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Understanding Tubal Factor Infertility

There are many potential causes of female infertility. Blocked fallopian tubes, also referred to as tubal disease or tubal factor infertility, account for 25-30% of all cases. Below, we explain how fallopian tube obstruction may prevent natural conception and what treatment options can support your family building journey.

How do blocked fallopian tubes impact fertility and pregnancy?

Fallopian tubes are female reproductive organs that connect the ovaries and uterus. They transport an egg from an ovary to the uterus during ovulation, the phase of each menstrual cycle in which the ovaries release a mature egg.

Healthy, functioning fallopian tubes are involved in several key steps of the natural conception process. First, they are the passageway through which sperm reaches an egg for fertilization. The fertilized egg will then move through the fallopian tubes until it reaches the uterus for implantation.

There are varying degrees of fallopian tube obstruction. The condition may take the form of:

Mild adhesions or scar tissue in either or both fallopian tubes

One narrowed fallopian tube as the result of adhesions or scar tissue

Two narrowed fallopian tubes as the result of adhesions or scar tissue

One completely blocked fallopian tube as the result of adhesions or scar tissue

Two completely blocked fallopian tubes as the result of adhesions or scar tissue

Hydrosalpinx, a severe form of tubal disease in which a blocked fallopian tube becomes enlarged and filled with fluid

While any of the above structural issues can potentially interfere with the fertilization of an egg, it is possible to become pregnant naturally if the fallopian tubes are only partially blocked. However, conceiving naturally with a partial blockage may increase the risk of an ectopic pregnancy, which is when an embryo implants outside of the uterus. (90% of ectopic pregnancies occur in the fallopian tubes.)

Ectopic pregnancies can lead to very serious complications, such as ruptured fallopian tubes, without prompt treatment to end the pregnancy. Given this risk, anyone with a history of fallopian tube blockage should inform their doctor as soon as they think they might be pregnant.

A hydrosalpinx may prevent the possibility of pregnancy in some cases, as the fluid can be toxic to an embryo. This interferes with successful embryo implantation in the uterus, a critical step in the reproductive process. In other cases, a person with hydrosalpinx may be able to become pregnant, but the resulting inflammation of the uterine lining can still interfere with the typical development of an embryo in a healthy pregnancy.

Blocked fallopian tubes may develop as the result of the following health conditions and infections.

Endometriosis is a condition in which tissue that should only grow in the uterus implants and grows in the ovaries, fallopian tubes, or lining of the pelvic cavity. When it develops in the fallopian tubes, the resulting scar tissue may lead to fallopian tube blockage.

Physical trauma to the female reproductive organs, like a previous abdominal surgery or ruptured appendix, can also contribute to the accumulation of scar tissue in the fallopian tubes.

Pelvic inflammatory disease (PID), an infection of the uterus, fallopian tubes, or ovaries, can lead to the accumulation of scar tissue and fluid in these organs. PID typically develops when bacteria enter the female reproductive tract. It is often a complication of untreated chlamydia or gonorrhea.

What are typical symptoms of blocked fallopian tubes?

Blocked fallopian tubes are rarely accompanied by noticeable symptoms other than difficulty becoming pregnant. Many women first learn that they have a fallopian tube blockage after consulting a doctor for a fertility evaluation. However, more extensive fallopian tube obstruction may be accompanied by chronic mild pelvic or abdominal pain. This is most common with a hydrosalpinx.

How is fallopian tube blockage diagnosed?

Blocked fallopian tubes are typically diagnosed with a hysterosalpingogram (HSG) or a laparoscopy.

A hysterosalpingogram (HSG) is an x-ray taken to examine issues within the uterus and fallopian tubes. In this process, dye is injected into the uterine cavity through the vagina and cervix. If there is no fallopian tube blockage, the dye will flow through the fallopian tubes.

A laparoscopy is a minimally invasive procedure that inserts a small camera through the abdomen to evaluate reproductive organs including the fallopian tubes.

Surgery and in vitro fertilization (IVF) are the two main treatment options for people with tubal factor infertility. The best option for you depends on the extent of the blockage and individual reproductive health factors.

