Whether your treatment involves intrauterine insemination, ovulation induction with oral or injectable medication, or in-vitro fertilization, you will be given specific instructions for your individualized treatment plan while in our office, or by telephone, or email, if you are an international patient, in a step by step fashion. You will always be given written instructions, as well. Be sure to take the time to read these carefully!
We realize, however, that there are times you may find yourself confused or unsure about your treatment or uncertain about how to take a particular medication. Our office telephone (954) 217-3456 will always give you information about how to get in touch with us 24 hours a day, seven days a week for critical situations. We continually check email, as well, so that is a good way to contact us for after-hours attention that is not urgent. Our email address is: [email protected]
Remember, it is always better to ask a question, even if you have already heard the answerthan to make a mistake in your protocol! We hope that the information included in this section of our website will reassure you, when necessary, answer some urgent questions, and help you plan or get through your treatment. We have included:
Instructions for Taking Some Medications:
Often, helpful, instructive videos can be found on YouTube and several pharmacy websites also offer graphic, detailed instructions about how to use infertility medication.
Instructions for *Daily Lupron (leuprolide) Injections
Lupron comes in 2 or 4-week kits which include a vial of liquid medication and special small syringes for injection just under the skin. This medication is started approximately 1 week before an expected menstrual period, or any time in your cycle if your physician gives you birth control pills to prepare your ovaries for the injections. We prefer that you take the injections in the morning. Try to take it at the same time each day.
Vaginal bleeding usually starts several days after starting the medication. We will give you specific instructions regarding your dose of Lupron and how long to stay on the medication.
Call our office if vaginal bleeding does not start after 10 days of starting Lupron. If you will be decreasing your dose, call our office if vaginal bleeding does not start before the decrease.
(*Some patients may use a long-acting, depot form of Lupron. This medication is given as a single, intramuscular injection.)
Summary for Lupron Injection
- Wash top of the bottle with an alcohol pad
- Draw up 0.20 cc of air in the syringe
- Put the needle in a bottle
- Push in the air and draw out 0.20 cc of medication
- Put the cap back on the syringe
- Decide where to inject
- Wash skin with an alcohol pad
- Pinch up skin
- Put the needle into the skin
- Pull back on the plunger
- Push in medication
- Take needle out
Call the office (954) 217-3456) if any questions about the medication arise. Report increasing local pain or redness at injection sites. Remember that hot flashes are an expected potential side effect.
Protocol for Suppression Therapy with Lupron
Medication: Lupron (bottle of 2.8 cc)
Injection Equipment: Tuberculin syringes with attached needles for subcutaneous injection.
Make sure to use a new syringe and needle for every injection.
Injection Site: Inject Lupron subcutaneously. Optimal sites are thigh and lower abdominal wall.
Lift up skin flap between thumb and index finger. Inject parallel to skin level.
Dosage for suppression: 0.1 cc or 0.2 cc of Lupron every morning starting approximately cycle day 21 and continuing until instructed to discontinue (if you will run out of needles and syringes, notify us!!) You may be instructed to lower your dose by cutting it in half at a certain point, even before starting stimulation.
Make an appointment for your next visit, if you have not already been given one.
Dosage During Stimulation: Stop medication or 0.1 cc of Lupron every morning from day 1 of stimulation through the day of hCG.
- Draw up your medication while sitting at a table, allow for adequate space and time to make these preparations. This will prevent spillage, waste of medication, or contamination of needles.
- If you are unable to dispose of the needles and syringes properly, recap the needle, leave it on the syringe, place it in a Ziploc bag and return it to our office during your next visit. We will assure proper disposal.
- Keep medication refrigerated or at room temperature. Do not leave in your hot car during the day when you are at work. Store all needles and syringes outside the reach of children.
- Please contact us if in doubt about any of the above steps, or if you have other questions, at (954) 217-3456
Instructions for Gonadotropin Injections
For Intramuscular Injections (Menogon, Humegon, Repronex or Menopur): Use ½ cc of liquid to dilute each ampule of powder medication you are going to use. After opening all the ampules you will use, draw up the liquid (1, 1½, or 2 cc) into your syringe. Squirt the liquid into the ampule containing the powder, then draw the mixture back into the syringe. Repeat this process using the same syringe and the same liquid until all powders have been mixed with the liquid in the syringe.
The mixture must be injected deep into the muscle of the buttock. Do not be concerned if you see a little blood on the skin after the injection or if some fluid leaks out of the injection site. You must use a 1½ inch needle to be sure the medication is injected deeply (past the fat).
For Subcutaneous Injections (Bravelle, Repronex, Follistim, or Gonal-F): For your total number of ampules, you will need to use between ½ and 1 cc of liquid to dilute the powders. After opening all of the ampules you will need, draw up the liquid into the syringe. Squirt the liquid into the ampule containing the powder, then draw the mixture back into the syringe. Repeat this process using the same syringe and the same liquid until all powders have been mixed with the liquid in the syringe.
The injection must be administered just into the fatty tissue, under the skin (upper arm, abdomen or thigh). Do not be concerned if you see a little blood on the skin after the injection or if some fluid leaks out of the injection site. You must use a ½ or â… inch needle.
Step-by-step Instructions for Repronex Injections
Sites for Subcutaneous Injections of Daily Lupron or Gonadotropins or GnRH Antagonist (Ganirelix, Cetrodtide, Antagon, etc.) or a Single Dose of Ovidrel (pre-filled syringe)
Instructions for Profasi (hCG) Injection
(Sometimes known as Pregnyl)
Profasi or “hCG” (Human Chorionic Gonadotropin 10,000 Unit) is taken when your follicles and the eggs they contain are determined to be mature.
We will inform you of the exact time you will need to inject the hCG. You will usually only need one injection of this medication. It is extremely important that you follow these directions and administer the injection at the time you are instructed to do so.
The hCG comes in powder form with another vial containing the liquid diluent. You will need to mix 2 cc of the diluent with all of the powder in the hCG bottle. When the powder is dissolved, draw the contents into the syringe and inject it deep into the muscle. A few patients will be instructed not to inject the entire 2 cc.
PLEASE, be sure you know the exact time at which to take the medication and follow all instructions carefully.
Instructions for Crinone Vaginal Gel Application
Crinone vaginal gel is the hormone Progesterone, in gel form, for absorption through the vaginal wall. Progesterone promotes implantation. Application of the gel is to begin the day of your egg retrieval. The dose will increase on the third day.
The gel is to be inserted vaginally and will be absorbed through the vaginal wall
Do not become alarmed if you notice some of the gel leaking from the vagina. Sufficient medication will still be absorbed.