Fertility treatments such as in vitro fertilization (IVF) typically include injectable medications. If you’re anxious about self-administering your injections, you’re not alone. Nerves are common, especially the first few times.

Knowing what to expect often makes the process easier to navigate. To help you feel confident in following your treatment plan, we’ve compiled important information about the two types of injections commonly used during a cycle: subcutaneous and intramuscular injections. Here’s what to know.

Subcutaneous injections

The majority of fertility medications are administered as subcutaneous injections. In this technique, a medication is injected into a layer of tissue between your skin and muscle.

Subcutaneous injections differ from intramuscular injections in several key ways:

• Injection site: The most common subcutaneous injection site for fertility medication is in the lower abdomen, at least one to two inches away from your navel. The front of your thigh is another potential option. In both cases, the medication can be easily injected into the fatty tissue beneath the skin without the risk of being injected into the muscle.

• Injection supplies: The needle used for subcutaneous injections is shorter and thinner than the one used for an intramuscular injection. Needle thickness ranges from 27 gauge to 31 gauge. (Thickness is inversely related to the size of the gauge, so a smaller gauge corresponds to a thicker needle and a larger gauge corresponds to a thinner needle.) The length can range from 0.3” to 0.5”.

In addition to fertility medications, these medications are also administered as subcutaneous injections:

• Insulin

• Some blood thinners

• Some allergy medications

• Some arthritis medications

How to administer a subcutaneous injection

1. Clean the injection site with an alcohol pad and allow the area to air dry.

2. Use your non-dominant hand to grasp a one to two-inch fold of skin between your thumb and index finger at the injection site.

3. Hold the syringe in your dominant hand like a pencil, and insert the entire length of the needle into the pinched skin at a 90-degree angle. You can insert the needle at a 45-degree angle if you have less fat on your body.

4. Push on the plunger in a slow and steady motion until all of the medication is injected. When done, release the pinched skin and gently withdraw the needle.

5. Discard the used needle and syringe into your sharps container.

You may see a small drop of liquid come out of the injection site. This is normal and not cause for concern. You can wipe it with gauze or a tissue if necessary.

Intramuscular injections

Your fertility medication protocol may include intramuscular injections, which deliver a medication into your muscle. This technique is also commonly used for many vaccines.

Progesterone, a “transfer medication” that supports successful embryo implantation in IVF, is a good example of a fertility medication commonly administered as an intramuscular injection, though there are other progesterone formulations that can be used vaginally or orally.

Intramuscular injections differ from subcutaneous injections in several key ways:

• Injection site: In this technique, a medication is injected deep into a muscle. The upper, outer part of the buttocks is the most common intramuscular injection site for fertility medications. (This can be difficult to reach when self-injecting — we have tips below to help!)

• Injection supplies: The needle used for intramuscular injections is longer and thicker than the one used for a subcutaneous injection. Needle thickness ranges from 18 gauge to 25 gauge. (Thickness is inversely related to the size of the gauge, so a smaller gauge corresponds to a thicker needle and a larger gauge corresponds to a thinner needle.) The length can range from 1” to 2” depending on your body mass index (BMI).

In addition to fertility medications and vaccines, these medications are also administered as intramuscular injections:

• Some allergy medications

• Some hormones, including testosterone and contraceptive hormones

• Steroids

How to administer an intramuscular injection

1. Clean the injection site with an alcohol pad and allow the area to air dry.

2. Hold the syringe in your dominant hand between your thumb and fingers, as if you were holding a pen.

3. Firmly stretch the skin at the injection site with your thumb and index finger on your non-dominant hand.

4. Insert the entire length of the needle into the stretched skin at a 90-degree angle with one swift motion, similar to a dart.

5. Stabilize the syringe with your free hand and pull back slightly on the plunger. If you see blood return, do not inject the medication and withdraw the needle. Remove the needle and change to a new one. Repeat the injection process at another injection site.

6. If there is no blood return, the needle is inserted properly and you can slowly inject the medication.

7. Push on the plunger in a slow and steady motion until all of the medication is injected. When done, quickly withdraw the needle and dispose of the used needle and syringe into the sharps container.

8. Apply pressure to the injection site with gauze or a tissue. You may see some light bleeding.

9. Gently massage the skin afterwards to reduce discomfort and help your body absorb the medication.

Tips for self-administering injections

Injection site reactions are one of the most common side effects during IVF, and you should expect to experience some soreness, redness, or bruising at the site of injection. This reaction will typically resolve itself within a few days.

If you are self-administering an intramuscular injection, ice the skin beforehand to keep soreness and bruising to a minimum. Massaging the area afterwards can help reduce soreness. For medications injected daily, such as progesterone, using a light heating pad after the injection can also alleviate discomfort.

Icing is not necessary for subcutaneous injections.

Intramuscular injections are typically administered in the upper, outer part of the buttocks. Since this can be difficult to reach, consider asking for assistance from your partner, a friend, or a family member. If you need to self-inject, try standing in front of a mirror for a better view of the injection site. You can also ask a nurse or another clinic staff member to circle the injection site on your body so that you can find it more easily.

With both injection techniques, it is best practice to rotate the injection site.

Want personalized injection guides at your fingertips?

Alto is more than just a pharmacy — we’re a partner in your fertility journey, and we offer a variety of resources to ensure that you’re never alone in navigating treatment.

In our injection guide videos, experienced pharmacists from our fertility team walk you through the entire process, from preparation to proper injection technique and safe sharps disposal. And you won’t have to sift through dozens of videos: as an Alto customer, you have your own unique playlist in the app, with videos for your specific medications.

Interested in learning more about how Alto can support your treatment? Request a price quote online or reach out through in-app messaging.

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.