After egg retrieval, the eggs are fertilized in a lab to create embryos. These embryos may be frozen or transferred soon after retrieval. You make take medicine before and after the procedure to prepare for a transfer. Here’s what you can expect. 

For a medicated frozen embryo transfer 

Medicines before transfer 

1. Medicine to prevent premature ovulation 

Your healthcare provider may prescribe birth control pills and a medicine called leuprolide (Lupron). These help prevent early ovulation by blocking the hormone surge that triggers it. Leuprolide is usually started 10 to 15 days before starting other medicines for the transfer. Your doctor may stop leuprolide when you start taking other medicines for the transfer, or they may lower the dose. 

2. Medicine to prepare your uterine lining 

After about 1 to 2 weeks of taking medicine to control ovulation, and once you get your period, you may begin taking estradiol. This can be a pill, patch, or injection. Estradiol helps thicken the uterine lining so it can support an embryo. Estradiol also prevents your body from growing a follicle (small, fluid-filled sac in the ovary) and ovulating.  

Medicines during and after transfer 

1. Medicine to support implantation 

When your uterine lining is thick enough, usually around 1 to 2 weeks after starting estradiol in a medicated transfer cycle, you will begin receiving progesterone. Progesterone can be given as an injection, a vaginal suppository, or both. Examples include progesterone in oil, Endometrin, Crinone, and Prometrium. 

The transfer usually happens 3 to 6 days after you start progesterone. If you become pregnant after the transfer, you may continue progesterone for the first 8 to 12 weeks of pregnancy. Your provider will guide the plan based on your history. 

Most providers will have you continue the estradiol medicines while you are on progesterone. Some people are also prescribed a short course of a steroid medicine like methylprednisolone (Medrol) or prednisone to support implantation.  

Some clinics also prescribe an antibiotic to lower the risk of infection after transfer, such as doxycycline or clindamycin. 

For a fresh embryo transfer 

1. Medicine to prepare the uterine lining 

You may take synthetic estrogen, such as estradiol tablets (Estrace) or patches (Minivelle, Dotti). Estrogen helps thicken the uterine lining for transfer. Your provider will monitor the lining during your cycle. The goal thickness is usually about 7 to 13 millimeters. 

Not everyone doing a fresh transfer needs added estrogen. Your provider will determine if more support is needed after retrieval. 

2. Medicine to support implantation 

You will begin progesterone 1 to 2 days after egg retrieval. Progesterone can be a vaginal suppository or an injection. It helps the uterine lining shift from growing to compacting, which creates a supportive environment for implantation. 

If you become pregnant, you may continue progesterone for the first 8 to 12 weeks of pregnancy, based on your history and your provider’s plan. 

Some clinics also prescribe an antibiotic to lower the risk of infection after transfer, such as doxycycline or clindamycin. 

If you have questions, Progyny is here for you. Please contact your Progyny Care Advocate for support.  

Disclaimer: The information provided by Progyny is for educational purposes only and is not medical advice. Always consult a qualified healthcare provider for medical guidance. 

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What is clomiphene citrate?

Clomiphene citrate (brand name Clomid) is an oral medication that helps stimulate ovulation. It may be prescribed if you don’t ovulate regularly, or if your reproductive endocrinologist (REI) wants to encourage the release of more than one egg.

Clomid works by making your brain think there is less estrogen in your body than there really is. In response, your brain produces more follicle-stimulating hormone, which helps eggs grow inside your ovaries.

What are the success rates with Clomid, with and without intrauterine insemination (IUI)?

Success with Clomid depends on your age and the reason for infertility. As age increases, egg quality declines, which can lower success rates.

• If the main issue is that you don’t ovulate on your own, Clomid is often very effective and can help many people to release their eggs.
• Clomid is commonly used for polycystic ovarian syndrome and can improve the chances of both ovulation and pregnancy.
• When no clear cause of infertility is found, Clomid on its own may not be as effective. In these cases, Clomid is often combined with IUI.

IUI places prepared sperm directly into the uterus with a thin catheter, making it easier for sperm to reach the egg. Using Clomid with IUI can increase the chance of pregnancy compared with Clomid alone.

What is involved in a Clomid and IUI cycle?

On day 3 of your cycle, you’ll have bloodwork and start taking Clomid for five days. Your REI will use ultrasound to track how your body responds to the medication.

