What Doctors Don't Tell You About Fertility Medications

Before you started your first intrauterine insemination (IUI) or in vitro fertilization (IVF) cycle, did you know that you would most likely end up injecting yourself with hormones several times a day for as many as three months? I didn’t. Possibly so as not to discourage potential patients, reproductive endocrinologists do not go into detail regarding your medication schedule until you are already emotionally involved and committed to complete the treatment.

When I switched to injectable medication (Menopur) for my second IUI, I was quite disconcerted at the thought that I (or my partner) had to inject a thick long needle in my belly for several days in order to stimulate the production of follicles in my ovaries. Each evening, I dreaded the hour we had appointed for administering the medication, and because of my excessive nervousness, my sensitivity to Menopur was heightened, and I began to experience a series of side effects.

In hindsight, my body’s response to Menopur was most likely amplified by my emotional unpreparedness for the injections and my fear that I wasn’t administering them correctly despite the detailed instructions my doctor’s office provided. The results? I was severely bloated, gained weight, and felt pain and discomfort at the site of injection.

In fact, I have no doubt that my introduction to Menopur injections was tainted to a large degree by my subconscious expectations that the experience will be unpleasant. Why do I think so? Because the second time I had to undergo the same protocol, it felt as easy as one, two, three. So did the third time.

My experience with IVF injectable medications was an entirely different matter. To begin with, I was amazed to see how long the prep. phase schedule was. Whereas my IUI stimulations lasted anywhere from 10 to 16 days and involved only injections of Menopur, my IVF ovarian preparation phase lasted about two months and included 20 days of intramuscular injections of Lupron in my thigh and 10 days of subcutaneous injections of Menopur and Bravelle in my belly at a dosage three times higher than that required for IUIs. To initiate ovulation, I also needed an intramuscular injection of hCG in my buttock (which I had to do for the IUIs as well).

Subcutaneous Injection in the Belly and Intramuscular Injection in the Thigh

But wait; that’s not all. After the egg retrieval, I was surprised yet again to receive another long schedule, which included more injectable medications. Since we were transferring a frozen embryo post preimplantation genetic screening, we had to add an extra month of preparation of my uterus. During that month, I was instructed to inject myself with estradiol valerate every three days (for a total of 10 times before my pregnancy test), then start injecting progesterone in my buttock twice a day starting 5 days prior to the embryo transfer. Adding 4 intramuscular injections of hCG to this already staggering count, I ended up administering a total of 80 injections from the beginning of my IVF cycle to my pregnancy test.

Daily IVF Medications Prior to Egg Retrieval

If you think that 80 injections in 9 weeks is a lot, let me disappoint you further. A few days before my embryo transfer, my doctor’s assistant told me that in the event of pregnancy, I will have to continue the estradiol and progesterone injections for another 9 or 10 weeks. That’s equivalent to 16–17 injections per week, for a grand total of about 230 injection from the beginning of the IVF cycle to the end of my first trimester. High number, isn’t it?

The point I am trying to make is that many of us first-time IVF patients have little idea as to what to expect when it comes to fertility medications, and doctors probably do not advertise the entire truth prior to the treatment so as not to intimidate their clients—not necessarily because they want to secure their business but primarily so as not to inflate their stress levels in what is already a stressful process. Don’t get me wrong, though. Sticking thick long needles in my body 1 to 4 times a day and taking 10 different pills throughout my IVF cycle is a minor inconvenience for the ultimate price: a risk-mitigated pregnancy followed by the birth of a healthy child.

P.S.: Though this post focused primarily on injectable medications, note that IVF patients are also given oral tablets of various sorts to support each phase of the IVF cycle. To see a list of all 10 medications I had to take during my IVF cycle, please visit my post “My IVF Medications.”