By Michael B. Doyle, M.D.updated Fri, August 2, 2013Though surrogates often cannot wait to start the process, the issue that usually causes the most concern is the injections. And even though medications protocols may vary between IVF centers, over 95% of the time some form of injection is required. So what exactly are they? Why are they used? And how can you navigate their administration, unpleasantness and occasional side effects?Almost all gestational carrier cycles require Lupron. Lupron suppresses the hormonal signals that your brain produces to trigger a natural ovulation. For surrogacy, this is essential so that your own "natural" hormonal surges do not interfere or compete with the hormones that you will later be given which are designed to most precisely develop the uterine lining. As a result, when the embryos (which are of a very specific age) are finally placed into you, they will be met by an ideal uterine lining of the exactly equivalent stage of development, determined by your medications and not by your body’s more natural rhythms. Lupron can essentially ensure this. Without Lupron (for example in a "natural cycle") it is almost impossible to pinpoint your hormonal surges with as much precision, and as a result pregnancy rates are much lower. Lupron usually is given for several weeks before any other medication, and then after your hormones are suppressed, they are continued while you take the Estrace to build up your optimal uterine lining. It is injected with a truly tiny needle just under the surface of the skin, with a subcutaneous needle. The most common side effects of Lupron are headaches and/or hot flashes. The other injectable hormone that surrogates often use is progesterone. Though this is sometimes given either vaginally and/or orally, many doctors still feel that the intramuscular injection is more reliably absorbed, and (except for the shot itself) ultimately less irritating. Injectable progesterone is suspended in oil, which enables it to act as a slow-release depositor of progesterone around the clock, and prevents it from passing directly through the stomach and losing some if its activity, which happens with pills. This is ultimately good, but also results in some people in annoying "bumps" or welts that are the oil deposits that can accumulate in the muscle. In addition, depending on what kind of oil is used (sesame, peanut, coconut, etc) you may find a sensitivity to one that is easily fixed by simply trying another form of oil and if it is less irritating, switching to it. Bloating, discomfort at the injection site, weight gain, and mood swings are not uncommon.As a gestational carrier you will always be given a thorough injection lesson (whether alone or with a spouse / partner) in which you will be shown how to draw up and administer each of the medications. You will also be given a very specific schedule that is tailored just for you, charting when to take each medication. All of your supplies will be ordered through a specialized fertility pharmacy, and included with your medications will be everything else you need -- alcohol wipes, cotton swabs, syringes and needles that you will need to administer your medications. Also be assured that each individual specialty pharmacy has an injection tutorial on their website. One of the most common online resources is www.freedommedteach.com. Michael B. Doyle, M.D., Medical Director, Connecticut Fertility
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