About 24 to 36 hours after ovulation, the insemination takes place. If you’re using partner sperm, a semen sample will be collected and prepared in the lab. If you’re using donor sperm, the frozen sample will be thawed and prepared the same way. This process removes substances that could cause cramping if placed directly in the uterus.

Does Clomid increase the risk of twins or triplets?

Yes. The risk of twins with Clomid and IUI is about 8%. The chance of triplets is less than 1%.

Are there cases where Clomid will not work?

Clomid is less likely to be effective if you have:

• Blocked fallopian tubes.
• Very low ovarian reserve, which means there are very few eggs remaining.
• Hormonal conditions, such as high prolactin levels or thyroid issues.
• Hypothalamic amenorrhea, which is a condition where the brain does not send signals needed to start ovulation. It can be linked to very low body weight, stress, or excessive exercise.

Which option is best for you?

Clomid alone and Clomid with IUI each have their own benefits, success rates, risks of multiples, side effects, and costs. Talk with your REI about which approach may be right for you.

If you have questions or concerns, Progyny is here for you. Please contact your Progyny Care Advocate for support.

Disclaimer: The information provided by Progyny is for educational purposes only and is not medical advice. Always consult a qualified healthcare provider for medical guidance.

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What is Clomid?

Clomid (clomiphene citrate) is one of the most common medications used in fertility treatment. It’s what’s called a selective estrogen receptor modulator (SERM). That means it attaches to the same receptors that estrogen normally does, but it changes how your body receives the signal.

Clomid works by adjusting the usual communication between your ovaries and your brain. Normally, your brain releases a hormone called follicle-stimulating hormone (FSH). FSH helps a follicle — the small fluid-filled sac that carries an egg — grow on your ovary. As the follicle grows, it releases estrogen. Rising estrogen tells your brain to lower FSH, so usually only one follicle grows each month.

When you take Clomid, it blocks the estrogen receptors in your brain. Because of this, your brain “thinks” your estrogen levels are low and continues to release more FSH. That extra FSH can help your ovary grow a follicle — or sometimes more than one. Having multiple follicles may increase your chance of pregnancy, though it also comes with some risks.

The risk of multiple pregnancy

One possible side effect of Clomid is a multiple pregnancy (twins or more). In some cases, your fertility specialist may want more than one follicle to grow, because this can raise your chance of success. But it’s always a balance between improving your odds and reducing risk. If you get pregnant using Clomid with timed intercourse or an intrauterine insemination, the chance of a multiple pregnancy is about 7% to 10%. It depends on your age and how many follicles develop.

Other possible side effects

Clomid is generally well tolerated. It works quickly and leaves your system fast — it’s usually taken for just five days during a cycle. Many people have no side effects at all, while others notice mild symptoms that end once treatment is finished.

The most common effects are mood swings, which affect more than 50% of people, and hot flashes, which happen in about 20%. A smaller number report breast tenderness, nausea, pelvic pressure, or headaches. These symptoms are usually mild and temporary.

Less commonly, Clomid may cause vision changes, such as blurred or double vision, light sensitivity, or small blind spots. This happens in only 1% to 2% of people and usually goes away once the medication is stopped. Because rare cases of lasting vision symptoms have been reported, it’s important to tell your fertility doctor right away if this happens to you. In most cases, your doctor will stop the medication.

Since Clomid sometimes stimulates more than one follicle, you may also feel abdominal bloating or pelvic pressure during treatment, depending on how your ovaries respond.

Key takeaways

• Clomid is a common fertility medication that helps stimulate ovulation by blocking estrogen signals in the brain.
• Most people have no side effects or only mild ones, and symptoms usually go away quickly.
• Common side effects include mood swings, hot flashes, and nausea.
• Rare but more serious side effects, such as vision changes or severe pain, should be reported to your doctor immediately.

If you have questions or concerns, Progyny is here for you. Please contact your Progyny Care Advocate for support.

Disclaimer: The information provided by Progyny is for educational purposes only and is not medical advice. Always consult a qualified healthcare provider for medical guidance.

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Fertility medicines are prescription drugs that help people reach their family-building goals. They may be used for ovulation induction (OI) or controlled ovarian hyperstimulation (COH) during in vitro fertilization (IVF).

These medicines work in different ways. Some block certain brain receptors, while others mimic hormones your body naturally makes. You may take them by mouth, apply them vaginally, or give them as self-administered injections.