Surgery may be an appropriate treatment option for someone whose fallopian tubes are not severely damaged if there aren’t additional infertility factors. If you are conceiving as a couple, a partner’s sperm count and quality should be accounted for as well.

Tubal surgery can increase the risk of an ectopic pregnancy. If you have had this procedure, it’s even more critical to contact your doctor right away if you believe you may be pregnant.

IVF is a form of assisted reproductive technology (ART) in which an egg is fertilized with sperm outside of the body and then placed into the uterus with the potential outcome of a pregnancy. Since IVF bypasses the fallopian tubes, implanting a fertilized egg directly into the uterine lining, it is a common treatment for tubal factor infertility.

It is typically recommended for people with fallopian tube blockage who are less likely to have success conceiving naturally. This includes people with severely damaged fallopian tubes as well as those with less severe fallopian tube damage but other infertility risk factors.

Hydrosalpinx has been associated with lower IVF success rates. If you have this type of fallopian tube damage, your doctor may recommend fallopian tube removal before starting IVF.

The cost of treatment and insurance coverage are also important factors to consider as you explore your options.

Fertility treatment can be a challenging journey, but Alto is with you every step of the way. We offer reliable same-day delivery of your medications and fertility resources like personalized injection guide videos and access to fertility-trained pharmacists.

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

There’s a spectrum of infertility experiences. The 11% of US couples affected by secondary infertility first have difficulty conceiving after previously giving birth without fertility treatment.

Infertility can be overwhelming to navigate regardless of when it occurs in the family building journey. And secondary infertility can bring unique challenges of its own. Fortunately, the condition is just as treatable as primary infertility, or difficulty becoming pregnant for the first time.

What to Know About Secondary Infertility

There’s a spectrum of infertility experiences. The 11% of US couples affected by secondary infertility first have difficulty conceiving after previously giving birth without fertility treatment.

Infertility can be overwhelming to navigate regardless of when it occurs in the family building journey. And secondary infertility can bring unique challenges of its own. Fortunately, the condition is just as treatable as primary infertility, or difficulty becoming pregnant for the first time.

Here’s what to know about causes, treatment options, and support resources for secondary infertility.

Like primary infertility, secondary infertility can be caused by female reproductive factors, male reproductive factors, a combination of both, or unknown causes.

Causes of secondary infertility in women and people assigned female at birth

Women become less fertile as they age, with a significant decline in the quantity and quality of their eggs from the mid 30s until they eventually reach menopause. Lower-quality eggs are more likely to have chromosomal abnormalities, which increases the chance of miscarriage and reduces the chance of a successful pregnancy.

Structural issues with reproductive organs

Blocked or damaged reproductive organs, specifically the fallopian tubes or uterus, can result in secondary infertility. There are several potential reasons for damage to the female reproductive organs.

Complications related to sexually transmitted infections (STIs) like pelvic inflammatory disease (PID), chlamydia, or gonorrhea can block the fallopian tubes.

Procedures such as dilation and curettage (D&C) or a c-section delivery can cause scarring in the uterus.

Benign polyps or fibroids may block fallopian tubes or interfere with the implantation of a fertilized egg, or embryo.

Polycystic ovary syndrome (PCOS) is characterized by a hormone imbalance that impacts ovulation. It is a leading cause of female infertility.

Endometriosis occurs when tissue that should only grow in the uterus implants and grows elsewhere. The abnormal tissue growth — as well as surgical procedures to remove it — can block the fallopian tubes, preventing the fertilization of an egg. Endometriosis can also interfere with embryo implantation.

Changes in weight or other lifestyle factors

Being underweight or overweight can both impact a woman’s fertility. So can behavioral or lifestyle factors including smoking and substance use.

Causes of secondary infertility in men and people assigned male at birth

Male infertility most often stems from issues with sperm production, including sperm quality, motility, or quantity. Contributing factors may include the following.

Decline in the quality of semen, the fluid that carries sperm

Health conditions including hormone, pituitary gland, or immune system problems and genetic conditions like cystic fibrosis

Certain medications and medical treatments, including some blood pressure and arthritis medications and treatment for cancer, urinary tract infections, and more

If you are experiencing secondary infertility, you may be wondering why it’s more difficult to conceive than before. Here are some reasons why a fertility issue may develop later in life.

