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Medications

Lupron (leuprolide acetate) is an analog of gonadotropin releasing hormone (GnRH). When given as a subcutaneous injection, it will stimulate the "turning-off" of your pituitary gland. We are able to take advantage of the suppressive actions to improve the recruitment of multiple follicles and prevent premature ovulation. Room temperature storage is advised. Be sure not to keep each vial past the expiration date. One vial will provide approximately four weeks of injections. 

Side effects are short term. Hot flashes may be felt when your estrogen level lowers and will disappear when you begin gonadotropin injections. Occasionally, patients experience headaches as well. 
A consistent time within the same hour each day should be chosen to give the injection. Lupron comes in a kit with alcohol wipes, small syringes, and one container of medicine. 

Lupron Injection Instructions:

  1. Wash and dry hands thoroughly.
  2. Assemble supplies: two alcohol wipes, one tissue, one syringe, medication.
  3. At first use, remove and discard plastic cap off the medication.
  4. Clean the Lupron vial with an alcohol wipe.
  5. Remove cap from syringe exposing needle.
  6. Pull the syringe plunger back until its tip is at the proper dose mark. Insert needle straight and firmly into the rubber center of the vial and push the plunger all the way in.
  7. Turn the vial upside down.
  8. Pull the syringe plunger down filling the medication to the amount needed and remove from the vial.
  9. Hold the syringe needle up and flick with finger to remove any air bubbles.
  10. Hold the syringe and new alcohol wipe in the right hand.
  11. Choose injection site, rotating sides daily. Pinch the skin gently with the left hand.
  12. Wipe area then save wipe to wipe the area again after the injection.
  13. Holding the syringe like a dart, briskly insert small needle quickly and entirely into the skin.
  14. Slowly inject all medication, release the pinch and remove syringe. Cover the area with alcohol wipe then with tissue.
  15. When you begin gonadotropin injections, Lupron dosage will usually decrease to half dosage or be discontinued. Medication may continue through the day of hCG administration or may be terminated when you begin gonadotropin injections.



Antagon and Cetrotide (ganirelix acetate) are antagonists (blocks the action) of gonadotropin releasing hormone (GnRH). Its effect action is similar to Lupron in that Antagon and Cetrotide prevent premature ovulation. Antagon or Cetrotide injections are begun later in the treatment cycle and duration of treatment is usually three or four days. As a drop in estrogen level may be associated with the start of Antagon or Cetrotide injections, your physician may modify the gonadotropin dose and medication prescribed. 

Side effects are infrequent, minor and usually limited to redness or soreness at the site of injection. The medication comes in pre-filled syringes.

  1. Hold the syringe and alcohol wipe in the right hand.
  2. Choose injection site, rotating sides daily. Pinch the skin gently with the left hand.
  3. Wipe area then save wipe to wipe the area again after the injection.
  4. Holding the syringe like a dart, perpendicular to the skin, briskly insert small needle quickly and entirely into the skin.
  5. Slowly inject all medication, release the pinch and remove syringe. Cover the area with alcohol wipe then with tissue.

Injectable Gonadotropins
Repronex and Pergonal are brand names for hMG. T hMG is a combination of the hormones FSH (follicular stimulating) and LH (luteinizing). Follistim & Gonal-F contain only pure FSH. They affect the ovaries directly to rescue multiple follicles before normal selection of a single dominant follicle. Follistim and Gonal-F may be given as a less painful subcutaneous (under the skin) injection. 

Side effects may include abdominal distention/discomfort, bloating sensation, mood swings, fatigue or restlessness. In most cases, the side effects are relieved by follicular aspiration. Multiple births may occur with this medication. 

The medication comes in ampules or vials of powder which need to be diluted with water. Several such ampules or vials are combined into just one syringe with water (diluent). 

Repronex/Luveris Intramuscular Injection:

