Preparation and Administration of Fertility Medications

Subcutaneous injection technique

1. Choose an injection site on the lower abdomen at least one inch away from the belly button.

2. Wipe the injection site with an alcohol swab and allow to dry completely.

3. Using your non-dominant hand, squeeze an area of fatty tissue.

4. Holding the syringe in your dominant hand like you would hold a dart, inject the needle quickly at a 90o angle.

5. Inject the fluid slowly.

6. Remove the needle and apply pressure to the injection site.

Intramuscular injection technique

  • Choose an injection site in the upper outer quadrant of the buttock, just behind the hipbone.
  • Wipe the injection site with an alcohol swab and allow to dry completely.
  • Using your non-dominant hand, pull the skin taut.
  • Holding the syringe in your dominant hand like you would hold a pen, inject at a 90o angle with one swift motion.
  • Withdraw slightly on the plunger to check for blood. (If blood appears, remove the needle and apply pressure to the injection site. Remove the needle from the syringe and replace with a new needle. Then choose a new site and begin again. Repeat steps 3 through 5.)
  • Inject the fluid slowly.
  • Remove the syringe and apply pressure to the injection site.

IMPORTANT REMINDERS

1. Always wash your hands thoroughly before beginning and use a clean surface for your work area.

2. You may experience some burning or redness at the injection site. This is completely normal and can usually be relieved by applying a hot compress or heating pad to the site. To minimize burning, be sure to allow the alcohol to dry completely before injecting.

3. DO NOT USE ICE TO NUMB INJECTION SITES- Ice will actually interfere with absorption of the medications.

4. REMEMBER: Do not use any ibuprofen or aspirin products during your treatment cycle unless instructed by your physician. Acetaminophen, Tylenol, or Extra-Strength Tylenol are okay to use.

Lupron/Microdose Lupron

1. Must keep this medication REFRIGERATED at all times

2. Prevents premature ovulation

3. Use small, unit dose syringe (usually with an orange cap)

Administration Instructions:

1. Wipe the top of the vial with an alcohol swab.

2. Using the syringe with the orange cap, pull back on the plunger to the appropriate amount (5,10, or 20-unit mark).

3. Insert the needle through the rubber stopper and inject the air.

4. Invert the bottle and withdraw the appropriate amount of Lupron (5, 10, or 20 units). Remove vial from needle tip.

5. Remove any air bubbles by flicking the barrel of the syringe and pushing up on the plunger until one drop of medication comes to the needles tip.

6. Inject medication. Follow the instructions for subcutaneous injection.

Bravelle

1. Flip the plastic cap off the vials and wipe the top of each vial with rubbing alcohol.

2. Using a 3cc (ml) syringe with a 22G 1½” needle (or Q-Cap), pull back on the plunger to the 1cc (ml) mark. Insert the needle into the vial of water or diluent and inject the air.

3. If you are using the Q-Cap, simple invert the vial and pull on the plunger to remove 1cc/mL of water. If you are using the needle you may either: invert the bottle and withdraw 1cc/mL of water (but please be sure the needle tip is in the water); or leave vial sitting on table top and insert needle all the way into the bottom of the vial. Either method is acceptable, just be sure you have 1 cc of water.

4. Remove any air bubbles by tapping on the barrel of the syringe and pushing the air out once it reaches the top.

5. Inject the water into the first vial of medication aiming towards the side of vial. Allow the powder to dissolve, swirling gently if needed.

6. Withdraw the entire mixture.

7. Squirt the water into the next vial, again aiming towards the side. Continue repeating steps 5 & 6 until all of the necessary vials of medication have been mixed.

8. Remove any air bubbles. You should have 1cc (ml) of mixture.

9. Recap the needle and exchange for a 27G ½” needle. Follow instructions for subcutaneous injection technique.

Multi-dose GONAL-f (450u or 1050u)

1. Flip off the plastic cap on the vial and wipe the top of the vial with an alcohol pad.

2. Remove the needle cap from the pre-filled syringe of water.

3. Carefully insert the needle directly through the rubber stopper of the vial and slowly inject all of the water. Withdraw the needle and discard the syringe.