Both male and female fertility change over time. The quantity and quality of a woman’s eggs decline with age. There is a similar, though not as severe, relationship between age and sperm quantity and quality. It’s also possible that a fertility issue has become more severe over time. 

Physical changes, new health issues, or lifestyle factors can influence a male or female partner’s fertility. Weight gain or loss or shifts in habits like smoking or substance use may lead to more difficulty conceiving.

A new diagnosis of pelvic inflammatory disease, chlamydia, or gonorrhea is another potential factor in secondary infertility.

Taking a new medication could also change a person’s fertility. For example, common treatments for high blood pressure, arthritis, seizures, or ulcerative colitis can impact sperm quality. And treatment for certain types of cancer can also affect both male and female fertility.

Fertility issues caused by a previous pregnancy or birth

Structural issues with the fallopian tubes or uterus can develop as the result of a complication from a previous miscarriage, pregnancy, or birth.

The timeline for seeking treatment for secondary infertility is the same as that for primary infertility and depends on your age. 

If you are under 35, most health experts suggest consulting a reproductive specialist after a year of trying to conceive.

If you are between 35 and 40, you may want to pursue testing or treatment after six months of trying to become pregnant.

If you are over 40, you may want to pursue testing or treatment before you start trying to conceive.

It’s important to be proactive about seeking treatment for secondary infertility. To increase your chances of success with treatment, don’t wait to pursue a consultation with a fertility specialist based on your past experience(s) conceiving.

It is also recommended to pursue testing or treatment before trying to conceive if you or your partner have any of the following risk factors for secondary infertility:

A history of a sexually transmitted infection such as pelvic inflammatory disease

Common treatment options for secondary infertility

There are many treatment options that can help increase your chances of conception. The most effective course of treatment depends on the underlying cause of your or your partner’s fertility issues. These are some common treatments for secondary infertility.

In vitro fertilization (IVF) is a form of assisted reproductive technology (ART) in which eggs and sperm are fertilized in a laboratory and then placed into the uterus with the potential outcome of a pregnancy. In addition to treating female infertility, IVF can also be used when male infertility is a factor.

Intrauterine insemination (IUI) is a type of artificial insemination in which sperm that have been washed and concentrated are placed directly into a woman’s uterus during ovulation.

Injectable fertility medications like gonadotropins and oral fertility medications such as Clomid® and Femara® can treat fertility-related hormonal imbalances in women.

Oral fertility medications such as Clomid®, letrozole (Femara®), and anastrozole (Arimidex®) and injectable gonadotropin therapy are common treatments for male infertility.

Secondary infertility can be a difficult and emotionally complex diagnosis to process. The need for support is just as great as it is for primary infertility. It’s often helpful to connect with others who have faced similar challenges. RESOLVE: The National Infertility Association offers virtual and in-person support groups specifically for secondary infertility.

To learn more, search their directory of support groups by topic.

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IVF is often a rewarding journey, but it is also a physically and emotionally taxing experience. For many people, uncertainty can be one of the most difficult aspects of the process.

How to Prepare for Your IVF Cycle

Many factors shape each person’s experience of IVF. You have more control over some than others. Preparation includes both taking steps to increase your chance of success while also learning what challenges to anticipate and how to navigate them. Here’s more on what to expect.

It’s important to know upfront that the IVF journey can be longer than hoped or expected and multiple cycles are common. Of those who eventually conceive through the process, it takes an average of 2.7 cycles to become pregnant.

However, certain health and lifestyle factors can influence the likelihood of a successful cycle, and it is definitely worth doing everything you can to be at your healthiest when you begin treatment. Use the following suggestions below as a starting point — note that they also apply to physical preparation for an egg freezing cycle.

Research has found that weight can factor into the outcome of fertility treatment. Being underweight or overweight can both impact your body’s response to IVF medications. Having a healthy weight as you start your cycle may increase your chance of success.

Keep in mind that there are many factors in a person’s overall health, and being at a healthy weight looks different for everyone. Your provider is an important resource and can advise you on whether your weight may impact your fertility.

