Fertility Medication Administration Instructions

Caution:

The instructions set forth herein are solely for the benefit of Fertility Centers of Illinois (FCI) patients who have had an appointment at Fertility Centers of Illinois and met with a physician and/or nurse regarding an individual and specific course of medical treatment. All other persons are cautioned that they should not follow or use these instructions in the absence of having an individual course of medical treatment prescribed by a Fertility Centers of Illinois Physician.

The following information is ONLY for Fertility Centers of Illinois patients, describing how to mix and administer the many injectable drugs used for fertility therapy. The information contained on this page contains information that is both generated from our FCI nursing staff and from the different companies that make the drugs themselves.


When you receive your shipment of medications, the first thing you should do is review its contents. Verify that you received all of the medications you may require, and call your nurse with any questions prior to the start of your treatment cycle. Please follow the recommended manufacturer storage instructions that come with each medication.

Sharps Container Disposal Instructions

Please note that we are not able to accept used sharps or sharps containers at any FCI office location.

Please contact your City or Village Manager’s office, local waste management company, or local health department to ask about the proper disposal of sharp containers in your area.

Medication Refills

You may call your pharmacy directly for refills, but please do not wait until you are completely out to do so. Please be aware of how much medication you have at all times and alert your nurse if you are running low to inquire if more is needed. The pharmacy can typically order additional medication within 24-48 hours. There is no delivery on Sundays, so please plan accordingly.

How to Administer Your Medications

The Freedom Pharmacy website may show more than one way of giving certain medications. Please use the medication chart (below) in conjunction with the website; the chart lists Fertility Centers of Illinois’ requirements for the route, preparation, and administration of each medication.

Injection techniques are clearly demonstrated on the Freedom Fertility Pharmacy MedTEACH Medication Instruction website. Please view the video for each medication that your nurse has ordered for you.


Still Have Questions?

If you have questions after viewing these materials, please contact your nurse for further instruction prior to the start of your treatment cycle. We will be happy to review it with you in-person if needed. To discuss medication administration, please contact your home office location by clicking here.


Medication Administration Terminology

Below are common acronyms for medication administration routes that you will find referenced in the medication list below:

    • Subcutaneous Injection (SQ): Administration of medication with a fine, small needle just below the surface of the skin, into fatty tissue.
      • Injection sites: lower abdomen (below & at least one inch away from belly button) or upper, outer thigh.
        Rotate sites daily
    • Intramuscular Injection (IM): Administration of medication deep into the muscle.
      • Injection site: upper, outer quadrant of buttocks.
      • Rotate sites daily
    • Transdermal Medication (TD): Applied to the skin (often in the form of a patch).
      • Application sites: lower abdomen (below and at least one inch away from belly button), upper area of buttocks, backs of upper arms, thighs
      • Rotate sites as needed.
    • Oral (PO): Medication taken by mouth
    • Transvaginal (TV): Medication inserted into the vagina.
    • Cubic Centimeter (CC) is the same as a milliliter (mL)

Injectable Medications List

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Medications

Route

Mixing/Preparing Medication

Administering Medication

Lupron/Leuprolide Acetate, Microdose Lupron,

Low-dose HCG

SQ

Already reconstituted- no mixing required. Use insulin syringes that come with kit to draw prescribed dose out of vial.

Use same insulin syringe with attached needle to inject.

Ganirelix Acetate

Full dose= 250 mcg/0.5ml

*Note: unless otherwise instructed, use a full dose.

Half dose= 125 mcg/0.25ml

*Note: half-dose syringes are good for 30 days.

SQ

Full dose: comes in prefilled Ganirelix syringe with attached needle- no mixing required

Half dose prepared by pharmacy: comes in prefilled 1cc syringes with either a cap or attached needle.

Half dose not prepared by pharmacy: inject half of the liquid from the Ganirelix syringe into the barrel of the supplied 1cc syringe (fill 1cc syringe to 0.25 mL). Use what’s left in the Ganirelix syringe for one day’s dose and what you injected into the 1cc syringe for another day’s dose. Repeat as needed for the rest of treatment cycle.

Using Ganirelix syringe: Use prefilled Ganirelix syringe with attached needle to inject.

Using 1cc syringes for half-dose:Attach 27g ½” or 25g 5/8”needle to 1cc syringe and inject.

