Injectable Infertility Medication
Follicle Stimulating Hormone Injectables
Individuals undergoing ovulation induction therapy will receive injection instructions from a reproductive endocrinologist in our Durham, NC clinic as they are prepared to start treatment. Written instructions and diagrams are included in our information packets.
The individual giving your follicle stimulating hormone injections should be available during your entire treatment cycle. Individuals who may be available to give injections include friends who are registered nurses, husbands (who can receive instruction from our nurse clinicians), a local reproductive endocrinologist, and staff at urgent care centers and emergency rooms.
This individual must be identified prior to proceeding with the ovarian induction therapy. If you are receiving follicle stimulating hormone injections from a professional, the cost of this service will vary among locations. It is advisable to ask about their fees in advance.
If the individuals or the facility at which you are receiving your injections require a prescription, please make us aware of this and we will give you the appropriate instructions.
Human Chorionic Gonadotropin (HCG)
Human chorionic gonadotropin (HCG) has a chemical structure that is very similar to luteinizing hormone (LH), which triggers ovulation. HCG is also the follicle stimulating hormone produced by the chorionic villi and placenta when a woman is pregnant.
A pregnancy test is essentially a test for the presence of HCG. Since HCG has a structure like LH but lasts much longer in circulation, HCG can be used to trigger ovulation at the appropriate time.
When the monitoring team thinks that your follicles are at the appropriate size to trigger ovulation, you will be instructed to take HCG.
The type of cycle and day of the procedure (oocyte retrieval or insemination) will determine what time the HCG follicle stimulating hormone injection will be given.
Once HCG is given, there will be no further Lupron or gonadotropin injections.
HCG may be given in different situations. To help you understand what to expect, several scenarios are included below:
- Timed intercourse: Timed intercourse can be done with Clomid and controlled ovarian hyperstimulation (COH) cycles. Patients taking Clomid may be given 10,000 units HCG, whereas patients undergoing COH generally get 5,000 units of HCG.These injections are administered in the clinic at the time of the monitoring visit since intercourse will need to be planned approximately 37 hours from the time of injection.As an example, if HCG is given at 9 a.m. then intercourse should be planned for around 10 p.m. the following night. This type of timing usually works for most couples that work during the day. The exact timing is a recommendation and should not be considered an absolute. Fortunately, nature does not require such perfect timing.
- Intrauterine inseminations (IUI): Inseminations with washed and donor sperm will be scheduled 39 to 42 hours after HCG injection. 5,000 units of HCG is usually administered at 6 p.m. two days prior to the scheduled insemination.For example, a patient with appropriately sized follicles seen on Monday is directed to stop all injections and take 5,000 units of HCG at 6 p.m. She will then be seen on Wednesday for an insemination around 9:30 a.m. to 10 a.m. (Semen samples will be collected at 8 a.m. if applicable.) Learn more about IUI.
- In vitro fertilization (IVF): IVF patients now take 5,000 units of HCG at 37 hours prior to retrieval. There is a margin of several hours before the release of the oocytes into the abdomen, although the timing is not absolute.Different IVF centers use different times for their retrievals and have become comfortable using their own timing. Be sure to take your medication at the time that was specified for you. Written directions are provided at the monitoring visit prior to your retrieval.Learn more about IVF.
HCG is supplied in a powder form and requires mixing. Below you will find our recommendations on the proper mixing ratios.
When Used to Trigger Ovulation (Usually in the Evening)
5,000 units by intramuscular injection to be given at a time designated by the physician.
1. Mix 10,000 units in 2 ml of dilutent.
2. Inject 1 ml, which will equal 5,000 units.
3. Refrigerate the remaining medication to be given as below (0.5 ml now equals 2,500 ml).
When Used to Maintain Progesterone Production after Ovulation
2,500 units intramuscular injections on the first and fourth day after insemination — the third and sixth day after ovulatory HCG is given.
1. Using the remaining medication from the first injection (see above) give 0.5 ml for first dose and 0.5 ml for second dose.
2. Refrigerate mixed HCG between doses.
Dosage and mixing instructions of HCG will be reviewed with you during monitoring clinic prior to administration. Written directions will also be provided.
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