Injection techniques and medications

Gonadotropins used for ovarian stimulation are made by several different drug companies. All may be given intramuscularly and some may also be given subcutaneously when indicated by your physician.

HMG drug is Repronex®.
FSH drugs include Bravelle, Follistim®, Gonal F, Follistim AQ Pen, and Gonal-F RFF Pen.

Some of the medications are supplied in vials and some in ampules. Each aliquot of medication (a powder) is accompanied by a liquid diluent .

INTRAMUSCULAR (IM) INJECTION

You can use 1.0 mL (cc) of diluent for up to six (6) powders. The diluent fluid is inserted into the first powder, mixed, drawn up, and the resulting solution is injected into the next vial or powder. The process is repeated for up to six ampules of drug. No more than 6 ampules or 2 mL of solution should be given in a single injection. Change the 18-gauge needle to the 25-gauge 1½" needle for the intramuscular injection.

SUBCUTANEOUS INJECTION

For subcutaneous injections, a 1-cc syringe and 27 gauge (5/8") needle may be used for injecting. The amount of diluent used is 1 mL for up to 6 ampules of drug. Use an 18-gauge 1½" needle for mixing and replace with original needle (27 gauge) on syringe for injecting. Ovidrel (HCG) subcutaneous comes in a prefilled syringe.

HCG (PROFASI, PREGNYL,NOVAREL OVIDREL ETC). (PROFASI 10,000 UNITS/PREGNYL 10,000 UNITS/NOVAREL 10,000 UNITS)

Use 1.0 mL (cc) of the 10 mL (cc) diluent with an 18-gauge needle to mix into the powder vial. One (1) cc of air must be injected into the vial of diluent prior to drawing out the fluid. Shake mixture gently before drawing into the syringe for injection. Change to a 25-gauge 1½" needle for intramuscular injection.

PROGESTERONE AND LUPRON:

These two medications are supplied in multi dose vials. The amount for injection should be verified with the nurse.

Progesterone should be injected with the 22-gauge needle and 3-cc syringe because of its oil consistency.

Lupron is injected with either the special Lupron syringes or the TB syringe and the 25-gauge ¼" needle.

Our office offers injection teaching during a specific class. Other alternatives may be available. Any questions should be directed to a nurse.

Lupron is packaged with one multi-dose vial of Lupron, 14 syringes, and alcohol swabs.

To administer Lupron:

Wash your hands.
Clean off the top of the bottle with alcohol before each use
Flip off the lid of the Lupron. Whenever you are using a vial, air must be injected into the bottle before the liquid will easily come out. Always pull back on the plunger of the syringe to the dosage mark before putting the needle into the rubber stopper.
Inject air into the bottle. Then invert the bottle and pull liquid out to the intended dosage. Always make sure the needle tip is in the liquid.
With the bottle still inverted, make sure there are no extra air bubbles in the syringe by gently tapping on the syringe. Then push air back into the bottle and pull the plunger back until reaching the desired dosage.
This injection is given in the fat of the arm, the lower abdomen, or the thigh. Gently pull the fat away from the muscle, clean the area with alcohol, and inject at a 90-degree angle. Push medication in and withdraw the needle. Clean the area again with alcohol after the injection. Make sure to rotate the injection sites!

LUPRON DOSAGES VARY. A NURSE WILL ADVISE YOU OF YOUR DOSE AMOUNT.

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