Needles, Injections, Hormones, Stimulation, Viagra, Vaginal Suppositories? Yikes!

Just giving a little personal humor and delight to my never ending list of my IVF Meds! I mean who can say they have taken Viagra vaginally? I will be sure to check that off my bucket list...be jealous my friends as I embark on the hormonally roller coaster ride of hormone and stimulation meds! I will go ahead and warn all my friends and family that I cannot be held accountable for anything I say or do in this time period! If someone tries to commit me or arrest me I will be sure to give them the link to blog so they will understand...I am just overstimulated and super hormoned up!

Dexamethasone 0.75 mg Tablet or Prednisone 10 mg

A lovely STEROID tablet (Gotta love Steroids). This little pill is going to help fight off inflammation or my body's need to fight off the embryo thinking it is a foreign invader of my body!

• Potential side effects are insomnia, increase in appetite and bloating. (these 3 together sound a little scary!)

Lupron (Leuprolide Acetate)

This is wonderful drug suppresses my "Pituitary Hormones" What are these you might ask? Stuff like the adrenal and thyroid. Even though my Ovaries are connected to the pituitary hormones my Ovaries will NOT be suppressed...Whew! Relief! This is another lovely stomach shot- yay me! We get to use "insulin syringes"

• The most common side effect is hot flashes, this will be relieved by the start of your hormone medication (i.e., E2V or Gonal-F or Follistim (Hot Flashes sound like I'm going to get a preview into menopause- good practice I shall never forget!)
  

E2V = Estradiol Valerate = Delestrogen

Basically a shot in the "buttocks" that gets my Stimulators primed and ready for Stimulation. Women who have had a hysterectomy take this for hormone supplements. I am going to venture to say that this medication is ONE of the meds that will probably make me feel like hormonal crazy mess! When I Googled It the med is described a Hormone Replacement Therapy.

Folic Acid 1mg tablet

This is one medication that I actually knew the functionality and have taken before as all pregnant women or trying to conceive women should! It prevents Spina Bifida.

SDF (Viagra) Suppositories (Let's Get the Party Started)

• Given to increase blood flow to endometrial lining
• Take vaginally 4 times daily (Really?!?!)
• No side effects, except possible vaginal irritation from so many suppositories. (No side effects? Irritation in the HooHaw is a big side effect in my opinion).
  

Terbutaline 5 mg Tablets

• Given to relax the uterine muscle which will allow more blood flow through the uterine vessels
• Starts with SDF suppositories. (I had to look this up- this is a suppository that goes in your HooHaw- I was hoping I was done with this part at the Viagra- guess not!)
  
• One tablet three times a day
• You will experience the side effects of nervousness, shakiness and a racing heart! If your heart rate is over 120 beats per minute, please skip a dose
• Your body will adjust to the Terbutaline in 2-5 days and you will no longer experience the side effects

I don't think I need to anything to this med- it pretty much says it all in the outline above! Sounds like this one is going to be LOTS of FUN!

Gonal F / Follistim

From what I have read this is the BIG DADDY in the stimulation meds. This is the medication that kicks your follices into overdrive and helps your woman business produce LOTS of EGGS! Yay for Eggs- we love Eggs!

Luveris

So what is exactly is a "pure Lutenizing Hormone"? Well I Googled It (imagine that). Here's what I got: A hormone used to support Follicle Stimulating Hormone (FSH) therapy.

It is always taken with Gonal F. So basically it is a booster for stimulation! Got it!

Read more: http://www.drugs.com/luveris.html#ixzz10XyZ8KxF

Don't forget the Important Warning: Contact your healthcare professional immediately if you experience severe pain or bloating in the stomach or pelvic area, severe upset stomach, vomiting and / or weight gain.

Progesterone in oil

This syringe and gauge process is enough to make my head spin! Use the 1 1/2 " this or that and 3ccs of this or that...I am confused- are you?

Injections sites

Intramuscular injection sites- this looks painful...all I'm saying!

Subcutaneous Injection Site (use upper thigh or lower abdomen)- never had a shot in the abs before this should be interesting since mine are obviously covered by layers of stretched marked skin! This should be fun!

So my fellow readers- what do you think of all this, as I like to call craziness, JICK JACK? It's amazing what medications can do to our body and how doctor can manipulate my entire reproductive system to make a baby! I feel like a science experiment! But a good one!

