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IVF and Fertility Medications

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IVF Medications and Instructions



Patients undergoing in vitro fertilization (IVF) will take certain medications to prepare their body for the procedure. Medication regimens vary from patient to patient; your physician will analyze your situation closely to determine your unique medication regimen.

Injectable medications are typically administered at home by the patient and her partner, between the hours of 6 and 11 p.m. Before being prescribed these medications, you and your partner will be taught all necessary administration techniques by our physicians and staff. Your progress will be monitored closely, via regular blood tests and ultrasounds, and your medication dosage will be adjusted accordingly. It’s important to keep in mind that ALL IVF medications carry the risk of side effects, which usually are temporary. If any side effects become persistent or bothersome, please call our office at 215-887-2010.

Listed below are some of medications we commonly prescribe for IVF patients. You can find information here on Clomid, Gonal-F, Follistim, Menopur, Repronex, Bravelle and Metformin.

Folic Acid

All women of childbearing age in the United States who are capable of becoming pregnant should consume at least 0.4 mg of folic acid per day to reduce their risk of having a pregnancy affected with spina bifida or other neural tube defects. This is the recommendation of the Center for Disease Control, the Food and Drug Administration, the National Institutes of Health and the United States Public Health Services.

It is our recommendation that all patients begin taking one (1) mg of folic acid daily. If you are taking prenatal vitamins, you do not need additional folic acid.

A prescription for folate (1 mg daily) can be given to you by our office, or you can purchase folic acid (0.8 to 1 mg daily) at your health food store.

 

Lupron

Lupron

Lupron (leuprolide acetate) prevents ovulation in order to control the timing of IVF or artificial insemination.  Please keep in mind:
 

  • Your Lupron dosage may vary depending on your physician's preference.  The most common dosage is ten units daily.
  • Injections should be administered at approximately the same time each day.
  • Expect to get your menses seven to 14 days after starting Lupron.  Please call our office at 215-887-2099 on your first day of full flow.  You may leave a message if it is a weekend or holiday.
  • Continue taking Lupron every morning until instructed to stop.  You will be scheduled for an in-office baseline ultrasound and blood tests at some point between days two and five of the Lupron period.  We will call you on the afternoon of these tests with a Repronex/Gonal-F®/Follistim start date.

Equipment:

  • Medication (liquid)
  • Insulin or Lupron syringe
  • Alcohol pad
  • Gauze pad or tissue
  • Rubbing alcohol

Note: Your injection materials MUST be sterile and MAY NOT be reused.

To prepare medication:

  1. Wipe off the top of the medication vial with the alcohol pad.
  2. Remove the syringe from the package.
  3. Draw air into the syringe by pulling the plunger out to the 10-unit mark.
  4. Inject the 10 units of air into the medication vial.
  5. Turn the vial upside down so that the needle is in the liquid.
  6. Withdraw the prescribed amount.

Injection instructions:

  1. Choose injection site: back of upper arms, abdomen or anterior thighs.
  2. Clean the injection site with rubbing alcohol and let try.  You may want to use ice to numb the site prior to injecting.
  3. Pinch the injection site with your non-dominant hand.
  4. Using your dominant hand, hold the syringe like a pencil, and with a quick, dart-like motion, insert the syringe at a 45-degree angle.
  5. Slowly, steadily depress the plunger until all the medication is injected.  The medication may burn as you depress the plunger; this is normal.
  6. Withdraw the needle and discard the syringe.
  7. Place a gauze pad or tissue over the injection site.  If any bleeding occurs, apply pressure to the site.

 

Antagon

Antagon is used to prevent ovulation during ovarian stimulation.  This medication must be taken every 24 hours until human chorionic gonadotropin (HCG), such as Pregnyl or Ovidrel, is given.  You will begin taking this medication as instructed when follicles measure 12 to 14 mm.

Equipment:

  • Prefilled Antagon syringe
  • Alcohol swabs
  • Tissue or gauze pad
  • Rubbing alcohol

Note: Your injection materials MUST be sterile and MAY NOT be reused.

Administration instructions:

  1. Choose injection site: back of upper arms, abdomen or anterior thigh.
  2. Clean injection site with rubbing alcohol and let dry.
  3. Pinch injection site with your non-dominant hand.
  4. Using your dominant hand, hold the syringe like a pencil, and with a quick, dart-like motion, insert the syringe at a 45-degree angle.
  5. Slowly, steadily depress the plunger until all the medication is injected.  The medication may burn as you depress the plunger; this is normal.
  6. Withdraw the needle and discard the syringe.
  7. Place a gauze pad or tissue over the injection site.  If any bleeding occurs, apply pressure to the site.