  1. Wash and dry hands thoroughly.
  2. Assemble supplies: one 3cc syringe, one 25-30 gauge 1.5"needle, one 22 gauge 1.5" needle, two alcohol wipes, one tissue, one ampule of water, and the designated ampules of medication.
  3. Unwrap supplies.
  4. Attach syringe to a 22 gauge 1.5" needle.
  5. Using an alcohol wipe, cover finger and thumb and snap open all glass ampules. For Repronex , remove the plastic protective caps and wipe the rubber stopper. Insert the needle through the rubber stopper.
  6. Remove needle cover and draw 1cc of water into the syringe, then distribute between the powder and ampules. It dissolves immediately.
  7. Fill the syringe with all the medication by inserting the needle as far into the ampule as possible and at an angle, then pulling back the syringe plunger. Stop before it reaches the end of the syringe, even if there is more medication. Push the syringe straight up and flick firmly with the finger. Remove all excess air in syringe.
  8. Change needles to the thinner 25 gauge 1.5"needle and express a drop of medication.
  9. Holding the syringe and new alcohol wipe in the right hand.
  10. Select injection site, rotating sides for comfort. Pinch your skin gently with the left hand. Standing on the opposite leg relaxes the muscle to be used.
  11. Wipe skin with alcohol then slide under left thumb.
  12. Hold syringe like a dart, perpendicular to the skin, insert needle quickly to 1 1/2" of depth to pass the skin and fat to the muscle.
  13. Slowly inject medication and withdraw the needle swiftly.
  14. Slide alcohol wipe over the area then wipe area with a Kleenex.
  15. All supplies are discarded in a milk carton or strong containers after single use. You may also place all needles in a glass jar with a dilute bleach solution.

Gonal-F / Follistim / Bravelle Subcutaneous Injection:

  1. Wash and dry hands thoroughly.
  2. Assemble supplies: one 3cc syringe, one 25 gauge 1.5"needle, one 25 gauge 5/8"needle, two alcohol wipes, one tissue, one ampule or vial of water, and the designated ampules of medication.
  3. Using an alcohol wipe, cover finger and thumb and snap open all glass ampules or remove the plastic cover over the vial's rubber stopper.
  4. Remove needle cover and draw 0.5cc of water (1 cc for Follistim) into the syringe then distribute between the powder and ampules. It dissolves immediately.
  5. Slowly turn the vial upside down, the medication will not run out. Fill the syringe with all the medication by inserting the needle as far into the ampule as possible and at an angle then pulling back the syringe plunger. Stop before it reaches the end of the syringe, even if there is more medication. Push the syringe straight up and flick firmly with the finger. Remove all excess air in the syringe.
  6. Switch to the shorter (5/8th inch) 25 gauge needle.
  7. Hold the syringe needle up and flick with finger to remove any air bubbles.
  8. Hold the syringe and new alcohol wipe in the right hand.
  9. Choose injection site rotating sides daily. Pinch skin gently with the left hand.
  10. Wipe area then save wipe to wipe the area again after the injection.
  11. Holding the syringe like a dart, perpendicular to the skin, briskly insert small needle quickly and just under the skin.
  12. Slowly inject all medication, release the pinch and remove syringe covering area with alcohol wipe then with tissue.

Follistim AQ Pen Subcutaneous Injections:

  1. Wash and dry hands thoroughly.
  2. Assemble supplies: one Follistim AQ Cartridge, one Follistim Pen, one BD Micro-Fine Pen Needle, one alcohol wipe and one tissue.
  3. Pull off the protective cap from the pen and set aside on a clean, dry surface.
  4. Unscrew the pen body from the cartridge holder. Place the cartridge holder and the pen body aside on a clean, dry surface.
  5. Take a Follistim AQ Cartridge out of its package and clean the rubber stopper on the cartridge with an alcohol pad. Insert cartridge into the cartridge holder by placing the metal-rimmed cap end first.
  6. Screw the pen body onto the cartridge holder. Make sure there is no gap between the pen body and the cartridge holder. The blue arrow on the cartridge holder should point to the middle of the yellow alignment mark on the blue pen body.
  7. Clean open end of the cartridge holder with an alcohol pad.
  8. Your Follistim AQ cartridge will contain either 300 IU or 600 IU. Record the Follistim AQ Cartridge content in your personal log. For doses of 50 IU up to 450 IU, turn the dosage knob until the dot beside the correct number on the dosage scale is sitting in the middle of the dosage window.
  9. If, by mistake, you dial past the correct number, do not try to turn the dosage knob backward to fix the mistake. Continue to turn the dosage knob in the same direction past the 450 IU mark as far as it will turn. The dosage scale must move freely. Push the injection button in all the way. Start to dial again starting from the "0" upwards.
  10. Clean the open end of the cartridge holder with an alcohol pad. Pick up your BD Micro-Fine Pen Needle. Peel off the protective paper shield. Do not touch the needle or place an open needle on any surface.
  11. Push the end of the cartridge holder into the outer needle shield. Screw them tightly together. Place your Follistim pen with the attached needle, flat on a clean dry surface.
  12. Swab the skin at the injection site. Pinch the already swabbed area of the skin between two fingers. With the other hand, insert the entire BD Micro-Fine Pen Needle straight into the skin. Press the injection button all the way in to make sure you give yourself a full injection. Wait for 5 seconds before pulling the needle out of the skin. The middle of the dosage window should display a dot next to the "0". If the injection button does not push in all the way, and the number in the dosage window does not read "0", it means there is not enough medication left in the cartridge. The number in the dosage window will give you the amount of medicine needed to complete the prescribed dose. Write down this number. This will be the number you dial for the completion of your dose. Start over with a new Follistim AQ Cartridge and a new needle and follow all the instructions up to this step. Make sure you choose a different injection site to complete your dose of Follistim AQ Cartridge.
  13. Pull out the BD Micro-Fine Needle and firmly press down on the injection site with a tissue. Rub gently.