Before you start any medicine or treatment plan, your reproductive endocrinologist (REI) will review your medical history and, if applicable, your partner’s history. A full evaluation, including a physical exam and lab testing, helps determine if there’s a reason you are having difficulty conceiving. From there, your REI will design a plan to give you the best chance of success.

Fertility medicines that stimulate the ovaries

These medicines increase the levels of follicle-stimulating hormone (FSH) and sometimes luteinizing hormone (LH). Higher levels of these hormones stimulate your ovaries to produce more than one follicle in a cycle.

The dose and the expected response depend on whether the medicine is for OI or for COH before egg retrieval in IVF. Examples include:

• Clomiphene citrate (Clomid) and letrozole (Femara) — oral medicines often used for OI
• Follitropin alfa (Gonal-f) and follitropin beta (Follistim) — injectable medicines that contain FSH
• Menotropins (Menopur) — an injectable medicine that contains both FSH and LH

Fertility medicines that prevent premature ovulation

In some treatment plans, especially IVF, your REI may prescribe medicines to prevent ovulation from happening too soon. When your body is growing multiple eggs, estrogen levels rise quickly, which may signal ovulation before the follicles are ready for retrieval. Ovulation suppression medicines give your follicles more time to mature.

These drugs work by preventing the natural LH surge that triggers ovulation:

• Leuprolide acetate (Lupron) — an injectable gonadotropin-releasing hormone (GnRH) agonist
• Cetrorelix (Cetrotide) and ganirelix — injectable GnRH antagonists
• Medroxyprogesterone acetate (Provera) — an oral progesterone medicine

Fertility medicines that trigger ovulation

If you don’t ovulate regularly, it can be harder to time intercourse or intrauterine insemination (IUI). Injectable medicines called “triggers” can help you ovulate at a specific time.

The LH surge or trigger is an important step in egg maturation — even in IVF when eggs are retrieved before release. These trigger shots are carefully timed so the eggs can be retrieved before ovulation.

Once a follicle is mature (about 18 millimeters in diameter), these medicines can cause ovulation within 36 to 40 hours:

• Choriogonadotropin alfa (Ovidrel)
• Chorionic gonadotropin (Pregnyl, Novarel)
• Leuprolide acetate (Lupron)

Fertility medicines that support implantation

After ovulation, the empty follicle becomes the corpus luteum, which makes progesterone. Progesterone helps prepare and stabilize the uterine lining for pregnancy.

If your progesterone levels are low, or in cases such as frozen embryo transfers where a corpus luteum may not be present, your provider may prescribe progesterone supplements. These may be injected, taken by mouth, or used as a vaginal suppository. Examples include:

• Progesterone in oil (injection)
• Progesterone in other forms: Endometrin (vaginal tablet), Crinone (vaginal gel), and Prometrium (oral/vaginal capsule)

If you have questions or concerns, Progyny is here for you. Please contact your Progyny Care Advocate for support.

Disclaimer: The information provided by Progyny is for educational purposes only and is not medical advice. Always consult a qualified healthcare provider for medical guidance.

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Intrauterine insemination (IUI) is a type of fertility treatment. It involves placing a concentrated sample of sperm directly into the uterus to help increase the chances of pregnancy.

Before the procedure, the sperm sample is washed in a lab to remove non-moving sperm and other fluids. What’s left is a small, active sample of healthy sperm. This sample is placed into a thin tube called a catheter, which is attached to a syringe.

Around the time of ovulation, you go to the clinic and lie on an exam table with your feet in stirrups, like during a Pap smear. A member of your fertility care team uses a speculum to see the cervix. Next, they gently guide the catheter through the cervix into the uterus and release the sperm. The goal is to get the sperm closer to the fallopian tubes, where the egg is traveling. If fertilization happens, a pregnancy test about 2 weeks later will confirm the result.

Success rates for IUI vary, but cumulative pregnancy rates may reach 15% to 20% after 3 cycles. IUI is often chosen because it’s low risk, has minimal side effects, and doesn’t require surgery. Your doctor may recommend IUI based on your specific situation.

Most IUI cycles include medicines to improve success rates, but sometimes an unmedicated cycle is the better choice.

Unmedicated IUI cycle

In an unmedicated cycle, no hormones or fertility drugs are used. This is usually for people who ovulate on their own and have regular menstrual cycles.

Ovulation is either tracked at home using ovulation predictor kits or by ultrasound in the clinic around day 10 to 12 of the cycle. The IUI is scheduled based on when ovulation is expected — either after a natural luteinizing hormone (LH) surge or after a human chorionic gonadotropin (hCG) shot to trigger ovulation. The insemination usually happens 24 to 36 hours later.