A LOT To Take In (Not for the faint at heart or weak at stomach)

I am going to be brutally honest and just say that yesterday when my nurse emailed me with my list of meds and then the pharmacy called to confirm my list of meds- I got a little dizzy and nearly had a panic attack! Just look at the names of these things? When the pharmacy called I was jotting down notes in Microsoft Word thinking the spell check would correct them and I misspelled over half of the meds! I got a little worried when the email came and this is what it said: (Keep in mind my hubby will be the one administering these shots!!!!!)

The Sher Institutes for Reproductive Medicine

Medication Administration Guidelines

________________________________________________________________

Tips:

• An ml = cc
• Needles are STERILE, do not touch them before using them to inject and only use them ONCE
• Rotate injection sites from one side of the abdomen to the other, and from one thigh to the other
• With a multi-dose medication vial, swab the top of the medication vial with an alcohol swab before each use
• When in doubt about medication dosage or injection, PLEASE call the office for clarification. DO NOT GUESS!
• There is a nurse on call through the service after office hours. Please call 702-892-9696 before 11pm and the service will promptly page the nurse on call
• Read all of the medication labels before taking the medication to ensure that you are taking the correct medication
• Report all medication errors and unusual reactions to your coordinator as soon as possible

Dexamethasone 0.75 mg Tablet or Prednisone 10 mg

• This is a steroid tablet
• This is given to decrease inflammation and reduce the inflammatory response of your body to foreign bodies (your embryo) before embryo transfer
• Take once a day in the morning with your breakfast to decrease GI upset and other potential side effects
• Potential side effects are insomnia, increase in appetite and bloating.

Lupron (Leuprolide Acetate)

• Lupron is taken to suppress your hormones at the pituitary level, it does NOT suppress your ovaries
• Injection to be given subcutaneous in either the upper thigh (up by panty line) or in the abdomen (stay 1 inch away from belly button) in the AM (between breakfast and lunch) with a few hour flexibility between days (See diagram on page 5)
• The medication comes in a multi-dose vial
• Use the insulin syringes with the orange cap to draw up dose and inject
• Refer to your calendar for dosage and measure units (U) on the syringe
• The most common side effect is hot flashes, this will be relieved by the start of your hormone medication (i.e., E2V or Gonal-F or Follistim
  

Ganirelix/Cetrotide

• To be taken like Lupron, subcutaneous in AM
• Also like Lupron, it is being taken to suppress your own hormones and has a better long term effect with fewer side effects
• Given at ½ dose (125 mcg) rather than prepackaged dose of 250 mcg (same as 0.25 mg)
• Ganirelix:
• To split Ganirelix (prefilled in a syringe) use a 1 cc syringe that does not have a needle and pull down plunger to 0.25 cc.
• Then inject 0.25cc from the prefilled Ganirelix syringe into the 1 cc syringe you have just prepared.
• Place a 27 gauge ½ inch needle on the 1 cc syringe to inject.
• Save the remaining 0.25 cc in prefilled syringe for next morning’s shot.
• Keep refrigerated.
• Cetrotide:
• To split Cetrotide fill the vial of powder with the prefilled water (1 cc) in kit.
• Now you will have 2 doses in vial.
• Use same orange cap syringe that you used for the Lupron and withdrawal 50 Units (½ cc) of Cetrotide for first morning’s injection.
• Save the remaining 50 Units (½ cc) in vial for next day’s injection.
• Keep refrigerated.
• Second dose may only measure up to 35 or 40 Units. This is normal, do not mix up another vial just inject whatever is left for the second dose.

E2V = Estradiol Valerate = Delestrogen

• Not all protocols involve E2V, so if this is not on your calendar then omit instructions.
• This is given to “prime” the receptors on the ovaries to improve response the following week to the stimulation medications.
• This is an IM (intramuscular) injection given in the PM (between dinner and bedtime) in the upper outer quadrant of the buttock (See diagram on page 5)
• Give while lying down to relax the muscle
• Verify that your Delestrogen concentration is 20 mg/ml
• Use a 1 cc syringe without a needle (NOT a Lupron syringe) and attach a 18 gauge 1 ½” needle to draw out the medication to 0.2 cc or the dosage in which you have been instructed to take. Switch needle to a 22 gauge 1 ½” to then inject intramuscularly.
  

