Fertility Preservation

1. Record chart

Blood tests are usually taken between 7.45 and 8.30 in the morning to ensure that we get the results back the same day. Blood is taken to check your oestrogen level. This indicates as to how your ovaries are responding to the stimulation drug.   Scans are usually internal and assess how your follicles are growing. You will be allocated individual appointment times for your scans.   Once you start your stimulation drug please do not stop this unless advised to do so by a nurse or doctor. It takes approximately 10-14 days of stimulation until you are ready for your final (trigger) injection.

2. Trigger injection

You are now ready to take your Pregnyl injection. Please write down all of the instructions given to you by the nurse on the telephone.

Please note: Your egg collection is timed to be 34-36 hours after your Pregnyl or Buserelin injection.

3. Day of egg collection

Please bring:

• • Dressing gown.
• • Slippers.
• • Sanitary towels.
• • Something to read.

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.

Post egg collection

Following your egg collection, you may feel bloated, have mild abdominal pain and light vaginal bleeding on some days. The lab staff will telephone you the day after your egg collection to inform you of the number of eggs/embryos stored:

4. 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.

5. 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.

6. 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.

7. 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.

8. 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.

9. 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 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.

10. Cabergoline

Ovarian hyperstimulation syndrome is resulted by administering human chorionic gonadotrophin (hCG) in ART (Assisted Reproduction Technology). Severe OHSS appears in about 3-8% of IVF cycles. Recently, cabergoline has been introduced to help prevent OHSS in women at high risk of OHSS who are undergoing ART treatment.

How to use cabergoline

Cabergoline is a tablet. Please take it as instructed.

11. 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.