 

 

Ovidrel

25O mcg for subcutaneous administration
Recombinant HCG

Ovidrel is given to mature the oocytes (eggs) and cause ovulation to occur. Taking Ovidrel will help time intrauterine insemination or intercourse more accurately.

Equipment:

  • Medication (powder)
  • Diluent (sterile water)
  • 3 cc 22 g 1 1/2” syringe
  • 27 g 1/2” needle tip
  • Alcohol swab
  • Tissue or gauze pad

Note: Your injection materials MUST be sterile and MAY NOT be reused.

To prepare medication:

  1. Using your thumb, flip off the plastic lids to reveal the rubber stoppers on each vial.
  2. Using a 3 cc 22 g 1 1/2” syringe, push the needle through the rubber stopper to the bottom of the diluent (sterile water) vial. Pull back on the plunger to withdraw all the diluent (1 cc).
  3. Slowly inject all the diluent from the syringe into the vial of medication (powder). Shake the vial gently until the powder dissolves completely.
  4. Push the syringe to the bottom of the vial and pull back on the plunger until all the dissolved medication is in the syringe.
  5. Remove the syringe from the vial.

To administer medication:

  1. Twist off the needle tip of the syringe and replace with a new 27 g 1/2” needle tip. Make sure the new needle tip is twisted securely in place.
  2. Choose injection site (the fatty tissue on: the back of arms, fold of abdomen below the belly button or the outer top of the thigh).
  3. Clean the injection site with rubbing alcohol and let dry.
  4. Use your non-dominant hand to pinch a fold of skin at the injection site.
  5. Using your dominant hand, hold the syringe like a pencil, and with a quick, dart-like motion, insert the syringe at a 45-degree angle.
  6. Depress the plunger in a slow steady motion until all the medication is injected.
  7. Withdraw the needle and discard the syringe.
  8. Place a gauze pad or tissue over the injection site. If bleeding occurs, apply pressure to the site.

Human Chorionic Gonadotropin

This medication is given to mature the oocytes (eggs) and release them into the follicular fluid, causing ovulation to occur. Taking HCG will help time intercourse or intrauterine insemination more accurately. The medication can be administered as a subcutaneous (SQ) or intramuscular (IM) injection according to your physician’s instructions. Note: IM HCG administration requires assistance from your partner.
If you have ANY questions about the following instructions or experience unusual or bothersome side effects while taking HCG injections, please contact our office at 215-887-2010.

Equipment:

  • Medication (powder)
  • Diluent (sterile water)
  • 3 cc 22 g 1 1/2” syringe
  • 27 g 1/2” needle tip for SQ administration or 22g 1 1/2” needle tip for IM administration
  • Alcohol swab
  • Rubbing alcohol

Note: Your injection materials MUST be sterile and may not be reused

To prepare medication:

  1. Using your thumb, flip off the plastic lids to reveal the rubber stoppers on each vial.
  2. Push the syringe through the rubber stopper to the bottom of the diluent (sterile water) vial. Pull back on the plunger to withdraw 1 cc (1 ml) of diluent. There will be a large amount of sterile water remaining that you may discard.
  3. Slowly inject the 1cc of diluent from the syringe into the vial of medication. Shake the vial gently until the powder dissolves completely.
  4. Push the syringe to the bottom of the vial and pull back on the plunger until all the dissolved medication is in the syringe.
  5. Remove the syringe from the vial.

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SQ HCG administration:

  1. Twist off the needle tip of the syringe and replace with a new 27 g 1/2” needle tip. Make sure the new needle tip is twisted securely in place.
  2. Choose the injection site: back of upper arms, abdomen or outer top of thigh.
  3. Clean the injection site with rubbing alcohol and let dry.
  4. Pinch the injection site with your non-dominant hand.
  5. Use your dominant hand to insert the needle at a 45-degree angle with a quick, dart-like motion. Slowly, steadily depress the plunger to inject the medication.
  6. Withdraw the needle and discard the syringe. Use a gauze pad or tissue to apply pressure at the injection site.

IM HCG administration:

  1. Twist off the needle tip of the syringe and replace with a new 22 g 1 1/2” needle tip. Make sure the new needle tip is twisted securely in place.
  2. Choose injection site: upper outer quadrant of the buttock, right or lift side.
  3. Clean injection site with rubbing alcohol and let dry. (You may numb the area with an ice cube before cleaning the site.)
  4. Lie on your side with your knee slightly bent.

