Even if they don’t get you pregnant, there’s one thing fertility treatments will do for sure: cure your fear of needles. Between daily injections and constant bloodwork, you might find yourself spending more time with needles than you do with your best friends. Being the scaredy-cat that I am, I was quite surprised by how quickly I grew comfortable with infertility injections. With these injections, it really is the case that the first time is the hardest, but once you’ve mastered the art of injecting, it just becomes part of your daily routine. I hope that these step-by-step instructions will help you understand how to inject Follistim, and I’m pretty sure that within a few times you’ll be able to do it with your eyes closed (well, not literally – there are still needles involved, after all – but you know what I mean). The steps in the photo guide are described in detail underneath it.
Before You Begin
Before you get started, make sure you have everything you need: a Follistim pen, a Follistim AQ cartridge, a BD Micro-Fine pen needle (you can expect to find some with the cartridge, and also inside the fancy case you get with the pen), alcohol swabs, sterile gauze and a sharps disposal container (either a real one or improvised – more details on that later). Wash your hands thoroughly, and you’re ready to go.
Follistim Pen Setup
Whenever you start a new cartridge of Follistim, your first step would be to load the pen. Begin by separating the three parts of the Follistim pen (see step 1 in the photo guide). Pull off the protective cap, and then unscrew the pen body (blue) from the cartridge holder (yellow). Set the three parts aside on a clean, dry surface.
Take the Follistim AQ cartridge, clean the rubber stopper with an alcohol swab, and then place the cartridge in the yellow cartridge holder with the metal cap going in first (step 2). Take the pen body and screw it back in (step 3). The small blue arrow on the cartridge holder should align with the small yellow rectangle on the pen body.
You will not need to repeat any of these steps again until your cartridge runs out and you need to replace it.
Preparing the Follistim Pen for Injection
Now it’s needle time. Just to be on the safe side and to make sure that everything is sterile, clean the open end of the cartridge holder with an alcohol swab. Now take a needle, peel off its protective cover and screw it on the open end of the cartridge (step 4). At this point you may want to take a quick detour and clean the area you selected for injection with an alcohol swab. This will give it enough time to dry off by the time you want to inject the Follistim.
With the pen pointing upwards, remove the outer protective cap off the needle, but don’t throw it away – you’ll need it to dispose of the needle later. Remove the inner cap and tap the cartridge holder lightly until you see a tiny drop at the tip of the needle (step 5). The tapping helps you remove air bubbles from the fluid in the cartridge, and if a tiny drop appears, it means you were successful in doing so. Don’t inject without seeing a drop first. It sometimes takes a few taps to get the drop to appear, but don’t give up on it – it will appear, sooner or later. If tapping fails you, you may have to dial the dosage knob to the nearest dose until you hear one click, and then push the injection button. This should do the trick.
Set your dose by turning the yellow dial to the left until your prescribed dosage appears in the window (step 6). The pen goes all the way to 450 IU, so if your dosage is higher than that, you’d need to do two injections a night. I was always worried that I’d turn the dial too much and miss my dose – if that happens to you, don’t try to twist it back. Instead, keep turning it all the way to the end, and then it will release and you’ll be able to bring it back to zero without losing any expensive medication in the process.
Follistim Injection Instructions
Congratulations – it’s time to inject the Follistim! If you have not done so yet, clean the injection area with an alcohol swab and let it air-dry. Most women inject into their belly fat, 1-2 inches to the left, right or just below their belly button. You may also inject in the upper outer area of your thigh.
Pinch an inch of fat in the area you selected and insert the needle in a swift motion straight into the skin, at a 90 degree angle, at the edge of the “pinched” area (step 7). This is the hardest part psychologically, and there are a variety of ways to overcome the fear of sticking a sharp object into yourself. My favorite was to just let my husband take the plunge for me. If you inject yourself, you may want to look away or distract yourself by singing along to your favorite song or having a fun TV show play in the background. I know it’s scary, but the truth is that it usually doesn’t really hurt – that’s the benefit of injecting into fat. Don’t inject in the same exact place every day to avoid bruising.
Once the needle is in your body, release your pinch and push the injection button all the way in. Slowly count to five and then remove the needle from your body. Press down on the injection site with a sterile gauze. Check the dosage window to make sure it’s back to zero. If it isn’t, it means that you ran out of medication midway through, and you’ll need to replace the cartridge and inject the remaining dose.
Disposing of the Needle
That’s it – the hard part is behind you. Place the protective cap back on the needle carefully without touching the needle itself, and screw the needle out (step 8). Place the used needle in a sharps container (step 9). Don’t have a sharps container? You can improvise one. Pick any closeable, puncture resistant container (such as a plastic bottle or a coffee can with a lid). Don’t throw your container in the trash – when it’s full, bring it to your doctor’s office or the nearest pharmacy and ask them to dispose of it for you.
Finally, place the blue protective cap back on the pen, put the pen in its case, and store it in a safe place in the fridge. You’re all done.
A Few More Tips
If you’re a control freak like me, you’d probably want to keep a diary to keep track of your treatment. Write down every day how much you injected at what time, and how much medication is left in the cartridge. It will help you stay organized, and prevent unpleasant surprises like running out of medication prematurely.
I hope this guide helped you learn how to inject Follistim and get over the squeamish feeling that most of us feel when they start using injectable medications. Gonal-F injection instructions, or really instructions for most other subcutaneous injections, are quite similar to this, so if that’s what your doctor prescribed, you can expect to follow almost the same steps. It’s not fun, that’s for sure, but if that’s what it takes to make a baby, then I’m happy to get friendly with needles, at least for a short while…