Shots, or taking injectable medication, are one of the biggest IVF worries that I hear from patients. There are a lot of people who are afraid of needles. I don't look forward to the idea of self-administering shots either, and it’s understandable why most (okay, all) feel the same way.
Having gone through it myself, I can give you the skinny on what it's actually like from both the patient and physician perspective. An IVF cycle involves 10 days of injections: this may be shorter or longer depending on how your ovaries respond to the treatment.
Three Types of Shots
Typically, there are two or three types of shots that we use for the best response. One shot is similar to follicle-stimulating hormone (FSH) and serves to help your ovaries grow lots of eggs. Usually, there are a group of eggs each cycle that is destined to grow or dissolve. In a normal menstrual cycle, only one of these eggs grows, but with the medication, we hope that all of the “ready” eggs will grow. Roughly half will grow larger with medication, and your doctor will determine the best dose of medication for you.
The second type of injected medication involves a little bit of follicle-stimulating hormone along with a second hormone, Luteinizing hormone (LH). In some women, this has been shown to help with egg quality and in rare situations, it is needed for development too. Your doctor will determine whether this is a medication you need or not.
The third type of injected medication serves to control ovarian timing to increase the number of eggs collected during an egg retrieval. In a regular cycle, developed eggs are released from the ovaries into the fallopian tubes once LH surges. This process is called ovulation. Medication prevents a natural LH surge, allowing control over ovulation timing. There are two different kinds of medication that we can use for this process and several different brands; they are either Gonadotropin Releasing Hormone (GnRH) agonists or antagonists. Agonists are usually used daily during ovarian stimulation. The antagonist is only used once a follicle (immature egg) reaches a healthy size for ovulation.
Some doctors recommend mixing a couple of the different medications together to minimize the number of shots. I don't typically recommend this as different medications are mixed with different pHs and may inactivate each other.
What this all boils down to: most IVF cycles require somewhere between 1 to 4 shots per day for about 10 days. This can be overwhelming and scary for patients. Realize that these needles are the small subcutaneous needles that go right under the skin and are similar to what patients with diabetes use. The fear and anticipation are much harder than the actual shot itself. Most patients get into the groove within a day or two.
Scientific Medicine Developments
There are several drug companies that are working on developing an oral medication form of the GnRH agonist or antagonist. These drugs are likely in development for medical conditions and not fertility purposes.
Drug companies are also working on longer acting injectable medication that is required every three days instead of daily. One of these drugs was not approved recently and the pharma companies are still working on a safe and effective formulation.
I think it will be interesting to see how these drugs will be applied to fertility treatment in the future. It may reduce the number of shots required, which could reduce the stress of treatment for patients. Unfortunately, it will probably be years before these new medications are ready for clinical use.
After investing so much from a physical, financial, and emotional perspective, we want patients to be successful and go through the minimum required to have a maximum benefit. As new treatment options develop, I will continue to investigate the safest and easiest way to accomplish the end goal – having a baby.
Have you used fertility shots? Share your experiences in the comments below.