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Tuesday, July 25, 2006

Sub-Cue Injections

Why you would be doing a sub-cue injection

There is a wide range of fertility drugs that use subcutaneous (usually abbreviated to sub-cue) injections. These include Gonal F, Follistim, hcG, Lupron, and Antagon. While some people will do unmedicated cycles, more people doing IUI or IVF will use injectible medications.

What you can expect

I always gave myself my injections. I was very squeamish about needles and I came to this decision because (1) I didn’t want to associate my husband with pain and (2) I thought I’d handle it better if I was in control. Know yourself. If you think you would be the best person to give the shot, do it yourself. If you think you’d rather have it out of your hands, pass on the task to someone else. You can have more than one person learn how to give the injection in case your primary person isn’t available on a day when you need a shot. For the sake of clarity, I wrote these instructions as if you are giving yourself the shot. But know that someone else can do all these steps as well.

Get everything together before you begin—maybe ten minutes beforehand. Unless you’re used to giving yourself injections (or having others do it), you don’t want to start preparing things too early or you’ll build a lot of anxiety. In order to do the Stirrup Queens-Giddyup-and-Inject-Yourself method, you’ll need a few alcohol wipes, a sterile gauze pad, an ice cube in a cup, a hot water bottle filled with…hot water, the needles, and a totally mindless half hour of television on tape.

The sub-cue injections I experienced (Follistim and hcG) were both prepared as a powder in one vial with an accompanying vial of sterile water. Mix them according to your doctor’s instructions after swabbing the top of each vial with an alcohol wipe. Take your time. Hold the needle upright and flick it a few times to get the bubbles to rise to the surface. Push them out. Gently (don’t waste any of that expensive medication!).

Pop the tape in the VCR. Why did I tell you that it had to be on the television? Because you need to distract, distract, distract. I always had the bright idea to tape reruns of E.R. Why did I do this? It didn’t distract. It only made me more anxious. Stick to sitcoms, favourite dramas, mindless cartoons.

When the time comes to give yourself the shot, take the ice cube out of the cup and rub it on the area being injected. Rub it for at least one full minute. You really want to numb the area. But don’t do this step until your ready to give yourself the shot. There’s nothing worse than going through freezer burn only to have to do it again and again because you don’t feel prepared for the shot.

When your belly (I always did the shots in my belly) is numb, wipe it off with a final medicated pad. Then take the needle and line it up so it is lightly touching your belly. Pull back your hand at least an inch, look away (distract, distract, distract), and plunge down. You’ll need to glance down and check that the needle is in. Then look away again and slowly depress the plunger. Pull out and immediately cover the site with the gauze pad (there may be a spot of blood). Press the hot water bottle to the site and hold it there for a half hour or so. The heat will help (specifically, the wet heat will help) minimize pain. Follistim is sometimes nicknamed Follisting because it has a burn afterwards. I’m sure there are other comments below giving you a heads-up on the specifics of other drugs.

Watch your television show and relax. You did it. You got through the first shot. Or maybe it’s your second or third shot. Or maybe you return here every time you need to do an injection. That’s okay too. You’re amazing and you’re already a fantastic mother doing so much to bring a baby into the world. Hang in there. The injections are terrible, but they’re worth it if they bring you closer to your family.

Here are some problems that might arise (and ways to troubleshoot)

Sometimes you’ll get bruising. I was never sure what caused the bruises and why they sometimes occurred and sometimes didn’t. There’s not a lot you can do for buising—the body just needs time to heal. You can alternate sides of your belly button each shot and ask your doctor if there are other locations on the body for your sub-cue injections.

Here are my personal tips

Look above—that’s about all I can say about sub-cue shots. Oh, except be really nice to yourself on injection days and get yourself a special treat. Better yet, make someone else get you a special treat—you’re the one enduring the shot!


Lyrehca said...


I'm a longtime type 1 diabetic, so I've been giving shots for decades. However, I've noticed that my Gonal F shot seems to go in easier than the Lupron shots. I think the tips of the Gonal F pens are sharper. But overall, pick a spot on your abdomen (where absorption is quicker than in the leg or arm or tush), and lightly touch the skin with the needle before the actual shot goes in. There are different nerve endings all around the body and some areas you'll feel no pain at all and others will be sensitive. I tend to inject in the "no pain" areas before I'd inject into the more sensitive ones.

