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Department of Obstetrics and Gynecology -
WVU Center for Reproductive Medicine

Administration of Medications

Administration of Medications

Injections: The correct methods for performing intramuscular or subcutaneous injections are available on video or will be taught to you in clinic. Do not attempt to give yourself injections if you have not received this training. The route of administration will be given to you at the beginning of each treatment cycle and varies depending on which medication you are using.

Human Chorionic Gonadotropin: This hormone can be obtained from the urine of pregnant women or placental tissue or by using advanced genetic techniques to obtain the compound from Chinese Hamster cells (rec-hCG). (recombinant hCG) (rec-hCG).

IM injections The package will contain a 10 ml vial of fluid and a vial containing 10,000 I.U. of the hCG powder.

  • Use a 3 ml syringe and a needle to draw up 1.5 to 2 ml air into the syringe
  • Inject the air into the vial containing the diluent (fluid solution).
  • Withdraw 1.5 ml of diluent into the syringe
  • Inject the diluent into the vial containing the hCG powder and swirl the vial to make sure that all of the powder has dissolved
  • Draw the hCG solution into a syringe using the larger needle. Attempt to draw up all the fluid, but don't worry if a couple of drops remain.
  • Change the needle to the smaller 23-gauge needle and inject IM
  • These are instructions for administering the entire 10,000 I.U. of hCG, your dose may be less (i.e. 5000 I.U. or 3300 I.U.) so amount injected will need to be adjusted.

Subcutaneous injection

  • Use a 1ml syringe and large needle and draw up 1 ml of air
  • Inject the air into the diluent (fluid solution)
  • Withdraw 1 ml of diluent into the syringe
  • Inject the diluent into the vial containing the hCG powder and swirl the vial to make sure that all of the powder has dissolved
  • Draw the hCG solution into a syringe using the larger needle
  • Change the needle to a 27-gauge needle and inject under the skin of the abdomen or leg
  • These are instructions for administering the entire 10,000 I.U. of hCG, your dose may be less (i.e. 5000 I.U.) so you may want to adjust the amount of diluent used in order to make it easier to calculate the amount to be injected.

Example:

  • If you are to use 5000 I.U., use 2 ml of diluent to mix up the powder and withdraw only 1 ml to inject IM.

Rec-hCG: This package will contain 250 mcg of recombinant hCG and 1 ml of sterile water

  • Use a 1ml syringe and large needle and draw up 1 ml of air
  • Inject the air into the diluent (fluid solution)
  • Withdraw 1 ml of diluent into the syringe
  • Inject the diluent into the vial containing the hCG powder and swirl the vial to make sure that all of the powder has dissolved
  • Draw the hCG solution into a syringe using the larger needle, attempt to withdraw all of the fluid
  • Change the needle to a 27-gauge needle, prep the skin with alcohol, and inject under the skin of the abdomen or leg
  • Gonadotropins: These are the hormones Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH). They can be obtained from the urine of menopausal women or by using advanced genetic techniques to obtain the compounds from Chinese Hamster Cells (rec-FSH and rec-LH)

    Urinary Products: These products were traditionally given as an IM injection and consisted of both FSH and LH or underwent further purification to FSH alone. Some of these medications can be administered subcutaneously. The products come as vials or ampules of diluent and gonadotropin powder

  • IM injection

    Vials:

    • Use a 3 ml syringe and a large needle and draw up 1.5 to 2 ml of air
    • Inject the air into the vial containing the diluent (fluid)
    • Withdraw 1.5 ml of fluid
    • Inject the fluid into the vial containing the gonadotropin powder and swirl the vial to make sure that all of the powder has dissolved.
    • If you require more than one vial of medication, use the gonadotropin solution from the first vial to dissolve the powder in the second vial.
    • Withdraw the concentrated solution from the second vial and continue this process until the required amount of medication has been drawn up into the syringe
    • Replace the large needle with a 23-gauge needle and inject IM

     

