One of the most common types of IVF cycles is the Ganirelix protocol. This protocol involves starting with oral contraceptives and then beginning the 2 stimulation medications which are most commonly Menopur and Follistim (or Gonal-F). After about 5-6 days of these 2 shots you would then add in a third injection which is the Ganirelix. Since you are typically on these medications 8-12 days while preparing your body for IVF, this can mean up to 36 injections! Added in with the frequent blood draws for monitoring and you have quite a bit of needle sticks. InVia is now working to decrease the amount of injections you need to do. We have begun using a single injection technique and have positive feedback so far.
In a Ganirelix IVF cycle, the patient is taking Menopur in the morning and the Follistim (or Gonal-F) and Ganirelix in the evening. With the single injection technique, the patient would take all the meds together in 1 shot in the evening. These shots are always done subcutaneously in either the abdomen or thigh. The only exception to this technique is the hCG (trigger shot). This shot remains separate and you will be given further instructions for it when the time comes.
The following steps will be given to you more detailed at your nurse teach appointment but this gives you an idea of how it is done.
You will dissolve the appropriate number of Menopur vials with only ½ ml of the saline fluid. After you have added the saline to the last Menopur vial, you will add the correct dosage of Follistim (or Gonal-F) right into that vial also. You will then draw all the fluid up (it should be ½ ml of saline mixed with the Menopur + the Follistim (or Gonal-F) you added) and attach the subcutaneous needle and inject the medication.
After 5-6 days of this you will most likely be instructed to add your Ganirelix. You will follow all the same steps, but after you inject the Follistim (or Gonal-F) into the last Menopur vial, you will add the pre-filled syringe of the Ganirelix medication to it. Then, you will draw the fluid up and give the injection subcutaneously. This will mean that last vial of Menopur contains the Menopur + the Follistim (or Gonal-F) + the Ganirelix.
In a leuprolide acetate (Lupron) cycle, you can similarly mix the Lupron, Follistim (or Gonal-F) and Menopur and take a single injection.
As mentioned previously, more detailed instructions will be given to you at your nurse teach appointment. You will have an opportunity to view the technique and also practice it yourself. And as always, we have the nurse portal and nursing voicemail to address any further questions or concerns. Hopefully, this is a step in the right direction to minimize the discomfort that some patients feel during their stimulation injections.
Katie Coss graduated from Northern Illinois University in 2002 with her Bachelor of Science in Nursing degree. She started working at InVia in Sept 2011 after almost 9 years of working as a Labor and Delivery RN. She nad her husband conceived their second son through IVF and she always remembers thinking she wanted to take care of other people going through the same thing.