4. Do not shake the bottle, but gently swirl until all of the powder has dissolved and the mixture is clear.

5. Wipe the rubber stopper with rubbing alcohol with each use.

6. Using the syringes provided in the kit, pull back on the plunger to the appropriate marking for that day’s dosage (in units). Insert the needle through the stopper and inject the air into the vial.

7. Invert the bottle and pull back on the plunger until fluid fills to the appropriate marking.

8. Remove the syringe from the vial and check to make sure there is no air in the syringe.

9. You are now ready to inject and should proceed to the subcutaneous injection directions.

GONAL-f RFF Pen

  • Remove the pen cap and wipe the tip with an alcohol swab. Remove the paper tab from the needle and twist needle onto the pen. Make sure the needle is on securely.
  • Turn the dosage dial so your prescribed dose is lined up with the black dose arrow. RECHECK that you have the correct dose lined up with the black arrow! If it is too high or too low, twist to the correct number.
  • “Load” the dose by pulling out the injection button as far as it will go. Find the last fully visible flat red arrow on the injection button. THIS CONFIRMS THE DOSE THAT IS LOADED AND READY TO BE INJECTED. If the loaded dose (red number) is lower than the prescribed dose, there is not enough medication in the pen to complete the dose. However, you do not want to waste any medication! Using the instructions below, inject what you can from this pen. Then, use a new GONAL-f pen to complete the dose (make up the difference).
  • Prepare injection site by cleaning it with an alcohol swab and let it air dry. Remove the outer and inner needle caps. Do not touch the needle or allow it to touch any surface. Pinch the cleansed skin area between two fingers. Insert the needle all the way into the skin at a 90-degree angle. Push the injection button until it stops clicking. After the last click, leave the needle in the skin for about 5 seconds before removing it.
  • Put the outer needle cap (big cap) back on the needle before twisting the needle off (counter clockwise). Put the cap back onto the pen and place pen back in the refrigerator.

Mixing GONAL-f Pen and Menopur

  • See instructions for preparing the GONAL-f pen.
  • Inject the desired dose of Gonal-f into a bottle of Menopur and swirl gently to mix.
  • Remove needle, put your Gonal-f pen back together and store in refrigerator.
  • Open one vial of fluid that is in the Menopur package.
  • Using a 3 cc (ml) 1 ½” 22G syringe, withdraw ½ cc/mL of fluid and gently inject the fluid into the Menopur / Gonal-f mixture.
  • Remove all the mixture using the same syringe.
  • Before changing needle tip, pull back on plunger to assure no medication is being wasted.
  • Remove the 1 ½ 22 G needle from the syringe and replace with a ½” 27G needle.
  • Remove any air bubbles. Rush up on plunger until one drop of med comes out of the needle tip.
  • You are now ready to inject. Follow instructions for the subcutaneous injection technique.

Mixing Multi-dose Gonal-f and Menopur

1. Reconstitute multi dose Gonal-f

1. flip off plastic cap on vial & wipe top of vial with alcohol, insert the needle of the water-filled syringe into vial and slowly inject all the solution, then swirl gently to dissolve

2. Using syringe provided in the multi dose kit, pull back on the plunger to the appropriate marking for that day’s dosage and inject the air into the vial. Invert the vial and pull back on the plunger until fluid fills to the appropriate marking. Recap and set aside.

3. Open a vial of Menopur.

4. Take the syringe you have set aside with the appropriate dose of Gonal-f mixture and inject the multi dose Gonal-f mixture into the Repronex or Menopur vial and swirl gently to mix. Discard this syringe.

5. Open the vial of fluid that is in the Menopur package.

6. Using a 3 cc (ml) 1 ½” 22G syringe, withdraw ½ cc/mL of fluid and gently inject the fluid into the Repronex/Gonal-f mixture.