Also, people are instructed to give shots quickly, like throwing a dart. This has never worked for me and instead I just keep pressing the needle into my skin until it slowly sinks in.

There's also something called EMLA cream that helps numb the skin before you give a shot. Check your local pharmacy; I think it's over-the-counter.

Anonymous said...

My RE has always said stomach or leg were fine for injections. I chose leg because it is not as common to tense up the outside of your thigh when you are nervous as it is your stomach. Also, it gives a reason for having all that extra fat on my thighs!

About Me said...

Hi. I just started injections myself. I started with Lupron on Saturday and injected myself both Saturday and Sunday. The needle did not hurt but the Lupron burned a little. Then I wanted to get my husband involved when I started the Follistim because he's going to be injecting my Progesterone in Oil in my butt and I want him to get used to stabbing me and injecting. I've read the Progesterone in the leg is way more painful.

Anyway, the Follistim hurt when he did it. But it was his first time, so I guess I can't blame him. So, just now, I injected the Follistim and he injected the Lupron. He doesn't have the gentle touch I have with myself. But I did notice that the FOllistim needle did hurt a little more than the Lupron.

The Lupron syringes came with insulin needles. But still, it hurt when he did it.

I didn't realize it until I read your directions that I was gently resting the needle on my skin before injecting which is probably why the Lupron injections didn't hurt me as much.

Nice blog.

Megan said...

I have to give myself my Lupron shot tonight, I'm TERRIFIED of needles and have been crying all day about it! Any suggestions?

Lollipop Goldstein said...


Not sure if you'll check back here, but if you do and want to talk, my email is

Holly said...

I did my first lupron shot this morning at my injection class. I was didn't hurt at all. I'm a big baby...the insulin needle is tiny. You'll feel silly like I did after it's over! Best wishes.

Anonymous said...

I always inject my stomach, I used lyrehcas tip of finding a less senstive spot, and injected after numbing with ice.
The gonal f pen is really good as there is no preparation and it didn't really hurt. It seemed to bruise or bleed more than the hcg shot though .The hcg shot definetly stings when you are injecting, but the actual needle doesn't hurt, and I find the stinging goes within 30 seconds anyway.
I was so nervous about giving myself injections, and spent many sleepless nights worrying about it. I have always been scared of needles. But I wanted to let others know it really isn't bad at all.

Anonymous said...

Thank you so much for this blog :-) I've been giving myself lupron injections for the past 10 days but just started having to do 3 injections each night (lupron, hcg, and follistim) and it's been breaking me! I spent 2 hours crying last night and feeling like such a baby.. It's so nice to read some friendly advice - from someone else who is clearly dsturbed by the injections too! :-)

Anonymous said...

Hi there

I am very squeamish with needles and had my hubby to the first two cycles.

I have now found a great way to do it- numb the area with an ice pack kept in the freezer; first a minute over your shirt, then, as your body adjusts, a minute or two on the bare skin. Voila, the skin is numb as you inject. Also doesn't hurt after if you put the ice pack on for 10 seconds ; )

Mrs. Higrens said...

I am a number one weenie when it comes to pain and needles - to the point of passing out and/or going into panic attack.

So I was just a LITTLE nervous when it came to the Follistim and Ovadrel shots I had to do for my most recent cycle.

The Follistim pen needles went in so smoothly I couldn't feel it (unless I hadn't let the alcohol swab dry fully). I had no problems giving myself this shot, even without numbing.

The Ovadrel pre-filled syringe was like having my ears pierced, down to the pop as it crossed the final barrier - this one I tried to pass out on (thank goodness it was only the one night!) thanks to holding my breath and increased nerves after it wouldn't go in easily on the first try.

Not saying I'd want to inject myself with Follistim every day, but it wasn't nearly as bad as I expected.

B said...

Pay attention at the injection class. This is a fairly easy one.
It doesnt hurt much. Once you know what to expect (day 2) it probably wont hurt at all. Pinch the fat (I do hope you have some) on your tummy around your navel by one hand and inject with the other. Alternating sides (left and right) daily helps. (not just because you have ovaries on both sides:)
Also after you have injected all the medication in hold the needle in place for atleast 20 seconds, then start to withdraw. Set your own speed going in and out. There is no such thing as too slow. Tell your husband that you will take care of the injection but he needs to give you a foot rub at the end of it for being so brave :)