Many times when you are prescribed an hCG trigger shot by your doctor, it can be mixed and administered by a nurse in the office and you don’t even have to worry about doing it all yourself. However, timing is critical when it comes to fertility treatment, and sometimes you aren’t scheduled to trigger until evening, in order to better time an IUI or an egg retrieval for IVF. There are so many factors, but sometimes, you just gotta do it yourself.
I felt a need to write a post on this after I had to mix my own trigger shot for the first time. My doctor talked me through it, but I was still terrified of messing it up (there’s a reason I’m not a medical professional, folks!), and unfortunately the box did not come with any mixing instructions. I relied on YouTube for some extra guidance. I figured I’d do a quick “how to” write-up to make it easy on those of you who also find yourselves having to mix and self-administer the hCG trigger shot. I wished I had a post like this to read before I did my own, so I hope it’s helpful to you!
The trigger shot I typically use is branded as Novarel, and is 10,000 units of hCG.
NOTE: I understand Ovidrel typically comes in a pre-filled syringe all ready to go (I used it once!), and is a popular trigger for a lot of fertility treatment, but we use Novarel. I think it is a higher level of hCG than Ovidrel and it’s just what we use.
When you pick up your medicine, ask the pharmacist for a sharps container if you don’t have one. I already had one from doing Follistim injections. Make sure the pharmacy also gives you alcohol swabs, a syringe, and two different sizes of needles (ask for an extra set, just in case you mess up or accidentally touch a needle to an unclean surface while mixing. Better safe than sorry). The larger needle is for transferring liquid and mixing, the smaller needle is for your injection. If you don’t ask them for it, they might assume you are taking this back to your doctor for administration and not give you these supplies. You definitely don’t want to be in that position!
Your medicine will come in two bottles: one contains the powder hCG, the other contains the liquid diluent. You will not use all of the diluent.
Trigger Shot: Step by Step Instructions
WASH YOUR HANDS BEFORE STARTING. Make sure you are working on a clean, dry surface. If your bathroom counter is raunchy (hey, I’m not judging), clean it, or lay down a clean towel as your work surface. Take a deep breath – you can do this!
- Remove lids from both bottles, exposing a rubber circle on both. Wipe both rubber circles down with an alcohol swab.
- If the larger needle isn’t already attached to your syringe, screw it on now. Remove the cap from the larger needle, and pull it back to 1 ml to pull air into the syringe.
- Keeping diluent bottle flat on the counter, insert needle into the rubber circle, push the syringe down, pushing air from syringe into the bottle. This will ensure you are starting with an air-free syringe.
- Pick up the diluent bottle with the needle still inserted, tip it upside down, and withdraw a little over 1cc of fluid. Just pull it back to one extra line, to make sure you have everything you need in order to mix the hCG.
- Once you have 1 ml (plus 1 line over), withdraw the needle, and stick it into the bottle with the hCG powder. Inject all of the liquid into the bottle. If you want, you can try to wiggle the needle around to help mix the hCG, but it doesn’t seem long enough, so I never do.
- Pick up the hCG bottle and roll it back and forth between the palms of your hands, warming it slightly and gently mixing. DO NOT SHAKE IT! It is imperative that you patiently roll it around to mix. Remove the needle while you swirl the mixture if needed, but make sure you cap it while it’s set aside. You can also try wrapping your hand around the bottle and rolling your wrist, so it swirls to mix. Once it is completely mixed, you are ready to trigger!
- If you removed the needle during mixing, put it back into the bottle. Tip hCG bottle upside down, and look at it to make sure the needle is below the liquid line. If not, you’ll just pull in a bunch of air and have a panic attack like I did the first time I did this. I remember texting my doctor in tears “I can’t get the stuff into the thing!” She immediately knew what was going on, and I felt like a dummy. Again, I’m not a medical professional, people! There is a reason! You will have to continuously and slowly pull the needle out in order to keep it below the liquid so it is taking it all in.
- Once you have it all, remove the needle from the bottle, put the cap back on, and unscrew it from your syringe. You are now done with the big needle (horray!) and can toss it into your sharps container.
- Screw on the smaller needle and remove the cap. You might see a little bit of air at the base of the syringe. Tap it to remove any bubbles you see, and push the hCG up until you get the air out and a droplet of liquid at the tip. Then it’s ready!
At this point, all you have to do is make sure you choose a good intramuscular location (ask your doctor preference, but usually it’s in your backside!), and clean it well with an alcohol swab before injecting. Safely discard your materials into your sharps container and you’re good to go.
Feel free to test with a cheapo pregnancy test after 24-36 hours to give yourself peace that you did it all correctly. 😉 It will register positive from the trigger if it’s in your system. It might be light, but don’t fret. A line is a line is a line IS A LINE!
If you need a visual guide on mixing and injecting like I did, this video on YouTube was very helpful to me and I suggest you watch it.
That’s it! I hope this was helpful to you if you’re having anxiety about mixing and self-administering a trigger shot. It’s really not that hard once you do it. The second time I had to do all this, no panic attack or tears were involved. 😉 Good luck!