A clear schedule and a plan for getting help can make IVF medication easier to manage, says Elisavet Petraki, Fertility Midwife, fertility midwife at Pelargos Fertility Group. Treatment can involve several medicines, each with its own purpose and instructions. Knowing when to take them, how to store them and whom to call can help patients feel more prepared.
IVF medication follows a sequence, but the details are different for each patient. Some people take medication to time the start of a cycle, followed by injections to stimulate the ovaries. Others may use a natural or semi-natural cycle rather than a full stimulation protocol.
During stimulation, follicle-stimulating hormone (FSH) or human menopausal gonadotropin (HMG) injections are generally used for 9 to 14 days to help several follicles grow. An antagonist is added to prevent ovulation from happening too early. Later, a trigger injection is given before egg collection, and estrogen and progesterone may be used to support the womb lining around embryo transfer.
Your written clinic plan matters more than a friend’s schedule or advice on a forum. The clinic may adjust doses after scans and blood tests, so a plan can change as treatment progresses. Change a dose only when your team tells you to, and ask about anything on the plan that is unclear.
Stimulation injections are usually taken at the same time each day, often in the afternoon or evening. A window of about an hour on either side can accommodate work and other commitments, but the clinic should be contacted about a longer delay. Antagonist timing matters too: a missed dose can allow ovulation to occur early and may lead to the cycle being cancelled.
A diary or phone reminder can make a busy schedule easier to manage. Record the dose, the time it was taken and the pen number, as well as any medication left in the pen. Keep the written plan close at hand so you can check it when your dose changes.
If you forget a dose, call the clinic as soon as you remember rather than trying to work out the correction yourself. The team may advise taking it straight away, depending on the medicine and circumstances. Do not double the next dose to catch up.
The trigger is the most time-critical injection in the cycle. It is given 34 to 37 hours before egg collection, at the exact time set by the clinic. Plan to be home and ready, set two alarms and write the time down.
Preparation is especially useful if the trigger medicine needs to be mixed and you have not done that before. Ask the clinic to show you the steps and practice in advance if you do not feel comfortable. If someone else will give the injection, make sure they are available at the specified time.
If the trigger is late, missed, or you are unsure whether it was injected, call the clinic immediately, day or night. Do not guess whether to repeat it. After the trigger, stimulation medication and the antagonist are generally stopped unless the clinic tells you otherwise.
Needle anxiety is common, and you do not have to manage injections alone. A partner can be taught to give them, and some couples share the task. If home injections are not possible, some pharmacies in Athens can administer them; for a precisely timed evening or Sunday trigger, an at-home nurse may be needed if pharmacies are closed.
Many IVF injections are subcutaneous, meaning they go just under the skin. The needles are small, and the injection generally hurts less than patients expect. Ask the clinic to demonstrate your particular device, including any preparation it needs before the first use.
Before an injection, wash your hands and lay out the medicine, needle, alcohol swab and sharps box. Check the medicine name, prescribed dose and expiry date; the liquid should be clear. Wipe the injection site with alcohol and let the skin dry before proceeding.
For the injections described in the treatment plan, the abdomen is a common site, about 5 centimetres from the navel, with sides alternated each day. Pinch a fold of skin and insert the needle at 90 degrees. If using a pen, hold it in place for 10 seconds before removing it so the full dose can go in.
Afterwards, press the site gently with gauze without rubbing and put the needle straight into the sharps box, not household rubbish. A small bruise or a drop of blood can be normal. If the abdomen becomes sore, ask about using the thigh as an alternative.
Use a new needle each time you use a pen, and follow the leaflet’s priming or drop-check instructions when starting one. Dial the exact dose prescribed. If a pen does not contain enough for the full dose, note the amount remaining and finish the dose with a new pen.
Some medicines come as a powder and solvent rather than a ready-to-use pen. The solvent is added slowly to the powder, and the mixture is gently swirled—not shaken—until the liquid is clear. Mixing and storage instructions vary, so ask for a demonstration and follow the instructions for your own medicine.
If a pen gets stuck, a new needle can be tried. If it still does not work, the notes recommend starting a new pen and recording the remaining dose. If you are unsure whether the full dose went in, do not reinject: call the clinic, which may ask for a picture of the pen or arrange a video call to help assess it.
Storage rules are not the same for every IVF medicine. Some need refrigeration, while others can be kept at room temperature or have a limited period outside the fridge. Check the leaflet in each box because instructions can differ by country and pack.
For medicine that requires refrigeration, keep the fridge between 2 and 8 degrees Celsius. Store the medication in its box on the middle shelf, not in the freezer. Medicine that has frozen should not be used, even if it has thawed.
Many stimulation pens have a limited usable period once opened, often about 28 days, but that is not a rule for every product. Some mixed medicines must be used immediately, while certain multidose preparations can be kept longer. Check the specific instructions and ask the clinic if the medicine has been left out or if you are unsure how long it has been open.
Protect medication from heat and light, and avoid leaving it near a window. If you need to travel by plane or train, keep injections in hand luggage with a clinic letter. A cool bag and ice pack can help with transport, but the ice pack should not touch the pen: freezing can make the medication unusable.
If an ice pack melts or you are uncertain about the temperature during a journey, contact the clinic with the name of the medicine and its storage details. Some medicines can spend limited periods outside the fridge, but the permitted temperature and time depend on the product. Do not assume the same allowance applies to every medication in your bag.
Egg collection is performed under sedation. The notes advise not eating or drinking for at least 6 to 8 hours beforehand, and bringing a list of medicines. Follow the clinic’s specific instructions for the day, and do not drive or make important decisions for 24 hours after sedation.
