Antagonist Protocol

Please visit the doctor on the first day of your next period (the day you wake up bleeding). Inform the unit that you are on the short protocol, and you can have the medication at home. Once treatment is accepted, the instructions regarding when to start your injections will be given. On the 2nd or 3rd day, a blood test and ultrasound scan should be taken. The date will be given to start daily stimulation injection. There are different types of stimulation drugs some are Gonal F, Bemfola and Menopur. These injections encourage the development of follicles in each ovary. On the 5th day of stimulation injections, the one should have an additional injection called Cetrotide, which suppresses your Luteinizing Hormone (LH) surge which is used to prevent ovulation. The one should continue both of these injections until advised to stop. If Metformin tablets are prescribed following consultation, please continue to take these until the day of egg collection. For every 2 or 3 days, the blood test is to be taken for checking the oestrogen levels which indicates how ovaries are responding to the drugs. This will be continued still 3 or more follicles are at the optimum size of 17-20 mm. Usually, it takes 10 – 14 days. After stimulation, a final injection called Pregnyl is to be taken, which helps to mature the eggs. This injection is taken approximately 35 – 36 hours before egg collection. If the injection is not given at the specific time, consult the specialist. At the time of egg collection, the fresh semen sample is to be provided by the partner for ejaculation. After egg collection, the team informs about the details of eggs that are fertilized and to get ready for embryo replacement.

Don’t forget!

• • Nothing to eat or drink from midnight the night before your egg collection.
• • If you are storing embryos your partner is to abstain from ejaculation for 2-4 days before the day of egg collection.

Menopur

What does it do?

Menopur with the aim of an egg developing within each follicle stimulates in ovaries.

Possible side effects:

• • Local irritation at the injection site.
• • Ovarian Hyperstimulation Syndrome (OHSS).

Signs/symptoms to look out for include:

• • Abdominal swelling/pain.
• • Shortness of breath.
• • Extreme thirst.
• • Nausea/vomiting
• • Headaches
• • Problems passing urine (small amounts or none at all).
• • Local irritation at the injection site.

How to prepare Menopur:

• • Remove the product from the box.
• • Open the top tray, which will contain pre-filled syringes of water, a vial of powder and a needle.
• • Remove the powder vial from the tray.
• • Flick the blue cap off.
• • Remove the grey lid off the pre-filled syringe of water and twist the orange needle on to the top.
• • Push the needle through the grey bung on the powder vial.
• • Push all the water into the vial of powder. If you have two pre-filled syringes of water, remove the needle from the first syringe and attach it to the second and inject it into the vial of powder.
• • The powder should all dissolve. If not completely dissolved, give the vial a gentle roll. Do not shake.

How to inject Menopur:

• • Take a needle from the large box.
• • Remove the clear lid.
• • Pierce the grey bung and tip the vial upside down.
• • Pull down the plunger to just past your required dose.
• • With the needle pointing upwards, flick the syringe so that any air bubbles move to the top.
• • Pull the plunger down and push out the air, ensuring the top of the black plunger lines up with your required dose.
• • Pinch an inch of skin below your belly button.
• • Inject at a 45-degree angle.
• • Inject the full dose.
• • Remove the needle.
• • Dispose in sharps bin provided.
• • The remaining solution of Menopur can be stored for the next dose.

Storage Information

Store in a refrigerator (2°C - 8°C) before reconstitution, in its original container to protect from light. The solution may be stored for a maximum of 28 days at not more than 25°C after the reconstitution and also don't freeze.

Gonal F

What does it do?

Gonal F is an injection that contains the follicle-stimulating hormone (FSH). It stimulates your ovaries to produce follicles, aiming to produce an egg inside each one.

Possible side effects:

• • Local irritation at the injection site
• • Ovarian Hyperstimulation Syndrome (OHSS)

Signs/symptoms to look out for include:

• • Abdominal swelling/pain.
• • Shortness of breath.
• • Exteme thirst.
• • Nausea/vomiting.
• • Headache.
• • Problems passing urine (small amounts or none at all).
• • Local irritation at the injection site.

How to use Gonal F:

• • Take out the Gonal F pen and one of the needles inside your box.
• • Take the white lid off the Gonal F pen.
• • Peel the paper cap off the needle.
• • Twist the needle on the top of the Gonal F pen.
• • Remove white cap off the needle.
• • Look in the black window at the end of the pen (there should be a ‘0’).
• • Twist the red end of the pen till you can see your required dose in the black box.
• • Remove the green lid on the needle.
• • Pinch an inch of fat below your belly button.
• • Inject Gonal F at a 90-degree angle.
• • Push the red plunger down and hold for 10 seconds.
• • Remove pen and look in the black window (it should read ‘0’ if you have injected the full dose).
• • Replace the white cap on the needle and unscrew it off the pen.
• • Dispose of the needle into the sharps bin provided.
• • Replace the lid of the Gonal F pen and store as advised below.

Storage Information

Store Gonal F in the original packaging to protect from light. Once opened, it may be stored at or below 25°C for a maximum of 28 days.

Cetrotide

What does it do?

The natural hormone which is called Gonadotropin-Releasing Hormone (GnRH) is effected by the blockage by cetrotide. GnRH controls the secretion of another hormone called luteinizing hormone (LH) which induces ovulation during the menstrual cycle.