E2V 2 mg suppositories

• Not all protocols use the Estradiol Valerate vaginal suppositories
• These are given to ensure that the uterus is being supplied with enough estrogen
• Insert vaginally at bedtime
• These may or may not be continued after CD9.
• Make sure you are inserting the E2V 2mg (Estradiol Valerate) suppositories NOT the suppositories used after embryo transfer which are Estradiol Valerate 1 mg/ Progesterone 50 mg suppositories (or E2V/ P4). If you use the latter in error your cycle will be immediately cancelled.
• Keep refrigerated

Folic Acid 1mg tablet

• Prescription strength folic acid dose (over-the-counter dose is only 400 mcg).
• These tablets are taken to prevent Spina Bifida-type problems in fetus.
• No side effects and can be taken anytime.
• You may opt to take a Prenatal Vitamin instead of straight Folic Acid, this is fine as long as it is prescription strength

SDF (Viagra) Suppositories

• Given to increase blood flow to endometrial lining
• Take vaginally 4 times daily
• No side effects, except possible vaginal irritation from so many suppositories.
• Place the suppositories over the course of a day (with the last at bedtime, unless you are taking E2V suppositories as well) and that it doesn’t have to be exactly a certain amount of hours apart.
• You may wish to wear a panty liner since not all of the wax absorbs and you may experience slight oozing.
• You should try to at least be sitting for 15 minutes after each insertion.
• Keep refrigerated

Terbutaline 5 mg Tablets

• Given to relax the uterine muscle which will allow more blood flow through the uterine vessels
• Starts with SDF suppositories.
• One tablet three times a day
• You will experience the side effects of nervousness, shakiness and a racing heart! If your heart rate is over 120 beats per minute, please skip a dose
• Your body will adjust to the Terbutaline in 2-5 days and you will no longer experience the side effects

Heparin 5,000 IU / Lovenox 30 mg

• Only use if indicated on your calendar
• Twice a day injections, to be given in the AM with Lupron/Cetrotide and in the PM with stimulation medications/hormone injections
• Subcutaneous injection given with a ½ cc or 1 cc insulin (Lupron) syringe
• Verify the concentration of your Heparin. If 10,000 units/ml then your dose twice a day is 5000 units or ½ ml (which is equivalent to 50 units on the insulin syringe).
• You may also use Lovenox 30 mg one a day subcutaneously anytime in the day in lieu of heparin.
• You may experience some bruising at injection site, do not rub vigorously

Gonal F / Follistim

• This is FSH (Follicle Stimulation Hormone) or stimulation medication
• This is given subcutaneously anytime in the evening anytime between dinner time and bed time
• Please refer to packet instructions for reconstitution as can come in multidose vial, single dose vial and Pen form
• Your coordinator will go over instructions with you or you may contact Fertility Lifelines (1-866-538-7879) for Gonal-F product support 24 hours a day
  

Luveris

• This is pure Luteinizing Hormone (LH)
• To be given as a separate injection in the PM with your stimulation medication
• This is given subcutaneously
• The dose is always 1/2 vial (37.5 IU) as indicated on your calendar
• Use the 3ml syringe with 22 gauge 1 ½” needle to draw up 1 cc of diluent
• Inject full 1 cc into vial of powder (this is now 2 doses)
• With same syringe/needle, withdrawal only ½ cc (0.5 ml) and refrigerate remaining ½ cc for next evening’s dose
• Change needle to the 27 gauge ½ “ to inject subcutaneously.

Progesterone in oil

• This medication will be given in one of two dosage amounts, 50 mg (1cc) or 100 mg (2cc). See your calendar for your dosage.
• This is an IM (intramuscular) injection given in the PM (between dinner and bedtime) in the upper outer quadrant of the buttock (See diagram on page 5)
• Give while lying down to relax the muscle.
• Use a 3 cc syringe with an attached 18 gauge 1 ½” needle (or 20 gauge) to draw out the medication to the dosage in which you have been instructed to take. Switch needle to a 22 gauge 1 ½” (or 25 gauge 1 ½” needle if your product is made in ethyl oleate oil) to then inject intramuscularly.

Final Comments

• On CD9 (cycle day 9 when monitoring in our office begins) you will be given a new calendar and instructions once we have determined how you are progressing
• There will be medications you have received that are not on your calendar at this point (i.e., Cipro, hCG 10,000 units, progesterone in oil, Clindamycin suppositories, E2V/ Progesterone suppositories). These will be used post CD9.
  

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Injections sites

Intramuscular injection sites

Subcutaneous Injection Site (use upper thigh or lower abdomen)

I WILL DISCUSS HOW I FEEL ABOUT EACH OF THESE AND THE OUTRAGEOUS COST IN MY NEXT BLOG......I THINK I'VE SHARED ENOUGH FOR ONE BLOG POST :)

JUST A LITTLE THOUGHT: "HOW DOES ONE TRAVEL WITH A CARRY ON THAT COULD BE PASSED OVER FOR A DRUG LORD WITH SYRINGES AND ENOUGH FERTILITY MEDS TO KNOCK UP A SMALL ARMY?" JUST WONDERING!!!