Thursday, October 14, 2010
Are IVF injections painful ?
One of the major reasons patients do not want to do IVF is their fear of injections. They know that during IVF they need to take injections for many days - and many patients are understandably reluctant to take these shots because they have been told that these injections are painful !
While it's no fun to take injections , the good news is that the injections used for IVF treatment are not painful !
Lupron and Anatgon ( which are used for downregulation) and given subcutaneously, just like a diabetic takes insulin injections. these are easy to self-administer and are not painful.
The injections which are used for superovulation ( the urinary gonadotropins such as Menogon) used to be given intramuscularly. IM injections are more painful than subcutaneous injections, because a larger volume needs to be deposited in the muscle; and because the muscles have more nerve endings than the subcutaneous fat. However, these are water soluble , and the pain is usually easy to handle. Using simple tricks ( such as ice-cubes to numb the area; or EMLA patches ) can help in managing the pain.
The good news is that the newer injections used for superovulation - the recombinant gonadotropins such as Follistim and Gonal-F; as well as the highly purified urinary gonadotropins
can also be given subcutaneously. These are not painful at all ( but are more expensive than the IM shots).
So why do IVF patients have the notion that the injections used for IVF are painful ? The painful injections are the oily progesterone injections which used to be given deep intramuscularly for luteal phase support after the embryo transfer. These are the shots from hell which patients never forget - and which leave a major scar - both in the mind and in the butt. In fact, it's these injections which often put patients off IVF treatment for ever !
The good news is that we do not use these at all - and many IVF clinics have stopped using them altogether ! Instead of giving the progesterone intramuscularly, we give it vaginally, in the form of a suppository. While this is messier, it's completely pain -free - and our patients are much happier !