Buserelin is the first injection given and is used to suppress the hormones temporarily before ovarian stimulation begins. These injections are started during the luteal phase of the menstrual cycle (approximately 21st day) and continued till the one is ready for egg collection. The Injections are given at the same time every day. After 2 weeks of continuing these injections, the blood test should be taken to test the oestrogen and luteinizing hormone. Once the test results are satisfactory, it is advised to start stimulation injection which is of different types. Some common drugs are Gonal F, Bemfola and Menopur which are similar in their effects. These injections encourage the development of follicles in each ovary. These injections are taken along with the Buserelin injection. Then the monitoring starts from the 8th day of stimulation. 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.
The First Injection details are given below:
Buserelin
What does it do?
Buserelin is a drug that causes ovarian suppression. It stops the production of natural hormones that control the release of eggs from the ovaries by acting on the pituitary gland in the brain.
Possible side effects:
- • Mood swings.
- • Hot flushes.
- • Vaginal dryness.
- • Headaches.
- • Nausea.
- • Local irritation at the injection site.
How to use Buserelin:
- • Remove Buserelin vial from the box.
- • Flick the blue cap of the lid (this does not need to be replaced afterward).
- • Take out a needle from the pack you were given.
- • Remove the orange cap from the needle.
- • Pierce grey bung of Buserelin with the needle.
- • Tip the vial upside down.
- • Pull down the plunger to just past your required dose.
- • Remove the needle from the vial.
- • 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 fat below your belly button.
- • The needle is to be injected at a 45-degree angle.
- • Push the plunger to give yourself the whole injection.
- • Remove the needle and dispose of it in the sharps bin that you have been provided with.
- • Put the remaining Buserelin in the refrigerator.
Storage Information
If Buserelin is once opened, it should be stored in a refrigerator.
Types of Stimulation Drugs are below:
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.
- • Extreme 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.
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.
The information about the Final Injection is below:
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.
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.
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.