522 N. New Ballas, Suite 206
St. Louis, Missouri 63141
Phone : 314 473 1285
Fax : 314 473 1287
After Hours : 314 277 8782

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Medications for IVF/IUI treatment

The day of egg retrieval Medications IVF/IUI Patient Education and Injection Outline

 

IVF/IUI Patient Education and Injection Outline

Introduction

Introduction
After your infertility evaluation is completed, you will have a "Protocol appointment" with Dr. Jacob and the staff at which time the treatment plan is discussed in detail. You will be given a spreadsheet with complete details of the protocol with all medications, their doses, when to take them and the route of administration. Please read it carefully. Below are the details relating to the medications and what can be expected on different days of the treatment cycle. Please feel free to call us if you have any questions.

 

Medications :

Birth Control Pills Lupron/Luperlide Follistm/Gonal-F Menopur/Braverle/Repronex Ovidrel/HCG

A. Birth Control Pills: used in most IVF cycles and sometimes IUI cycles

  1. Used to "down regulate" a patient before treatment and control the timing of next bleed.
  2. If you experience "break through bleeding", increase birth control pills to one every 12 hours and notify the nurse. We prefer a woman NOT bleed until she takes her last dose on the designated date.

B. Lupron/Luperlide: Keeps your pituitary gland in the brain from interfering with your treatment.

  1. The start date for your Lupron is at the top of the protocol
  2. Take this injection in the morning only (usually at 7 AM), every 24 hours exactly.
  3. It is given sub-cutaneous (sub-Q) in the belly. Remember to stay at least an inch away from the belly button when giving this shot (just think "pinch an inch").
  4. Inject slowly! Remember to withdraw needle half-way, count to 5, and then pull out needle the rest of the way. We don't want the injected medicine to "shoot" back out!
  5. Side Effects: usually most patients do not have any side effects except for being tired. But occasionally (rarely) patients may experience migraines, hot flashes, night sweats, mood swings, vaginal dryness or vaginal bleeding (we're shutting off all estrogen production with Lupron). Nothing to be done if you experience any of these side effects. You may take Tylenol for headaches.

C. Follistm/Gonal-F: Both are the same drug (rFSH), just made by different manufacturers. You will be prescribed one based on what your insurance will cover.

  1. These drugs stimulate the ovaries to make follicles. Remember…the follicle is the "house" for the egg!
  2. Injection is given with a "pen", Sub-Q, every 12 or 24 hours. It begins on treatment cycle day 3 after your first baseline monitoring appointment.
  3. Biological effects: It stimulating follicle growth and estrogen levels. You will feel better! You might have some bloating/cramping at the end of 8-10 days of stimulation.

Tips for Gonal-F Pen:

  1. Once you "lock and load" the pen there is no turning back!
  2. Keep track of how much you have used from the pen and save any leftover! You may be able to use it at the end.

Tips for Follistm Pen:

  1. Do not put the needle on until you have dialed up the dosage and confirmed.
  2. If you "over" dial the amount, dial all the way through and start over.
  3. The cartridges contain "overfill". You can drain the cartridges dry…it just takes two needle sticks!
  4. Keep cartridges in refrigerator until ready to use.

D. Menopur/Braverle/Repronex:

  1. stimulates the ovaries and can be used instead of Follistm/Gonal-F or in conjunction with them.
  2. Reconstitute with ½ CC of saline and take Sub-Q

E. Ovidrel/HCG

  1. This is the "trigger injection"
  2. For IUI, this medication is given 40 hours before insemination
  3. For IVF, this medication is given 36 hours before egg retrievaL
  4. HCG is an IM (Intramuscular Injection). Reconstitute with 1 CC Normal Saline and give IM in the "upper outer" quadrant of buttock.
  5. Ovidrel comes in a pre-filled syringe. Keep in refrigerator until 15 min before use. When ready to give, point needle towards ceiling, push air bubble out and give Sub-Q in abdomen.
  6. WITHOUT THIS MEDICATION, YOU WILL NOT OVULATE PROPERLY FOR IUI AND, IN IVF, YOUR EGG RETRIEVAL WILL BE A FAILURE!!


Doxycycline and Zithromax Estrogen Support Progesterone Support MONITORING APPOINTMENT BLOOD WORK The Day of Egg Retrieval The Embryo Transfer Day Day of IUI

Doxycycline and Zithromax

  1. Preventative antibiotic used during your treatment cycle. Yes…both partners must take these medications if NOT allergic and if you are going to be sexually active during the month of your treatment. Please notify nurse immediately if you have an allergy to the above medications. .
  2. ALWAYS take these medications on a full stomach as they may cause nausea, vomiting or diarrhea.

Estrogen Support

  1. Minivelle Dot patches (one patch every 2 days or as directed) are used to support the uterine lining through 10-12 weeks of pregnancy.
  2. Estrace is an oral estrogen used to support uterine lining during frozen embryo transfer cycles.

Progesterone Support
Prometrium (200 mg capsules): use one vaginally with your finger every 8 hours through 14 weeks of pregnancy to support the uterine lining. It's helpful to lay down for 15 min after the morning dose. Just take the nighttime dose before bedtime. Alternatively patient may use vaginal crenone gel (use 1 applicator daily)

Alternatively you may be asked to take Progesterone in Oil (usually 50 mg daily) by intramuscular injection. Please note that you should take the injection with sterile precautions to avoid abscess formation. Please use the “Z” technique to take the shots. Please feel free to call us with questions and to schedule shot lessons.
You will need to wear a panty liner due to increased vaginal discharge.

MONITORING APPOINTMENT BLOOD WORK
Depending on the type of cycle, you will have 2-6 mandatory ultrasound appointments. These must be scheduled BEFORE 12 AM.
ALL BLOODWORK IS DRAWN BEFORE 12 AM THE MORNING OF YOUR ULTRASOUND APPOINTMENT. These labs are run "STAT" "SAME DAY" and are a huge factor in determining the dose of your injectable medications. Your cycle will be compromised if we are NOT able to get same day results of your blood work. These blood work are drawn at the center prior to your ultrasound scan.
The Day of Egg Retrieval

  1. This procedure is done here at the office.
  2. You will be given anesthesia and must have a driver. You will not be able to work, drive, etc. that day.
  3. We ask that couples arrive 60 min prior to procedure in order to provide a "fresh" semen specimen and to do the pre-op preparations.
  4. The procedure takes about 45 min and women will recover in the office for at least 30 min. Plan on spending 2-2½ hours in the office that day.

The Embryo Transfer Day
The embryo transfer is done on day 3 or day 5 after the retrieval. This is dependent on the quantity and quality of the embryos you have.

  1. Please arrive for the transfer 15 min early with a semi full bladder
  2. Bring a pillow, blanket, book, etc. You will lay flat for I hour after transfer, then go on Bed Rest for 24 hours.
  3. The pregnancy test is done 14 days after retrieval.
  4. If you are pregnant, the first trimester U/S is 4 weeks after the blood pregnancy test.

Day of IUI

  1. If your husband/partner is providing a "fresh" semen specimen in our office, please arrive at the office 2 hours prior to the scheduled insemination
  2. You will need to lay flat after the insemination for at least 15 min
  3. The blood pregnancy test will be drawn 14 days after the insemination.