles every day, I almost fainted. I’m fine with getting shots in my arms (vaccines and allergy shots have always been part of my life), but I knew there was no way I’d be able to jab the fatty and muscular parts of my belly, back, buttocks and thighs with a needle myself. I volunteered my husband for the job.
Though he was hesitant at first (he didn’t want to hurt me), it turned out to be a great decision to have him do it. Not only did he feel more involved in the IVF process but it also allowed me to focus on relaxing my muscles while he focused on injecting me correctly.
2. Creating a routine
To ensure that my husband and I knew what to expect, we created an easy-to-follow routine for injections. It helped us stay calm and ensured that we both knew what to do.
- My husband and I would discuss where we would inject the needle: my stomach, lower back, buttocks or thigh.
- We would turn on the radio so that the music would distract us.
- While my husband prepped the needle, I would lie down in a way that was conducive to receiving the shot. I’d often clutch a pillow and count to 100 (and back down to zero) as a way to manage my anxiety. If that didn’t work, I’d sing along to whatever song was playing on the radio.
- I would begin deep breathing when he wiped the injection site with rubbing alcohol.
- When he was ready, he would start counting down from 10 out loud. Once he got to five, he’d jab me, and he would remove the needle by the time he got to zero.
3. Focusing on pain management
Receiving hormone injections can be brutally painful. The needles I had to use were long and thick (as they are for every woman), and they have to be injected into the midsection multiple times a day. The result can be extensive swelling and bruising, so finding ways to minimize pain became a major priority for me.
I had a few friends suggest using ice to numb areas before the shots, but that didn’t work for me. One suggestion from a nurse helped a lot, though. She told us that some of the serums in the needles are very thick—almost the consistency of molasses—and that we could thin them out by running the serum-filled needles under hot water before injections.
We also got some great advice from my naturopathic doctor, Jen Newell. She recommended applying arnica gel, which comes from a sunflower-like plant known for its healing properties, to my midsection after each injection. “The plant contains anti-inflammatory chemicals called sesquiterpene lactones, which help reduce swelling, and flavonoids, which strengthen blood vessels and reduce leakage of blood under the skin that occurs with bruising,” she says. It actually helped with the bruising.
We also rotated the injection site (if we injected my left hip in the morning, we would inject my right thigh at night). This helped keep some of the swelling and bruising at bay, though my entire midsection was pretty sensitive until about four weeks after I wrapped up my treatment plan.
4. Indulging in acupuncture
The last thing most people want to do during daily injections is to subject themselves to more needles, but I found acupuncture incredibly helpful. “Acupuncture is beneficial for reducing stress in a number of ways,” says Newell, who practices naturopathy and acupuncture at the Integrative Health Institute in Toronto. “During visits, all patients have to do is lie down and relax. Quite often, patients will take brief naps or listen to guided meditations.”
The practice is based on the ancient Chinese belief that there is a specific energy flow (chi) through the body. This natural flow can be blocked by stress or negative emotions, which can, in turn, result in negative outcomes, such as weight gain and insomnia. The goal of an acupuncturist is to place very fine needles under the skin at specific points to help re-establish the body’s natural chi movement. “The acupuncture points used are based on the individual’s needs and can be modified depending on how she is feeling on a particular day or where she is in her menstrual cycle,” adds Newell. “Certain points are selected to target stress and reduce stress-induced elevations of hormones.”
While it may sound a little out there to some people, studies have repeatedly shown that the practice can be used to reduce everything from headaches to back pain. One study from the University of Maryland even found that acupuncture can increase a woman’s chances of conceiving by 65 percent. Two or three times a week (depending on how stressed I was), I spent 30 blissful minutes at Newell’s office. I always left feeling calm, relaxed and more optimistic about the IVF process.
5. Getting strict with my schedule
One thing that fertility doctors stress is that injections have to be given at exactly the same time every day (I was told that being off by 15 minutes was fine, but 30 minutes was not) to ensure that hormone levels stay consistent. At first, I told myself it would be easy to ensure that I was home for the needles, but then I lost track of time at a dinner with friends and had to race home in time for one of my very first injections. I was so tense and stressed when I ran through the door that my muscles wouldn’t relax for the injection. It took two tries for my husband to jab me and I ended up with a giant welt on my hip.
After that, I became incredibly strict about my schedule. I avoided making plans with friends an hour before I was due for an injection (I also gave myself about 30 minutes after to decompress from the shot and apply arnica gel). I made sure that my work calendar was blocked after 4 p.m. so that no late-day meetings could be scheduled. I declined events and functions that would conflict with my timing in the evenings. The calendar shuffling was annoying (and not something I was used to), but it only lasted a few weeks and the calm that came with knowing I’d never miss a shot was worth it.
6. Treating the hormonal ride
Beyond bruising and swelling, the side effect that most women complain about is mood swings. I didn’t think I’d experience them because I felt fine until day 5 of my injection schedule, but my general demeanour shifted on day 6. I started to get anxious about everything: I couldn’t figure out what to wear or eat without worrying. My mind started to feel cloudy, like I hadn’t slept in weeks. I wasn’t unhappy, but I wasn’t happy either. I never experienced mood swings like those depicted in books and films—where someone goes from laughing to crying in seconds—but I was definitely off.
To cope, I took small doses of two supplements that were recommended by Newell and approved by my doctor: magnesium and a vitamin B complex. “Magnesium is a particularly helpful supplement during times of stress because it promotes deeper, more restful sleep and a sense of calm relaxation,” notes Newell. “It helps regulate the nervous system and can prevent or reduce feelings of anxiety, fear, nervousness, restlessness and irritability. B vitamins are critical for energy production within the body, as well as mood regulation. Pyridoxine [vitamin B6] helps manufacture neurotransmitters, such as serotonin, which aid in the body’s ability to cope with depression, stress and anxiety.”
I also gave myself a break. I knew the hormonal rush wouldn’t last forever and that the best way to keep my mood stable was to relax. I spent the weeks that I was undergoing injections doing whatever I wanted. My husband and I went to our favourite restaurants, spent weekends watching television or reading on the couch and going for long walks. By giving up control and just rolling with the situation, I found that I could manage my emotions better.
This article was originally published online in January 2019.