For embryo transfer, estrogen may be used to prepare and support the lining of the womb. It can be prescribed in different forms, including tablets, patches, gel or spray. Doses should be spaced as directed; taking them in the morning does not make them more effective.
Progesterone prepares the lining to accept the embryo and keeps it ready. Many patients use it vaginally, although other forms are also used. White discharge or gel residue can be normal and does not necessarily mean the medication has not been absorbed.
Take estrogen and progesterone according to the schedule for your stage of treatment rather than combining doses for convenience. If progesterone has been prescribed vaginally, the notes recommend inserting it while lying down and staying flat for 10 to 15 minutes. Do not stop progesterone because of bleeding unless the clinic tells you to, and do not stop estrogen suddenly without instruction.
Not everyone needs additional medicines such as steroids or blood thinners. These are prescribed selectively according to a patient’s history. Tell the clinic about all medicines, supplements and herbal products you use, and check before taking other medication during treatment.
Some discomfort can occur during stimulation. Mild bloating or fullness, pelvic twinges, breast tenderness, headache, tiredness and small injection-site bruises are among the symptoms described as common. They usually settle after egg collection.
Severe symptoms should not be dismissed as routine bloating. Call the clinic the same day for severe abdominal pain or swelling, vomiting or inability to drink, passing very little urine, gaining more than 1 kilo per day, or shortness of breath. These can be signs of ovarian hyperstimulation syndrome, an uncommon condition that is treatable when caught early.
Contact the clinic immediately for fever above 38 degrees Celsius, worsening pain after egg collection, heavy bleeding or soaking a pad in an hour. Any bleeding while taking blood thinners also needs advice. For chest pain or serious breathing problems, including a severe allergic reaction, contact emergency services first and then inform the clinic.
At the end of a cycle, check what is left before putting it away. Opened stimulation medication may have a limited usable life; the notes give up to 28 days for opened stimulation medication, but the product instructions remain the guide. Check the expiry date and whether the medicine has been stored as directed.
Unopened medicines may also be left over, and the notes describe some patients giving sealed estrogen or progesterone to others. Before passing medication to anyone or planning to use it in a later cycle, ask the clinic for advice. A medicine that suited one person’s plan is not necessarily part of another person’s treatment.
Keep used needles in the sharps box rather than household rubbish. Ask the clinic what to do with unused or expired medicines and the full sharps box. That final check is also a chance to clarify which medicines, if any, you should continue.
IVF medication can feel complicated at first, but the practical work comes down to a few habits: follow your own written plan, keep to the schedule and check the storage instructions for each product. Give the trigger injection extra planning time, and arrange help with injections before you need it. When a dose, device or symptom leaves you uncertain, contacting the clinic is a safer next step than guessing.
No. Do not reinject if you are unsure whether you received the full dose. Contact your clinic: the team may arrange a video call or ask for a picture of the pen to check what it shows and give you tips.
Pens can get stuck, and this is very common. The clinic team will also show you how to use the pen when you attend the clinic.
An hour either side of the scheduled time is generally okay, but the clinic does not want a delay longer than one hour. This flexibility can help if you are working and cannot have the medication with you.
Injections given in the morning or afternoon to prevent ovulation are especially important. If ovulation occurs, the cycle is cancelled. If you miss a dose or are unsure what to do, ask your clinic.
Bruising, bloating, a feeling of heaviness, migraines, and discomfort can occur during stimulation.
Toward the end of stimulation, inform the clinic if pain becomes very intense and feels like more than bloating or heaviness. The team may need to speed things up or consider the pain, particularly depending on how many follicles you have. The aim is to avoid ovulation and prevent you from becoming too uncomfortable.
Yes. Needle anxiety is common, and a partner who is comfortable with needles can be taught to give the injections and help you through the process.
If that is not possible, some pharmacies in Athens can administer injections. If you need a trigger injection when pharmacies are closed—for example, in the evening or on a Sunday—an at-home nurse may need to give it at the correct time. IVF clinics are not always open, so a nurse or midwife may not be available there.
Stimulation medication is given in the afternoon. Ergaliutron or Cypriotide is used to prevent ovulation. Protocols are very individualised.
When stimulation starts on the second day of your period, blood tests and a scan are done, and the results are needed the same day. You are then given a medication plan for three days before the scan, and blood tests are repeated to adjust the doses.
During embryo transfer, estrogen and progesterone are spread out rather than taken just once a day. Taking them in the morning does not increase their effect; dosing depends on the stage you are in.
Use a cooling bag and protect the medication from light. Keep ice or cooling packs against the box, but not touching the needles. The box is usually placed on top of the packs inside the bag.
Keep the medication away from windows and heat, and consider the weather and air conditioning when travelling by train or plane. The medication can be kept at up to 25°C, so it is not a problem if the ice packs melt and it is not kept at up to 8°C. Unused medication can be stored at up to 25°C for some time. Transport by train or plane is safe; freezing is what will destroy it.
Opened stimulation medication has a limit of up to 28 days, after which it should be discarded.
Estrogen pills and closed boxes of progesterone are sometimes given to other women going through the same cycle. If the medication has been stored appropriately at room temperature and has not expired, it is safe to use. If it is closed and unopened, the indication is clear.
Keep a schedule and set reminders, especially if treatment must fit around a busy job and daily life. Prepare in advance for the trigger injection: the box usually contains seven powders and liquids to mix, and not all will be used in a trigger cycle. If you have not done this before and do not feel comfortable, practice so you can give the trigger right on time.
Store medication correctly, as it will not work if it is not stored properly. If you are unsure or confused, ask your clinic—it is better to double-check than to feel uncomfortable.