7. Remove all the mixture using the same syringe.

8. Before changing needle pull back on plunger to assure no medication is being wasted. Remove the 1½” 22G needle from the syringe and replace with a ½” 27G needle.

9. Remove any air bubbles. Gently push up on plunger until one drop of med comes to needle tip.

10. Inject the medication using the subcutaneous injection technique.

Mixing Multi dose GONAL-f and Two Menopur

1. Reconstitute multi dose Gonal-f

  • Flip off plastic cap on vial & wipe top of vial with alcohol
  • Insert the needle from water-filled syringe into vial and slowly inject all the solution
  • Swirl gently to dissolve

2. Using syringe provided in the multi dose kit, pull back on the plunger to the appropriate marking for that day’s dosage and inject the air into the vial. Invert the vial and pull back on the plunger until fluid fills to the appropriate marking. Recap and set aside.

3. Open a vial of Menopur.

4. Take the syringe you have set aside with the appropriate dose of Gonal-f mixture and inject the multi dose Gonal-f mixture into the Menopur vial and swirl gently to mix. Discard this syringe.

5. Open the vial of fluid that is in the Menopur package.

6. Using a 3 cc (ml) 1 ½” syringe, withdraw ½ cc/mL of fluid and gently inject the fluid into the Menopur/Gonal-f mixture.

7. Open the second vial of Menopur and inject the first vial of mixture (Gonal-f/Menopur powder) and ½ cc/mL water into the 2nd vial of Menopur using same 3 cc (ml) 1 ½” syringe.

8. Remove all of the mixture using the same syringe.

9. Before changing needle pull back on plunger to assure no medication is being wasted. Remove the 1½” 22G needle from the syringe and replace with a ½” 27G needle.

10. Remove any air bubbles.

11. You are now ready to inject.

12. Follow instructions for subcutaneous injection technique.

Preparing the Follistim Pen

Loading Your Pen:

  • Pull the protective cap off the pen body and put it aside.
  • Unscrew the entire pen body (blue) from the cartridge holder (yellow). Place pen body (blue) on a clean dry surface.
  • Remove the Follistim cartridge from the package (this should be in the refrigerator) and insert it into the cartridge holder (green), metal cap down.
  • Screw the pen body back into the cartridge holder. The arrow > and the yellow alignment mark [] should line up.
  • Clean the open end of the cartridge holder with an alcohol pad. Peel off the protective paper from the pen needle shield. Push the end of the cartridge holder into the outer needle shield. Screw tightly together.

Setting Your Dose:

Dial the Dosage Knob until the dosage aligns with the dosage marker on each side of the Dosage Window.

If you dial past your dose, do not turn the dosage knob back! You won’t damage the pen, but you will lose medication. Continue turning until you pass the 450 IU mark (as far as you can go). Then, push the injection button in as far as it will go. This should reset to “0” and you can start re-dialing your dose.

Injecting Your Dose:

Now you can prepare your injection site by wiping it with an alcohol swab and allow it to air dry.

Remove the outer and inner needle caps. Do not touch needle or allow it to touch any surface. Pinch the cleansed skin area between two fingers. Insert the needle all the way into the skin at a 90-degree angle. Push the injection button until it stops clicking. After the last click, leave the needle in the skin for about 5 seconds before removing it.

Look at the dosage window and make sure it says “0” to assure that you received the entire dose. If you see “0”, carefully remove and dispose of the needle. Put the cap on the pen and place in the refrigerator.

Mixing Follistim and Menopur

(Follistim must be refrigerated!)