Cetrotide

SQ

Comes with prefilled syringe of diluent and 20g 1.5” needle. Attach 20g 1.5” needle to syringe and inject all of the diluent into powder. Once diluted, draw up mixture back into syringe.

Change to 27g 1/2” needle to inject.

Follistim AQ cartridge

SQ

Load cartridge into Follistim pen device. Dial up prescribed dose.

Twist on pen needle unit included in package to inject.

Follistim AQ vial

SQ

Use 3cc syringe and 22 g 1.5” needle to mix 1 cc of diluent with powder. Using same supplies, draw 1cc of mixture back into syringe.

Change to 27g 1/2” needle to inject.

Gonal-F MultiDose Vial

SQ

Comes with prefilled syringe of diluent; inject all of the diluent into powder then dispose of that syringe. Use 1 ml syringe with attached needle that comes in the kit to draw prescribed dose out of vial.

Use same 1ml syringe with attached needle to inject.

Gonal-F RFF Pen

SQ

Already reconstituted in pen- no mixing required. Dial up prescribed dose.

Twist on pen needle unit included in package to inject.

Bravelle, Menopur

SQ

Use 3cc syringe and 22g 1.5” needle (or Q-cap) to inject 1cc of diluent into powder. Use same supplies to draw 1cc of mixture back into syringe. Use that mixture to dilute and mix additional vials as needed for total dose.

Change to 27g 1/2” needle to inject.

Repronex

IM

Use 3cc syringe and 22g 1.5” needle (or Q-cap) to inject 1cc of diluent into powder. Use same supplies to draw 1cc of mixture back into syringe. Use that mixture to dilute and mix additional vials as needed for total dose.

Change to 25g 1.5”needle to inject.

HCG (Chorionic Gonadotropin, Novarel, and Pregnyl)

IM

Use 3cc syringe and 22g 1.5” needle to inject 1cc of diluent into powder. Use same supplies to draw the amount of mixture back into the syringe directed by your physician or nurse.

Change to 25g 1.5” needle to inject.

Ovidrel (same action as HCG)

SQ

Comes in prefilled syringe with attached needle- no mixing required.

Use prefilled syringe with attached needle to inject.

Progesterone in Oil,

Delestrogen

IM

No mixing required. Use 3cc syringe and 18g or 22g 1.5” needle to draw prescribed dose out of vial.

Change to fresh 22g 1.5” needle to inject.

Lovenox

SQ

Comes in prefilled syringe with attached needle- no mixing required.

Use prefilled syringe with attached needle to inject.

Non-Injectable Medications List

Medication Route Preparing Medication Administering Medication
Crinone TV Comes in prefilled applicator Use prefilled applicator to insert vaginally
Endometrin TV Comes with disposable applicators Place tablet in applicator then insert vaginally
Progesterone Vaginal Suppositories TV N/A Using finger, insert suppository vaginally
Prometrium PO or TV N/A Take tablet orally or insert vaginally, per your physician or nurse instructions
Estrogen patch (Estraderm, Vivelle, Minivelle, Climara)

Testosterone patch (Androderm)

Testosterone gel (Androgel)
TD N/A Apply to skin as directed by physician or nurse



*Pay special attention to the precautions that come with the Androgel/Androderm.
Estradiol (Estrace) PO or TV N/A Take tablet orally or insert vaginally, per your physician or nurse instructions.

**Please note: although this medication is in tablet form, we often ask patients to insert the tablet vaginally to increase absorption to the uterus. Please follow your physician or nurse’s instructions and do not hesitate to ask if you have questions.
Clomiphene Citrate (Clomid) PO N/A Take tablet orally at the prescribed dose
Letrozole (Femara) PO N/A Take tablet orally at the prescribed dose
Doxycycline PO N/A Take tablet orally at the prescribed dose
Zithromax (Z-pack) PO N/A Take tablet orally at the prescribed dose
Baby Aspirin PO N/A Take tablet orally at the prescribed dose
Metformin (Glucophage) PO N/A Take tablet orally at the prescribed dose
Dexamethasone PO N/A Take tablet orally at the prescribed dose
Methylprednisolone (Medrol) PO N/A Take tablet orally at the prescribed dose

Reminder: Avoid taking full dose aspirin and any non-steroidal anti-inflammatory (NSAID) medication during a treatment cycle or during pregnancy, as these medications can increase bleeding times. Use during menses is permitted.

If you have a specific physician’s order to take them, due to a medical condition, please discuss this with your Fertility Centers of Illinois physician.