A well-balanced diet can help you maintain a healthy weight and feel your best throughout your IVF journey. In general, load up on fruits and veggies, lean proteins like fish and poultry, and whole grains. Opt for healthy fats such as avocados, nuts, and seeds as much as possible. It’s recommended to limit your intake of red meat, sugar, and processed foods.

Most health experts advise against any significant changes to your diet before or during an IVF cycle.

Taking prenatal vitamins may improve the quality of your eggs — which is important for a successful embryo transfer during IVF — and prepare your body for a healthy pregnancy. 

Prenatal vitamins that include folic acid, coenzyme, iron, calcium, and omega-3 fatty acids like DHA are typically most beneficial, but check with your provider about the best option for your needs.

Some evidence suggests that healthy vitamin D levels can impact your IVF experience. Ask your provider if you would benefit from a vitamin D supplement.

Avoid unhealthy habits and lower your caffeine intake

You’re likely already aware of the dangers of smoking during pregnancy, but the reasons to avoid the habit while preparing for IVF go beyond the obvious.

While research on the link between IVF and smoking is ongoing, there’s strong evidence that smoking leads to lower success rates. More specifically, it can decrease the thickness of the endometrium, the layer of tissue lining the uterus. This can lower the chance of successful embryo implantation.

Research has also found a link between alcohol consumption during IVF and live birth rates.

Don’t be afraid to ask your provider for support if you are attempting to give up smoking or drinking in preparation for fertility treatment.

Experts haven’t yet determined specifically how caffeine impacts fertility, but several studies have found a link. It is recommended to limit your daily caffeine intake to 200 mg — approximately two 8-oz cups of coffee — during preconception and the first trimester of a pregnancy.

Not only will staying well rested improve your mental and emotional well-being during IVF, some studies have found a correlation between sleep quality and IVF success.

Of course, getting enough rest can be easier said than done: 1 in 3 U.S. adults report that they sleep less than the recommended minimum of seven hours per night. To improve the quality and duration of your sleep, try the following strategies:

Maintain a consistent sleep schedule, going to bed and waking up at the same time every day, including weekends.

Avoid use of electronic devices close to your bedtime.

Get plenty of natural light and stay physically active during the day, but avoid exercising close to bedtime.

Avoid eating or drinking close to bedtime, particularly caffeine, alcohol, and high-sugar or high-fat foods.

Keep your bedroom dark and quiet and maintain a comfortable temperature.

Staying physically active is part of maintaining good health as you prepare for the IVF journey. Check with your doctor about your individual needs, but 150 minutes of moderate physical activity per week is generally a good target to aim for.

High-impact cardiovascular exercise isn’t recommended during IVF, but low-impact exercise is typically safe. However, some clinics advise against exercising altogether during an IVF cycle. Your care team can provide individualized recommendations.

Remember that your partner’s health matters, too

If you are a woman attempting to conceive with a male partner, remember that, while you are the one undergoing the process of IVF, your partner’s health can also affect the outcome of treatment.

There are many factors in sperm quality, including sleep, exposure to chemicals and toxins, and lifestyle habits like smoking and alcohol consumption.

Steps that a male partner should take before IVF include limiting alcohol intake, quitting smoking or using other harmful substances, maintaining a healthy weight, and eating a nutritious, balanced diet.

Review current medications with your doctor and make treatment adjustments if necessary

Some over-the-counter and prescription medications can impact your body’s response to fertility medications and the outcome of treatment. Make sure your doctor is informed of all medications and supplements you take. If any aren’t recommended to take during an IVF cycle, discuss how to safely taper off of them and whether to switch to an alternative medication.

Fertility treatment is a highly personal experience, and the process — including how stressful it is — looks different for each person. One thing that’s universal, however, is that information and support make the journey more manageable.

IVF is a significant financial investment, and the cost of treatment is a common source of stress. It isn’t always possible to predict the course of treatment, or how much it will cost, since there are so many variables, but doing preliminary research and mapping out your personal goals can help you prepare.

If you have health insurance, look into the details of your plan as a starting point. Coverage of fertility treatment varies significantly from one plan to another.