Unmedicated cycles don’t significantly improve pregnancy chances for people or couples using sperm from a partner, but they may help if they’re using donor sperm.

Medicated IUI cycle

In a medicated cycle, prescription medicines are used to help the ovaries grow eggs. This can help people who don’t ovulate regularly and may improve success rates for those who do.

Common medicines:

• Letrozole is often used for people with irregular periods. It blocks an enzyme that helps make estrogen, which tricks the brain into sending out more follicle-stimulating hormone (FSH). This hormone helps a follicle with an egg grow.
• Clomiphene citrate (Clomid) is often used for people with regular cycles. It works by blocking estrogen in the brain, which also causes the brain to release more FSH.

Injectable fertility drugs used to be more common, but they carry a higher risk of multiple births. Today, they’re only used in special cases.

How medications are used

Letrozole and Clomid are taken as pills for 5 days, usually at the beginning of the cycle when hormone levels are low. Blood work may be used to check hormone levels in people with irregular periods.

After finishing the medicine, you may track your LH surge at home using ovulation predictor kits. You could also go to the clinic for an ultrasound to check follicle growth. A follicle is a tiny bubble-like structure in your ovary that helps an egg grow and get ready to be released so pregnancy can happen.

Once the follicle is the correct size on ultrasound or an LH surge is found with bloodwork in the clinic or urine testing at home, you may receive an hCG trigger shot. This shot helps start or boost ovulation. The IUI is typically scheduled 24 to 36 hours later.

Risks of medicine with IUI

The biggest risk of using fertility medicines with IUI is having a multiple pregnancy, such as twins or triplets. Since the body makes its own FSH, it’s hard to control how many eggs are released. If more than one egg is fertilized, it can lead to a higher-risk pregnancy.

Multiple pregnancies can increase the risk of:

• High blood pressure
• Preeclampsia
• Gestational diabetes
• Caesarean section
• Preterm birth
• Breathing or brain issues in babies

If an ultrasound shows too many follicles growing, your doctor may cancel the cycle to avoid these risks. Your fertility care team will help you balance your chance of success with your overall health and long-term family goals.

If you have questions, Progyny is here for you. Please contact your Progyny Care Advocate for support.

Disclaimer: The information provided by Progyny is for educational purposes only and is not medical advice. Always consult a qualified healthcare provider for medical guidance.

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While in vitro fertilization (IVF) is a safe and effective fertility treatment, it can come with some side effects. One potential side effect is a condition called ovarian hyperstimulation syndrome (OHSS). Thanks to modern advances in fertility care, the risk of OHSS has dropped a lot. Still, it’s good to know about it during your IVF journey.

What is ovarian hyperstimulation syndrome?

OHSS happens when the ovaries have an excessive response to the medicines used during IVF. These medicines are meant to help your body grow multiple follicles — small sacs in the ovaries that hold eggs. However, there are times when the response is stronger than expected.

When that happens, the ovaries make very high levels of hormones, and fluid can leak from the blood vessels into the belly.

With mild to moderate OHSS, symptoms can include bloating or abdominal pain, nausea, vomiting, and diarrhea.

In severe cases, you would see symptoms such as rapid weight gain, trouble breathing, persistent nausea and vomiting, and blood clots. Moderate to severe OHSS is now extremely rare, thanks to newer medication protocols and improved treatment strategies.

A little hyperstimulation is normal

Keep in mind that IVF is designed to stimulate your ovaries. So, some symptoms such as bloating and discomfort are expected after egg retrieval. This is different from true OHSS.

If you’re feeling more than just mild cramping or bloating, you may have mild OHSS. It can make recovery harder, but it’s generally harmless and goes away on its own.

Why OHSS is rare now

There have been many changes in fertility care to make OHSS uncommon.

Antagonist medications

These newer medicines help control ovulation more precisely, giving your reproductive endocrinologist (REI) better control over stimulation.

Lupron trigger

Previously used to prevent ovulation, Lupron is now used to trigger egg maturation. It helps hormone levels drop faster than traditional triggers such as high-dose human chorionic gonadotropin (hCG), so you start to feel better, sooner.

Lower or no hCG trigger

hCG can keep hormone levels high, which can make OHSS worse. Using less hCG, or skipping it, lowers that risk.