Gonal-F 450 IU and 1200 IU Multi-Dose (MD) Subcutaneous Injection:

  1. Wash and dry hands thoroughly.
  2. Assemble supplies: one multi-dose kit, two alcohol wipes, and one tissue.
  3. Flip the protective cap off of the Gonal-F MD vial.
  4. Rub the top of the vial with an alcohol swab.
  5. Carefully remove the rubber cap from the pre-filled syringe of bacteriostatic water. To prevent contamination, avoid contact with the needle.
  6. With the vial face up, insert the pre-filled syringe needle straight down through the center of the circle on the rubber stopper of the vial. Slowly inject the water into the vial. Do not shake.
  7. After all the water has been injected, release your finger from the plunger of the syringe. Allow the plunger to rise to its original position, releasing pressure in the vial. Withdraw the syringe and dispose.
  8. Wipe the rubber stopper of the vial of the Gonal-F MD with an alcohol swab.
  9. Remove the wrapper from the 27-gauge syringe provided.
  10. Carefully pull the plastic cap from the needle and avoid touching the needle.
  11. With the Gonal-F vial on a flat surface, insert the needle straight through the marked center of the rubber stopper.
  12. Keep the needle in the vial as you lift the vial and turn it upside down with the needle pointing upward.
  13. Slowly pull back the plunger until the syringe fills to slightly more than the unit marking for your prescribed dose of Gonal-F. Then push the plunger slowly toward your prescribed dose. This prevents bubbles from forming.
  14. Carefully remove the syringe from the vial and recap the needle. The syringe is now filled with the prescribed dosage of Gonal-F and is ready for administration.
  15. Wipe the skin and save wipe to wipe the area again after the injection.
  16. Holding the syringe like a dart, perpendicular to the skin, briskly insert the needle quickly and just under the skin.
  17. Slowly inject all medication, wait 3 seconds, release the pinch and remove syringe, covering area with tissue. Rub gently.

Gonal-F RFF Pen Subcutaneous Injection:

  1. Wash and dry hands thoroughly.
  2. Assemble supplies: one Gonal-F RFF Pen, one needle, one alcohol wipe and one tissue.
  3. Priming the Pen: FIRST TIME USE ONLY - Attach needle as follows: remove pen cap and wipe threaded tip with alcohol wipe. Remove peel tab from outer needle cap. Press threaded tip of pen into open end of outer needle cap. Remove outer needle cap. Set dose at 37.5. Pull out injection button as far as it will go. Remove inner needle cap and hold pen so needle points upward. Tap pre-filled reservoir to let any air bubbles rise to the top. It is normal if a few small air bubbles remain.
  4. Keep needle pointing upward and push in injection button completely. Hold until you hear a click. A small amount of liquid should appear from needle tip. If no liquid comes out, reprime the pen until it does. Replace inner needle cap.
  5. Set the dose as follows: Turn dosage dial so your prescribed dose is lined up with the black dose arrow. CONFIRM THAT THE CORRECT DOSE ON DOSAGE DIAL IS LINED UP WITH THE BLACK DOSE ARROW BEFORE PROCEEDING. IF THE DIALED DOSE IS TOO HIGH OR TOO LOW, RESET BEFORE PULLING THE INJECTION BUTTON.
  6. Load and confirm as follows: Load the dose by pulling out injection button as far as it will go. Confirm correct dose by looking at red dosage confirmation scale. The last visible flat red arrow indicates the loaded dose. If loaded dose is lower than set dose, there is not enough drug to complete the dose. Use new Gonal-F RFF pen to complete dose.
  7. If set and loaded dose is too low, turn dosage dial to correct dose and pull out injection button again. If set and loaded dose is too high, discard dose by pushing liquid out into safety container and repeat step 5.
  8. Inject as follows: Clean recommended injection site with alcohol swab and let air dry. Remove inner needle cap. Do not touch needle or allow it to touch any surface. Inject needle into skin at a 90 degree angle and push injection button until it stops clicking. After last click, release pressure. Keep needle in the skin for at least 5 seconds. Remove needle and apply pressure as needed with tissue. Rub gently.