If your insurance plan covers IVF medications, that coverage may fall under the medical portion of your plan rather than the pharmacy one. We encourage you to contact your insurance carrier for an in-depth explanation of your fertility benefits. Additionally, some clinics have an insurance department, which can be another resource as you do your research.

As you prepare for the financial aspects of IVF, it is helpful to determine how many cycles you are willing or able to try. Keep in mind that there are many financial resources that can help you manage or lower the cost of IVF.

Beyond the emotionally taxing nature of fertility treatment, IVF can cause anxiety purely as an unfamiliar medical treatment. Take time to discuss the process with your clinical team. Some phases can cause additional stress, like the egg retrieval and embryo transfer. Knowing what to anticipate will likely help.

You should also prepare to make certain decisions, including how many embryos to transfer and what you will do with unused eggs or embryos. For some individuals and couples, the IVF process involves donor sperm or eggs. Discuss your options with your care team and give yourself time to determine what the right choice is for you.

Additionally, familiarize yourself with common side effects and make a plan for treating them. Injections can be particularly stressful to navigate, so take time reviewing the techniques. As an Alto customer, you’ll have personalized videos for each injectable medication in your protocol in the app.

Reducing stress and building a support system

Be mindful of your emotional and mental well-being throughout your fertility journey and make a plan for reducing stress. Don’t hesitate to lean on your friends and family for support — especially those who have gone through the IVF journey themselves — but remember, too, that sharing your decision to pursue IVF is a personal choice.

A pharmacy partner for your fertility journey

Fertility treatment can be a challenging journey, but Alto is with you every step of the way. We offer same-day hand delivery of your medications and fertility resources like personalized injection guide videos and access to fertility-trained pharmacists.

Despite how widespread infertility is, affecting about 9% of U.S. men and 11% of U.S. women, the condition remains underdiscussed and misunderstood.

Information is critical to making the right decisions throughout your family building journey, but with so many misconceptions about fertility — and so much unsolicited advice — it can be difficult to know the best way forward. To help set the record straight, we’ve debunked several common myths about infertility.

Top Fertility Myths Debunked

Despite how widespread infertility is, affecting about 9% of U.S. men and 11% of U.S. women, the condition remains underdiscussed and misunderstood.

Information is critical to making the right decisions throughout your family building journey, but with so many misconceptions about fertility — and so much unsolicited advice — it can be difficult to know the best way forward. To help set the record straight, we’ve debunked several common myths about infertility.

Myth: Infertility is purely a female health issue

Infertility is often considered a women’s health issue, but in reality, only a third of all infertility cases are exclusively caused by female reproductive factors. Of the remaining two-thirds, half stem from only a male reproductive factor and half stem from a combination of male and female factors or unknown causes.

Male infertility is most often the result of issues with sperm production, including problems with sperm quality and quantity. Fertility treatment can help address both male and female fertility issues. In fact, one reason for the perception of infertility as purely a female health condition is that it is sometimes women who undergo assisted reproductive technology (ART) treatments such as in vitro fertilization (IVF) and intrauterine insemination (IUI) even for a male infertility factor. (Men can be treated for infertility with oral medications or injectable hormone therapy, but these treatments can take six months to a year or more whereas a typical IVF cycle is just two weeks.)

If you and your partner are experiencing challenges conceiving, you both may wish to consult with a doctor about a fertility evaluation to determine the best next steps. Experts recommend seeking an evaluation after six months of trying to conceive if the female partner is over 35 and after a year if the female partner is 35 or younger.

Read Male Infertility: Causes, Symptoms, and Treatment.

Myth: Age doesn’t affect male fertility

Many people are aware that women become less fertile as they age, with a significant decline in the quantity and quality of their eggs from the mid 30s until they eventually reach menopause. Male fertility also declines with age, typically beginning around 35-40. And though the changes men experience are less significant — men never stop producing sperm and may be able to conceive well into their 50s, 60s, or later — a male partner’s age can influence pregnancy rates and how long it takes to conceive.