The following steps (5-6) should be completed by your partner:

  1. Use the thumb and first two fingers of your non-dominant hand to hold the skin in position.
  2. Using your dominant hand, hold syringe like a pencil and with a quick, dart-like motion, insert entire needle at a 90-degree angle. Once the needle is in place, release your grasp of the skin.
  3. Slowly pull back on the plunger with your non-dominant hand (the hand that just let go of the skin). If blood enters the syringe at this time, pull the needle out of the skin slightly and test again.
  4. If no blood appears, depress plunger in a slow, steady motion until all medication is injected.
  5. Withdraw needle and discard the syringe. Use gauze pad or tissue to apply pressure at the injection site.

Note: You may notice some soreness at the injection site the next day (similar to the feeling of a sore muscle). Occasionally, some women experience a brief period of nausea. Please call our office at 215-887-2010 with any concerns about this particular side effect.

 

Methylprednisolone

Methylprednisolone is used to relieve inflammation. Patients typically take a four (4) mg methylprednisolone tablet dose pack of 21 tablets, divided over six days as noted on the package instructions. Most patients begin the methylprednisolone pack the day of their ovum retrieval. An IVF nurse will give you specific instructions about your methylprednisolone regimen after your retrieval.

Note: Methylprednisolone may cause stomach upset and should be taken around mealtime. You should NEVER discontinue this medication abruptly.

 

Progesterone

Progesterone is a steroid hormone secreted by the ovary after ovulation that prepares a woman’s uterine lining for implantation.

Equipment:

  • Medication
  • 3 cc 22 g 1 1/2" syringe
  • Needle
  • Alcohol swab
  • Rubbing alcohol

Note: Your injection materials MUST be sterile and MAY NOT be reused

To prepare medication:

  1. Remove the syringe from the wrapper.
  2. Remove the needle cap. Pull back on the plunger of the syringe, filling it with the same amount of air as the volume of medication to be administered. For example, if 1/2 cc of medication is desired, fill syringe with 1/2 cc of air.
  3. Cleane the rubber stopper with an alcohol swab.
  4. Insert the needle through the rubber stopper and depress the plunger, forcing the air into the vial.
  5. Turn the vial upside down and pull back on the plunger, allowing the desired amount of medication to enter the syringe.
  6. Withdraw the needle from the vial.

To administer medication:

  1. Twist off the needle tip of the syringe and replace with a new 22 g 1 1/2” needle tip. Make sure the new needle tip is twisted securely in place.
  2. Choose injection site: the upper outer quadrant of the buttock, left or right side.
  3. Clean the injection site with rubbing alcohol and let dry.
  4. Lie on your side with your knee slightly bent
  5. Hold the syringe as you would a pencil and with a quick dart-like motion, insert the entire needle at a 90-degree angle.
  6. Pull back on the plunger to check for proper placement.
  7. Slowly, steadily depress plunger until all the medication is injected.
  8. Withdraw the needle and discard the syringe. Use gauze or tissue to apply pressure after the injection.

Note: Progesterone can sometimes cause lumps or tenderness at the injection site. This may be relieved by applying heat to the site. Please call our office at 215-887-2010 with any concerns about this particular side effect.

Crinone
(8% Progesterone Gel)

Crinone coats the vaginal tissues to provide long-lasting release of progesterone. Small, white globules of gel may appear as a discharge, even several days after use. DO NOT insert your Crinone gel the day of embryo transfer until after you are back home. Crinone gel should be taken in the morning.
If you have ANY questions about the following instructions or experience unusual or bothersome side effects while taking Crinone gel, please contact our office at 215-887-2010.

Equipment:

  • Prefilled applicator

Instructions:

(Application is similar to tampon insertion.)

  1. Remove the applicator from the sealed wrapper
  2. Hold the applicator at the thick end and shake it down several times as you would a thermometer. This will ensure that the contents are at the thin end of the applicator.
  3. Hold the applicator by the flat section of the thick end. Twist off and discard the tab at the thin end. Be careful not to squeeze the "bubble" at the thick end while removing the twist-off tab.
  4. While in a sitting position or while lying on your back with your knees bent, gently insert the thin end of the applicator well into the vagina.
  5. Once in place, firmly squeeze the "bubble" at the thick end of the applicator to release the gel into the vagina.
  6. Remove and discard the applicator. After removal, you may notice some gel left inside the applicator; this is normal and not a cause for concern; you have received the full dose you need.
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