Possible side effects:

• • Mood swings.
• • Hot flushes.
• • Headaches/nausea.
• • Vaginal dryness.
• • Local irritation at the injection site.

How to use Cetrotide:

• • Remove from packaging.
• • Remove blue cap from vial of powder.
• • Take a pre-filled syringe of water and remove the cap.
• • Attach the yellow needle (larger needle) on the end of the pre-filled syringe of water.
• • Pierce the grey bung with the needle and push all of the water into the vial.
• • Draw up all the solution back into the syringe once the powder has been completely dissolved.
• • Remove the large yellow needle and dispose in sharp bin provided.
• • Attach on a grey smaller needle.
• • With the needle pointing towards the ceiling, flick the syringe so that any air bubbles move to the top.
• • Push the plunger up so no air is in the syringe.
• • Pinch an inch of fat below your belly button.
• • Inject at 45-degree angle.
• • Push the plunger down to administer Cetrotide.
• • Dispose of needle and syringe into a sharps bin.

Storage information:

Keep in the box in a dry cool place.

Pregnyl

What does it do?

Pregnyl is your final injection and is used to mature the egg within the follicle.

Possible side effects:

• • Headache.
• • Feeling restless or irritable.
• • Depression.
• • Breast tenderness or swelling.
• • Local irritation at the injection site.

How to use Pregnyl:

• • Remove the two glass vials from the box.
• • The black dot on the bottle is the weakest point of the vial, flick this dot to make the neck of the vial weak.
• • Put your left thumb underneath the black dot and your right thumb above the black dot.
• • Firmly snap the top of the vial.
• • Repeat with the other vial.
• • Remove syringe and green needle from the packaging.
• • Twist green needle at the end of the syringe.
• • Put the needle into the water and pull the plunger to draw up all the water.
• • Remove the needle from the bottle and put the needle into the vial of powder.
• • Push all the water into the vial.
• • Leave to dissolve for a few seconds then pull the plunger back to draw up a dissolved drug.
• • With the needle pointing upwards, flick the syringe so that any air bubbles move to the top.
• • Twist off the green needle and dispose in sharps bin provided.
• • Twist on an orange needle and push the plunger up to remove any air.
• • Pinch an inch of fat below your belly button.
• • Inject at 45 degrees and push the plunger down to give yourself a full injection.
• • Remove the needle and dispose into the sharp bin.

Storage Information

Store in a refrigerator until it is time to administer the injection.

Metformin

What does it do?

Metformin is prescribed during IVF treatment for some people with Polycystic Ovary Syndrome (PCOS) or those with a high ovarian reserve. The use of Metformin can help to reduce the risk of Ovarian Hyperstimulation Syndrome (OHSS).

Possible side effects:

• • Diarrhoea.
• • Nausea/vomiting.
• • Abdominal pain.
• • Loss of appetite.

Storage information

Keep Metformin in the packaging in a cool, dry place.

Progesterone (luteal support)

Progesterone is given in the form of a rectal or vaginal suppository.

What does it do?

Progesterone, the natural female hormone produced in the body is used in IVF treatment. It helps to support the endometrium and possible early pregnancy.

Possible side effects:

• • Diarrhoea.
• • Flatulence.
• • Soreness in the vagina or rectum.
• • Headache.
• • Leakage after the pessary gets dissolved after using progesterone.

Storage

Store below 25-degrees centigrade.

Bemfola

What does it do?

With the aim of an egg developing within each follicle, Bemfola stimulates the follicles in your ovaries,

Possible side effects:

• • Local irritation at the injection site.
• • Ovarian Hyperstimulation Syndrome (OHSS).

Signs/symptoms to look out for include:

• • Abdominal swelling/pain.
• • Shortness of breath.
• • Extreme thirst.
• • Nausea/vomiting.
• • Headaches.
• • Problems passing urine (small amounts or none at all).

How to use Bemfola:

• • Take the syringe and needle out of the box.
• • Remove the peel tab from the injection needle after washing your hands.
• • Gently push after aligning the injection needle with the pen.
• • Remove the outer needle protection cap.
• • Remove the inner needle protection cap.
• • Hold the pen with the needle pointing upright to make eventual air bubbles rise.
• • Push the dosage plunger until it stops and a small amount of fluid is seen. If a small amount of fluid is not seen the pen should not be used.
• • Turn the dosage plunger until the prescribed dose is aligned with the middle of the indent.
• • Pinch an inch of fat below your belly button.
• • Inject Bemfola at a 90-degree angle.
• • Push the plunger until it stops.
• • Remove the injection needle after 5 Sec.
• • Dispose of the needle into the sharps bin provided.

Storage

Store Bemfola in the refrigerator and in the original packaging to protect from light. Once opened, it may be stored at or below 25°C for a maximum of 28 days.

Sedation in IVF

During the egg recovery, the surgeon places a scanning probe into the vagina. Then a needle is inserted alongside the probe. The needle is used to suck out the ripen egg where discomfort occurs. Then the person is sedated and not unconscious. During the procedure, she will be fully monitored. The sedation method is the preferable method after the egg recovery process.