The age-related decrease in male fertility often stems from changes in sperm quantity and quality. Sperm quantity refers to the amount of sperm produced, while quality refers to its movement, size, and shape. These characteristics are important factors in male fertility, as they affect sperm’s ability to reach and fertilize an egg.

Myth: You’re too young to experience fertility challenges

Given that age is a factor in both male and female infertility cases, it’s understandable to assume that you won’t have difficulty conceiving in your 20s or early 30s. However, infertility affects people of different ages. According to the American Society for Reproductive Medicine, 7% of women between the ages of 20-24 face infertility, as do 9% of women between the ages of 25-29.

Age-related changes in fertility can vary by individual. While fertility typically begins to decline around the ages of 30-35 for most women, it’s possible to enter premature menopause and experience these changes even earlier.

Beyond the variation in age-related fertility issues, there are some causes of infertility entirely unrelated to age, including:

A history of pelvic inflammatory disease, chlamydia, or gonorrhea — conditions that can lead to blocked fallopian tubes

Other health issues including a history of chronic illnesses or cancer of a reproductive organ

Lifestyle factors including smoking and substance use issues

Remember that no one is ever too young to pursue fertility testing, and you are your own best advocate.

Myth: Getting a regular monthly period means you won’t struggle with fertility

Yes, the majority of female infertility cases are caused by problems with ovulation — the release of a mature egg from the ovaries — and a regular period typically indicates that you are ovulating normally. However, there are other drivers of female infertility, and it is possible to struggle to conceive even with a regular menstrual cycle.

Here are some reasons why you might have difficulty conceiving despite getting a regular monthly period:

Structural issues with the uterus or cervix

Endometriosis, a condition in which tissue that should only grow in the uterus implants and grows elsewhere

Silent anovulation*, a condition in which a person does not ovulate despite getting a regular period

Fortunately, there is treatment for a wide range of fertility issues. A fertility evaluation is an important first step toward addressing your specific challenge.

*The majority of anovulation cases are characterized by an irregular period and therefore more easily recognizable, hence why those that include a regular period are referred to as silent cases.

Myth: Couples who naturally conceived previously won’t struggle with fertility in the future

Having an easy time getting pregnant once doesn’t necessarily indicate that you will have the same experience in the future. Infertility may develop at different stages of life, particularly when age is a contributing factor.

Secondary infertility occurs when individuals or couples who already have one or more children have difficulty conceiving again. It affects approximately 11% of U.S. couples and is caused by many of the same factors as primary infertility, or difficulty conceiving for the first time.

Regardless of whether you’ve been pregnant previously, don’t delay on seeking a fertility evaluation if you are struggling to conceive.

Myth: If you’re trying to conceive, just relax

It’s commonly assumed that stress makes it more difficult to get pregnant. While chronic stress may affect a person’s ability to conceive, it’s important to remember that infertility is a medical condition, and stress alone is unlikely to drive fertility struggles. In other words, try not to let your stress become a new source of stress.

That said, while healthy stress management isn’t a substitute for fertility treatment, staying mindful of your emotional and mental well-being can only make it easier to navigate the challenges of infertility.

Fertility treatment can be a challenging journey, but Alto is with you every step of the way. We offer free same-day delivery of your medications and fertility resources like personalized injection guide videos and access to fertility-trained pharmacists.

Interested in learning more about how Alto can support your treatment? Request a price quote online or reach out through secure in-app messaging or by phone at 1-800-874-5881.

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.

The Difference Between Intramuscular and Subcutaneous Injections During IVF

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.

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:

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.

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 hormones, including testosterone and contraceptive hormones

How to administer an intramuscular injection

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.

Blog

Understanding Tubal Factor Infertility

What to Know About Secondary Infertility

How to Prepare for Your IVF Cycle

Top Fertility Myths Debunked

The Difference Between Intramuscular and Subcutaneous Injections During IVF

What to Consider Before Freezing Your Eggs

What is Ovarian Hyperstimulation Syndrome?

How to Navigate Common IVF Side Effects

A Guide to Traveling During Fertility Treatment

Endometriosis: A Leading and Treatable Cause of Female Infertility

How Alto Lowers the Cost of Fertility Treatment Through Better Medication Management

AMH Testing in Fertility Treatment

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