Medication Preparation- Single Injection Technique Lupron (leuprolide acetate) Protocol

This instruction sheet has been prepared for you to assist in mixing all of the medications you will need for your stimulation so that they can all be given together in one single subcutaneous injection.

Please note that the only exception is the hCG injection (Ovidrel, Novarel, Pregnyl), which must be given at the time you are instructed and separate from all the other medications.

Please assemble the following items:

• 2- Alcohol Wipes

• 1- 3cc syringe

• 1- 22G 1” needle

• 1- 25G 5/8” needle or 27G ½” needle

• Sodium Chloride vial (comes in the Menopur box)

• Follistim Cartridge and Pen Device or Gonal-F Pen

• Menopur Vials (each vial = 75 units)

• Q-Cap (optional)

• Lupron/leuprolide acetate 2 week kit

Procedure

• STEP 1

  Wash your hands

• STEP 2

  Cleanse the top of the Menopur vial and the Sodium Chloride vial with an alcohol wipe

• STEP 3

  Take the 3 cc syringe and attach the 22 G 1½ inch needle to it (or attach the Q-Cap if you are using this instead of the needle).

  Pull the plunger of the 3cc syringe down to the 0.5cc marking (with the needle or Q-Cap pointing up, the top ring of the black piece should be at the long line at the number 0.5cc).

  Insert the needle or Q-Cap through the rubber stopper of the Sodium Chloride vial.

  Turn the Sodium Chloride vial upside down with the needle still through the rubber stopper, and push the plunger in all of the way. This will dispense air into the vial and make it possible for you to remove the fluid.

• STEP 4

  Make sure that the top of the needle is in the fluid, and draw back the plunger until the top ring of the black piece lines up with the 0.5cc marking on the 3cc syringe.

• STEP 5

  Take the 3cc syringe (which has the Sodium Chloride solution in it) and inject it into the vial of Menopur. Swirl the fluid around until the Menopur powder completely dissolves.

• STEP 6 (if you are only using one vial of Menopur, skip to step 7)

  Take the 3 cc syringe, remove the fluid from the first Menopur vial, and inject it into the second Menopur vial. Swirl the fluid around until the Menopur powder completely dissolves.

  Take the fluid from the second Menopur vial and insert it into the third Menopur vial.

  Repeat this step until you have added fluid to the total number of vials of Menopur that you have been instructed to use.

  Remember that one vial of Menopur = 75 units of Menopur.

• STEP 7

  Insert the cartridge of Follistim into the Follistim pen (you do not need this step if you are using a Gonal-F pen),

  Attach the pen needle

• STEP 8

  Dial the pen to the correct dosage. You will receive dosage instructions on the portal.

• STEP 9

  You are now ready to use the Follistim or Gonal-F pen.

  Inject the Follistim or Gonal-F pen directly into the Menopur vial and swirl it gently.

• STEP 10

  Take your vial of Lupron/Leuprolide Acetate and using your thumb lift the plastic cap off the vial (if using for the first time). Wipe the top of the vial with an alcohol wipe. Take a new orange top Lupron syringe and remove the cap from the needle taking care not to touch the needle itself. Pull the plunger back to the number of units you have been instructed to take. Insert the needle through the rubber stopper in the vial of Lupron/Leuprolide Acetate and inject air into the vial.

  With the needle still inside the vial, turn the vial so the stopper side is pointing down. Make sure the needle is within the fluid line then slowly pull back the plunger to withdraw 5 units of Leupron/Leuprolide Acetate from the vial.

  Usually, the number of units of Lupron/leuprolide acetate will be 5 or 10. If you are instructed to use 5 units, you will pull back the plunger to the number 5 line. If you are instructed to use 10 units, you will pull back the plunger to the number 10 line.

  Insert the filled Lupron syringe needle through the stopper of the vial of Menopur mixed with Follistim or Gonal F. Inject the entire contents of the Lupron syringe into the vial and swirl it gently. Remove the needle and syringe from the vial and discard in your sharps container.

• STEP 11

  Take the 3 cc syringe (with the 22G 1 1/2 inch needle or Q-Cap attached to it) and insert it into the Menopur vial in which you have mixed everything.

  Remove all of the fluid from this vial.

• STEP 12

  Remove the 22 G 1½ inch needle or the Q-Cap from the syringe.

  Attach the 25 G 5/8” needle or 27 G ½” needle. Hold the needle facing up and remove all air from the syringe by gently pressing on the plunger. If there are any air bubbles in the syringe, you can tap it gently to remove these. A small amount of bubbles or air is safe to inject.

• STEP 13

  Cleanse the area on your abdomen or thigh where you will be injecting the medication with an alcohol wipe.

  Inject the entire contents of the syringe into your abdomen or thigh. Give injection by pinching area and injecting at a 90-degree angle.

  You may notice a small droplet of blood at the injection site. You can wipe this off with a piece of gauze.

• STEP 14

  Dispose of the needle into the sharps container that was provided to you with you medication order.

  If you have any questions regarding these instructions, please leave a message with the nurses at 847-884-8884 ext. 3, or email “ask nurse” via the portal. If you have an after hours question, contact the answering service directly at 773-279-0000.