I’m an acupuncturist who has been supporting fertility patients for the last several years and I recently finished my own first round of IVF.
Having gone through the onslaught of multiple daily injections, I realized I may have an approach to injections that the average fertility patient may not know could help them. So here’s how I avoided bruising during my treatment and you can too.
First, this is not a 100% guarantee that you won’t bruise at all. Why? The area that your med teach team has instructed you to use avoids any major veins and arteries so you’re not going to do any serious damage. However, capillaries are still present in this area, individually they’re too small to be seen and avoided, and there’s no reliable map for them. So capillaries can be punctured and produce small areas of bruising. If this happens, you’re fine. This doesn’t interfere with your results. But bruising is just one more thing that may make your IVF experience less comfortable and more stressful and if that can be avoided, I’m all for it. The techniques I’m outlining here will prevent most bruising and I’ll include some notes at the end on treating any bruising that does appear.
Second, if anything I’m saying goes against what your med teach team instructs you to do, go with their advice above mine. You must follow the instructions for your medications. I don’t anticipate any conflicts, but of course I want to make sure you’re using your medications properly and I don’t know your individual case.
The basics? Palpate, ice, alcohol swab, let the alcohol dry, distract, inject, sustained pressure, ice again.
Let’s go over this in more detail including why these steps are helpful:
Japanese style acupuncture uses abdominal palpation to assess what needs treatment and why. You can use similar gentle yet firm pressure at home to find the right injection site.
Palpate: Palpation is examining by feeling or touch. Before you’re going to inject a spot, gently but with firm pressure, press with a finger or two until you find an area that’s not tender. Explore your body. If you’ve already done an injection or you’re several days into your stimulation cycle, it may be harder to find a non-tender spot. But there’s going to be some spot that’s less tender than the others. It might be small. But injection needles are smaller than your finger. Your finger might hurt more than the needle does (that’s my goal here, anyway)!
Ice: Why ice? Generally acupuncturists don’t like ice because cold constricts and constriction means stagnation and prolonged stagnation will eventually lead to pain. And pain is what we’re often presented with to treat in our patients. So other than acute trauma (for example, right after spraining your ankle or tearing a muscle), we tend to recommend warmth over ice to open up the capillaries, promote bloodflow, and introduce healing to the area (think platelets, endorphins, white blood cells, etc).
Ah, did you catch that? Warmth will open up the capillaries. Cold constricts them. And in this case we don’t want the capillaries open (briefly) because we want to avoid bruising! So wrap an ice cube in a paper towel or kitchen towel, choose your injection site, and press the wrapped ice cube to your skin until you feel numb when you poke yourself in the area with a finger.
Alcohol swab: Alcohol swab because we want the injection site to be clean. Don’t rub the swab around. One neat swipe or a spiral so you don’t go over the spot and then ruin your work by going back over it again with a now not perfectly clean swab.
Wait: Make sure you wait to inject until the alcohol is no longer wet! Sometimes I think we have this idea that it’s only clean while it’s wet, but that’s not true! If you inject while it’s wet, it’s going to sting. Wait until it’s dried on the skin (this doesn’t take long - isopropyl alcohol evaporates quickly). 15-20 seconds should do it, which is about how much time it’ll take for you to do the next few steps anyway unless you’re rushing. (Don’t rush. Breathe.)
Distraction: Once you have your syringe assembled and ready to go (depending on how long that takes you, you might want to do all that before you start step one), grab the skin around your chosen injection site hard enough to get your attention. I even used my fingernails (not enough to do damage, but enough to notice), something I wouldn’t do with my patients. The trick here is to distract your brain with more sensation than just the needle insertion.
If you have a partner/ moral supporter with you, have them put their hand on your shoulder, back, knee, or other easy to reach comforting spot and gently massage.
