What Are Injectables?

Gonadotropins with syringe
Gonadotropins are given via injection. Side effects are usually mild, but can be serious or even life threatening. AWelshLad / iStock

Definition:

When talking about fertility treatments, injectables refer to drugs taken via injection, for example, gonadotropins, GnRH agonists and progesterone in oil. There are two kinds of injectables: intramuscular and subcutaneous. Intramuscular injections must be injected in muscle tissue, usually your buttocks.

Subcutaneous injections are shots that are injected in to the fatty tissue below the skin.

For fertility treatments, these are usually given an inch below the belly button or in to the fatty tissue of the thighs. Injectables are most commonly used during intrauterine insemination (IUI) cycles and during IVF treatment. However, they are sometimes used with just timed intercourse at home.

As opposed to fertility drugs taken by mouth, injectables are typically stronger medications and come with a higher risk of multiple pregnancy and ovarian hyperstimulation syndrome.

Common Injectable Fertility Drugs

The most commonly used injectables include…

FSH injectables: FSH stands for follicle stimulation hormone, and it occurs naturally in the body. It helps stimulate follicle (and egg) growth in the ovaries.

The most commonly used FSH injectables are Gonal-F and Follistim. These are both created in a lab, and are considered to be bio-identical to the hormones in your body.

Less commonly used FSH injectables include Bravelle and Fertinex.

These injectable hormones are actually derived from the purified urine of post-menopausal women. (Women post-menopause have naturally high levels of FSH.)

LH injectables: LH stands for luteinizing hormone. It helps the eggs in the ovaries reach the final stage of maturity and prepare for ovulation. Your body has a natural surge of LH just before you ovulate.

When you use ovulation predictor tests, LH is what those at-home tests are detecting.

There is only one LH injectable available, and that’s Luveris. It’s created in a lab using DNA technology.

hCG injectables: hCG is human chorionic gonadotropin. You may know it best as the pregnancy hormone. hCG acts in the body similar to LH, and in fertility treatments, injectable hCG is used the way LH would be used.

Ovidrel is the most commonly used injectable hCG. It is created in a lab using DNA technology.

Other forms of hCG injectables include Novarel, Pregnyl, and A.P.L. These three injectable drugs are derived from the purified urine of pregnant women. (Pregnant women have naturally high levels of hCG.)

hMG injectables: hMG stands for human menopausal gonadotropins. These are a combination of FSH and LH. They are derived from the purified urine of post-menopausal women and are sometimes used during IVF treatment.

Brand names of hMG include Menopur and Repronex.

GnRH antagonists: GnRH stands for gonadotropin-releasing hormone. GnRH is produced in the brain, specifically in the hypothalamus. This hormone stimulates the pituitary gland to secrete FSH and LH. In other words, GnRH— gonadotropin-releasing hormone—stimulates the release of the gonadotropins FSH and LH.

An antagonist is something that works against. GnRH antagonists work against or suppress the body’s response to GnRH. It essentially shuts down your body’s ovulation cycle. During IVF treatment, this allows your doctor to control ovulation and egg stimulation.

Brand names of GnRH antagonists include Cetrotide, Antagon, Ganirelix, and Orgalutran.

GnRH agonists: Agonists are the opposite of antagonists. While a GnRH antagonists works against the GnRH in your body, a GnRH agonist increases the body’s response to GnRH.

Even though GnRH agonist initially create a surge of reproductive hormone production, the body’s naturally feedback loop forces that surge to stop.

So, both GnRH agonists and antagonists are used to control the ovulation cycle, just one shuts things down right away, and the other triggers a surge of hormones and then a shut down.

(If this is confusing, you can read more about GnRH agonists here.

Lupron is the most commonly known injectable GnRH agonist. There are other GnRH agonists available, but they are not injectable.

Progesterone in oil: Progesterone is produced after ovulation takes place. Its role is to maintain the uterine lining and a pregnancy, if you conceive.

During IVF treatment, progesterone in oil may be prescribed after egg retrieval.

Who Will Give Me the Injections?

Injectable fertility drugs are usually taken daily for several days. You may have more than one injection per day as well. Do you need to go to your doctor’s office to get these injections?

The good (and bad) news is no. Your fertility clinic will show you how to give yourself the injections. They may also show your partner or a friend how to help you with injections, if you can’t do it yourself (or you don’t feel comfortable doing it yourself.)

Giving yourself injections isn’t as difficult as it sounds. After the first few times, you’ll become a pro.

Do Injectables Hurt?

You’re sticking a needle into yourself, so it’s going to be somewhat uncomfortable. But they aren’t necessarily painful.

Most injectable fertility drugs come with very thin needles. They aren’t thick like the ones used to draw blood.

On the other hand, some injectables can hurt more than others. For example, progesterone in oil and any fertility drug that must be taken intramuscularly (into the muscle) will be more painful than subcutaneous injections (ones given into the fat.)

Ask your fertility clinic nurse to show you how to make the injections some what less uncomfortable. Some ways to reduce pain include apply a heating pad to the muscle for several minutes before the injections, icing the area before, using a numbing gel (sold over the counter to help with sore gums), and taking deep breaths and relaxing the muscle being injected before placing the needle.

Before you give yourself the injection, be sure to wipe the injection site with a sterilizing alcohol pad after using any sort of ice, numbing gel, or heating pad.

Doing the injection smoothly and quickly can also reduce discomfort. This is something you'll get better at with practice.

Source:

Medications for Inducing Ovulation: A Guide for Patients. American Society of Reproductive Medicine.  http://asrm.org/uploadedFiles/ASRM_Content/Resources/Patient_Resources/Fact_Sheets_and_Info_Booklets/ovulation_drugs.pdf