  • After loading the Follistim pen, dial to the prescribed dose.
  • Inject the desired dose of Follistim into a bottle of Menopur and swirl gently to mix.
  • Check the window on the Follistim pen to assure it states “0”. If the window states “0” remove needle, put your Follistim pen back together and store in refrigerator or at room temperature.
  • If the window states anything other than”0”, you did not get the full desired dose. You must take off the used needle (discard in your “sharps” container), remove the empty cartridge and put in a new cartridge, put on a new needle and inject the remaining amount it states in the window.
  • Open one vial of fluid that is in the Menopur package.
  • Using a 3 cc (ml) 1 ½” 22G syringe, pull back on the plunger to the ½ cc mark and inject the air into the bottle of sodium chloride (saline). Invert the bottle and withdraw ½ cc/mL of fluid.
  • Gently inject the 1/2cc (ml) of sodium chloride (saline) into the Menopur/Follistim mixture.
  • Remove all the mixture using the same syringe.
  • Before changing needle tip, pull back on plunger to assure that no medication is being wasted.
  • Remove the 1 ½” 22 G needle from the syringe and replace with a ½” 27G needle.
  • Remove any air bubbles. Gently push up on plunger until one drop of med comes out of the needle tip.
  • You are now ready to inject. Follow instructions regarding subcutaneous injection technique.

Mixing Follistim and 2 Menopur

(Follistim must be refrigerated!)

1. After loading the Follistim pen, dial to the prescribed dose.

2. Open two vials of Menopur powder and wipe the tops with an alcohol swab.

3. Inject the desired dose of Follistim into one bottle of Menopur and swirl gently to mix.

4. Check the window on the Follistim pen to assure it states “0”. If the window states “0” remove needle, put your Follistim pen back together and store in refrigerator or at room temperature.

5. If the window states anything other than”0”, you did not get the full desired dose. You must take off the used needle (discard in your “sharps” container), remove the empty cartridge and put in a new cartridge, put on a new needle and inject the remaining amount it states in the window.

6. Open one vial of fluid that is in the Menopur package.

7. Using a 3 cc (ml) 1 ½” 22G syringe, pull back on the plunger to the ½ cc mark and inject the air into the bottle of sodium chloride (saline). Invert the bottle and withdraw ½ cc/mL of fluid.

8. Gently inject the 1/2cc (ml) of sodium chloride (saline) into the Menopur/Follistim mixture.

9. Remove all the mixture using the same syringe.

10. Slowly inject the Follistim/Menopur mixture into the second vial of Menopur powder and swirl gently to mix. Remove all of the mixture using the same syringe.

11. Before changing needle tip, pull back on plunger to assure that no medication is being wasted.

12. Remove the 1 ½” 22G needle from the syringe and replace with a ½” 27G needle.

13. Remove any air bubbles. Gently push up on plunger until one drop of med comes out of the needle tip.You are now ready to inject. Follow instructions for the subcutaneous injection technique.

Ganirelix

  • Prevents premature ovulation.
  • Is given after 4-5 days of stimulation.
  • Doctor will instruct you when to inject.

Instructions

  • Remove the cap from the needle. Do not touch the needle or let it touch any surface.
  • To remove any air bubbles, aim the needle pointing upwards and gently tap on the syringe until all of the bubbles rise to the top. Then, gently push on the plunger until you see 1-2 drops of medication on the tip of the needle. Recap the needle and set aside.
  • Select an injection site in the abdomen or thigh and wipe the site with rubbing alcohol.
  • Hold the syringe in your other hand like you would hold a dart.
  • Using your non-dominant hand, grasp an area of fatty tissue.
  • Remove cap and quickly insert the needle into the injection site at a 90º angle.
  • Push the plunger in completely until all the medicine is injected.
  • Gently release skin, withdraw the needle and apply pressure to the injection site.
  • Discard the needle safely.
  • Apply a band-aid if needed.

Cetrotide

  • Must be kept REFRIGERATED at all times.
  • Prevents premature ovulation.
  • Comes in a kit with medication, syringe of water, needles and alcohol swabs.
  • Is given after 4-5 days of stimulation.

Mixing Instructions:

1. Remove the plastic cap from the vial of powder and wipe the top with an alcohol swab.

2. Screw 20G (Yellow base) needle onto the pre-filled syringe of liquid and slowly inject all the fluid into vial of Cetrotide powder. Gently swirl to mix.