Inject: Take a deep breath. Longer than standard inhale and exhale. Do it again if you have to to relax. Your sympathetic nervous system (fight/flight/freeze) will release its hold with longer breaths. As you breathe out, insert the injection needle firmly and steadily (not too fast, not too slow). The med teach instructions I got advised to “insert like a dart.” No one likes to be a dartboard. You’re not throwing it at yourself. Just put it in perpendicularly. But it doesn’t have to be sudden. You can insert the initial aspect of the needle quickly and then slowly continue as you breathe at a calm pace.
I found having my thumb on the plunger of the needle was the most comfortable and strongest position. So I could insert with the syringe in my palm with fingers wrapped around it (like a fist) and my thumb free for the plunger. That meant that even with the hard pressure pens (like Gonal-F), I didn’t have to reposition if I was having trouble making sure the entire dose was administered.
Once the needle is fully inserted, slowly and steadily push the plunger to administer the full dose. Pause at the end to ensure the dose has left the needle before beginning to remove the syringe.
Sustained pressure: Have gauze standing by. I found it was best to have my partner hand me gauze as I removed the syringe slowly and steadily. Otherwise you can have it on a clean surface already unwrapped from its package within easy reaching distance. As immediately as possible while carefully disposing of the syringe in a sharps container (again, I traded my partner for gauze), place gauze against the injection site and apply pressure. I found it helpful to combine this step with ice.
Ice again: Put that covered ice cube over the gauze and use it to apply pressure and re-chill the area (constricting capillaries). If anything was punctured, pressure and cold will minimize bruising. This also helps to distract the brain and resolve pain from the injection, including any burning or stinging sensation from the medication. I also recommend singing, sighing, crying, or cursing. If that injection hurt, make noise! My theory is that this is also a form of distraction as well as a movement of the qi (great for relieving pain). You’ve seen those studies that say people who curse had higher pain thresholds? No? Check it out. Fascinating stuff.
I found that sometimes a minute was sufficient with that last icing and sometimes I wanted to sit with it for longer. You’ll know when you’re ready to take it off. And if you have to do another injection right afterward, just repeat all the steps (you’ll probably need a new ice cube in addition to the obvious new gauze, alcohol swab, etc).
Oh no, I bruised anyway!
Remember, you’re not a failure. We don’t have total control over our capillaries (we generally can’t see them) and you just happened to hit one. You’ll recover and this in the grand scheme of things in this cycle is truly small. You’ll have used some extra gauze and maybe you’ll want a small bandaid, but you’re ok. Breathe.
There are some things that help with bruising, but you may not want to use them and that’s ok. If you’re unsure, discuss with your physician and follow their advice. Even as a licensed acupuncturist and herbalist I was surprised by how many things I would normally feel totally safe doing that I wanted to avoid during IVF because any controllable variables felt like they should be avoided. And there were so many things I couldn’t control or was stressed out by. Decreasing stress and anxiety is key during IVF so if you have a little bruise and you aren’t bothered by it or the thought of treating it is more upsetting to you, breathe and move on.
Some things that address bruising include:
Arnica gel. This is a homeopathic remedy you can get at most drugstores now over the counter. I would not recommend oral arnica during IVF even though it may be safe. Applying a small dot of the gel on the bruise is intended to help resolve bruising and relieve pain.
Moxibustion. If you’re working with an acupuncturist who has given you at home moxa tools, they can instruct you on how to use these to treat bruising. Do not use without the aid of a licensed acupuncturist or herbalist knowledgeable about moxa, abdominal acupuncture points, and fertility.
Mild heat. A hot water bottle at mild to medium heat the day after you bruise may be helpful to resolve bruising.
I hope that your cycle goes well and you feel supported during this time. If this was helpful or you have more questions about IVF, fertility treatment, or acupuncture, please get in touch.
Photo by Alicia Petresc on Unsplash
ABOUT SHAWNA
Shawna Seth, L.Ac. is a California state licensed and nationally certified acupuncturist currently pursuing physician assistant training. To better understand acupuncture and how you can use it in your daily life, and to explore the connections between Western and Eastern medicine, follow her blog A Cuppa Qi. She also invites connection via email contact@shawnaseth.com or Instagram @acuppaqi.