  • Subcutaneous injection
Unmixed Vials:
  • Use a 1 ml syringe and a large needle and draw up 1.0 ml of air
  • Inject the air into the vial containing the diluent (fluid)
  • If you are using 2 or less vials of gonadotropin powder withdraw 0.5 ml of diluent. If you are using 3 or more vials of gonadotropins, withdraw 1.0 ml of fluid
  • Inject the fluid into the vial containing the gonadotropin powder and swirl the vial to make sure that all of the powder has dissolved.
  • If you require more than one vial of medication, use the gonadotropin solution from the first vial to dissolve the powder in the second vial.
  • Withdraw the concentrated solution from the second vial and continue this process until the required amount of medication has been drawn up into the syringe
  • Replace the large needle with a 27-gauge needle and inject under the skin of the abdomen or leg
  • Recombinant DNA products (rec-FSH)
    • Single Dose Vials or Ampules
      • Use the same method as was used for administering urinary products subcutaneously
    • Single Dose Premixed Vials
      • Draw up the prescribed amount of medication (number of vials or units) into a syringe using a larger needle. Change to a smaller needle and inject as directed.
    • Injection Pens
      • The medication will be provided in a premixed cartridge that fits into a special “pen” that allows you to dial the dose of medication that you are to receive for each injection. Thus, you do not have to mix the medication

    • Single Dose Vials plus Prefilled Syringe
      • The medication is in a vial and the diluent is in a prefilled syringe that is provided. The diluent is injected into the powder using the larger needle that is provided. The dissolved powder is drawn up, the larger needle replaced with the smaller

Multidose Vials: These vials contain I.U. 450of rec-FSH

  • Take the prefilled 1 ml syringe of diluent and mix it with the vial of powder
  • Use the supplied "custom" syringes to draw up the prescribed dose of gonadotropin and inject subcutaneously under the skin of the abdomen or leg
  • Refrigerate the remaining gonadotropin solution and use it the following day

Luteal Phase Medications: These are medications that are meant to replace or augment luteal function.

Human Chorionic gonadotropin

  • Repeated doses of hCG, usually at 3 day intervals are given after ovulation, usually at a dose of 2500 I.U. per dose (see hCG above for administration technique)

Progesterone

Suppositories

  • 50 mg suppositories are used twice daily
  • These suppositories need to be refrigerated
  • Continue the suppositories until menses occurs
  • If menses does not occur after 2 weeks of using the suppositories, a pregnancy test will be done.
  • If the pregnancy test is positive, you will use the suppositories until 10 weeks gestation

Gel

  • One applicator of gel is used on a daily basis
  • Continue the gel until menses occurs
  • If menses does not occur after 2 weeks of using the gel, a pregnancy test will be done.
  • If the pregnancy test is positive, you will use the gel until 10 weeks gestation

Preparation of the uterus for frozen embryos or donor oocytes

Absence of menses:

  • If you are no longer having menses, you will be instructed to start estrogen on a specific day (usually 6 mg of estradiol)
  • You will be instructed to return for ultrasound
  • If you are receiving frozen embryos, you will be given progesterone when the lining of the uterus is determined to be adequately developed by ultrasound
  • The frozen embryo/blastocyst will be transferred when scheduled by your physician, usually 3-5 days later
  • If you are receiving donor embryos, you will be given progesterone when the donor receives her injection of hCG.
  • Transfer of embryos or blastocysts will then occur 3-5 days later
  • Estrogen and Progesterone therapy will then be continued until 10 weeks gestation.

Presence of menses:

If you are still having menses, then your hormonal cycle may need to be suppressed but the majority of the time suppression is not required.

Frozen embryos

  • When suppression is required, Suppression is usually achieved by the use Oral contraceptives
  • When menses occurs and suppression has been demonstrated, estradiol (usually 6 mg/day) is begun for preparation of the endometrial lining. This higher dose of estrogen usually prevents spontaneous ovulation. This treatment will usually begin on day 1 of the cycle.
  • If suppression was not used, estrogen therapy will be started on day 1 and you will not have to come in for an appointment to confirm suppression of the ovaries.
    You will be scheduled to return for ultrasound on cycle day 14.
  • You will be given progesterone on a daily basis when the lining of the uterus is determined to be adequately developed by ultrasound and the estrogen will be continued but at a decreased dose
  • The frozen embryo/blastocyst will be transferred when scheduled by your physician, usually 3-5 days later
  • Estrogen and Progesterone therapy will then be continued until 10 weeks gestation.

Donor oocytes

  • Suppression is usually achieved by the use of Gonadotropin Releasing Hormone analogs beginning day 21 of the preceding cycle.
  • When menses occurs and suppression has been demonstrated, estradiol (usually 6 mg/day is begun) at the same time that the donor begins to undergo stimulation
  • You will be scheduled to return for ultrasound.
  • The GnRH-analog will be continued until adequate endometrial development has occurred and the donor receives her hCG.
  • You will be given progesterone on a daily basis when the donor receives her hCG
  • The frozen embryo/blastocyst will be transferred when scheduled by your physician, usually 3-5 days later
  • Estrogen and Progesterone therapy will then be continued until 10 weeks gestation.