3. Draw all of the mixture back into the syringe.

4. Before changing needle, pull back on plunger to assure no med is being wasted.

5. Remove 20G needle from the syringe and replace with the ½” 27G (gray base) needle included in kit.

6. Remove any air bubbles by pushing up on plunger until one drop of medication comes to the needle tip.

7. Inject the medication using the subcutaneous injection technique.

Ovidrel

1. Keep Ovidrel in the refrigerator.

2. This medication is injected ONE time only.

3. This medication will “trigger” ovulation.

4. Most commonly used in IUI cycles.

5. The doctor will tell you when to take it and when to return to the office for your IUI.

Instructions

1. Remove the cap from the needle. Do not touch the needle or let it touch any surface.

2. To remove any air bubbles, aim the needle pointing upwards and gently tap on the syringe until all of the bubbles rise to the top. Then, gently push on the plunger until you see 1-2 drops of medication on the tip of the needle. Recap the needle and set aside.

3. Select an injection site in the abdomen or thigh and wipe the site with rubbing alcohol.

4. Hold the syringe in your other hand like you would hold a dart.

5. Using your non-dominant hand, grasp an area of fatty tissue.

6. Remove cap and quickly insert the needle into the injection site at a 90º angle.

7. Push the plunger in completely until all the medicine is injected.

8. Gently release skin, withdraw the needle and apply pressure to the injection site.

9. Discard the needle safely.

10. Apply a band-aid if needed.

HCG 10,000 units (chorionic gonadotropin), Pregnyl® Novarel®

1. This medication is injected ONE time only.

2. This medication will “trigger” ovulation.

3. The doctor will give you an EXACT time to inject it.

4. Your egg retrieval will be EXACTLY 36 hours after taking this medication.

Administration Instructions:

1. Flip off the plastic caps on the powder and water and wipe both tops with an alcohol swab.

2. Using a 3cc (ml) 1½” 22G needle, pull back on the plunger to the 1cc (ml) mark.

3. Insert the needle through the rubber stopper of the vial of water and inject the air.

4. Invert the bottle and withdraw 1cc (ml) of water. Remove any air bubbles.

5. Gently inject the water into the vial of powder. Swirl gently to mix. Allow the powder to completely dissolve.

6. Invert the bottle and withdraw the entire 1cc (ml) of the vial.

7. Before changing needle, pull back on plunger to assure that no medication is being wasted.

8. Remove the 1 ½” 22G needle and replace with a ½” 27Gneedle.

9. Remove any air bubbles. Gently push up on plunger until one drop of medication comes to the needle tip.

10. Inject the medication using the subcutaneous injection technique.

Progesterone

  • Enriches the lining of the uterus.
  • Start these injections the day after the egg retrieval.
  • If you are pregnant, these injections will continue until you are discharged (8-10 weeks of pregnancy).

Administration Instructions:

1. Wipe the top of the vial with an alcohol swab.

2. Use 3 cc (ml) 1 ½” 22G syringe.

3. Remove the needle and set aside.

4. Replace with 18G (pink) needle to draw up medication.

5. Pull back on the plunger to the appropriate amount ½, 1 , or 1 ½ cc (ml).

6. Insert the needle into rubber stopper and inject the air into the vial.

7. Invert the bottle and withdraw the appropriate amount of progesterone. Remove vial from needle tip.

8. Before changing needle tip, pull back on plunger to be sure no medication is being wasted.

9. Remove the 1 ½” 18G needle from syringe and switch back to original needle (1 ½” 22G needle) to inject.

10. Remove any air bubbles. Push up on plunger until one drop of oil comes to needle tip.

11. Follow injections for the intra-muscular injection technique.

Injection Comfort Tips :

1. Place a heating pad or warm compress on the area to be injected for 10 minutes prior to injection and 10 minutes after.

2. Just prior to injecting, place loaded syringe in ziplock bag and place in warm water for 30 seconds. This will not change the concentration, only consistency.

3. After the injection, rub the area firmly for a couple of minutes.