Frozen embryo transfers

Before, transferring a fresh embryo right after retrieval could make OHSS symptoms worse, especially if pregnancy occurred. Now, with reliable freezing methods, your REI can freeze all embryos and do the transfer later once your body has had time to recover.

Because of all these advances, only 0.02% of IVF cycles now result in moderate to severe OHSS, according to the Society for Assisted Reproductive Technology.

Who’s at higher risk?

Some factors can make OHSS more likely, such as:

• Polycystic ovary syndrome
• A baseline ultrasound follicle count greater than 24
• An anti-Müllerian hormone level greater than 3.4
• An estrogen level higher than 3,500 picograms per milliliter
• A retrieval of more than 15 eggs
• A history of OHSS

How OHSS can be prevented

If your REI sees that you’re at risk for OHSS, they may adjust your treatment plan. They may try:

• Lowering or pausing your stimulation medications.
• Using a Lupron-only trigger shot.
• Starting a medicine like cabergoline or bromocriptine after your trigger.
• Choosing to freeze all embryos and delay transfer until a future cycle.
• Giving you letrozole or other medications after retrieval — these are still being studied but may help.

What you can expect after retrieval

Feeling bloated is very normal after egg retrieval, even if you don’t have OHSS. Here are a few things to keep in mind as you recover:

• Your ovaries stay enlarged until your next period, which usually comes about 10 to 14 days after retrieval.
• During this time, it’s best to limit activity and drink electrolyte-rich fluids such as coconut water, sports drinks, or broth.
• If you have risk factors for OHSS, try to stay local for at least a week after your retrieval, in case you start feeling worse.
• You don’t need to check your weight or labs unless directed by your REI — just pay attention to how you’re feeling.

If you’re ever unsure whether your symptoms are normal, it’s always OK to reach out to your fertility care team. They’re there to help.

Progyny is here for you, too. Please contact your Progyny Care Advocate for support.

Disclaimer: The information provided by Progyny is for educational purposes only and is not medical advice. Always consult a qualified healthcare provider for medical guidance.

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Fertility medicine often requires giving yourself at-home injections. If you’re not used to giving yourself a shot, you may be worried if you see blood or medicine leaking from the injection site.

Some people wonder if these leaks mean that they’re doing something wrong. When removing the needle from the injection site, you can expect one of three things:

• Nothing
• A small drop of blood
• A small drop of medicine

Over the course of doing daily injections, you may experience all three scenarios. None of them are a cause for concern — leaks don’t mean the whole dose is lost. Any visible leaks are likely a very small amount that won’t affect its efficacy. For example:

• If you see blood at the injection site after the needle is removed, you likely nicked a small blood vessel at or below the skin surface. The blood is just following the needle back out to the surface.
• If you see a drop of medication after the needle is removed, it’s only the medication following the needle back out to the surface.

Here are a few tips that may help:

• Release the skin pinch once you have the needle in your skin, before you inject.
• Once you have injected the medication into the skin, count to five before removing the needle.
• Apply gentle pressure with a gauze pad over the injection site as you remove the needle from your skin and hold it for about 10 seconds. The gauze helps seal the punctured tissue and prevents leakage.
• Rotate injection sites from day to day. This will keep the skin healthy and prevent scarring or hardening of fatty tissue that may decrease absorption of medication.

Summary

It’s OK to see a small drop of blood or medication after an injection. It doesn’t mean you did anything wrong or lost your full dose. These minor leaks are common and not a cause for concern. To reduce the chance of leakage, release the skin pinch before injecting, count to five before removing the needle, apply gentle pressure afterward, and rotate injection sites daily.

If you consistently see a lot of medication leaking or have injection site pain, swelling, or rash, call your clinic to be safe.

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Disclaimer: The information provided by Progyny is for educational purposes only and is not medical advice. Always consult a qualified healthcare provider for medical guidance.

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Understanding Ovarian Stimulation

In a regular menstrual cycle, one egg matures and is released during ovulation. However, fertility treatments aim to grow multiple eggs to increase the chances of a successful pregnancy. This is where ovarian stimulation comes in. The ovaries are encouraged to produce several eggs by administering specific medications. This process is crucial in treatments like in-vitro fertilization (IVF) and intrauterine insemination (IUI).

Types of Drugs Used in Ovary Stimulation

Various medications are used in ovary stimulation, each with distinct functions:

• Clomiphene Citrate: This non-steroidal fertility drug is commonly used to induce ovulation. It stimulates the production of hormones that prompt egg growth and release. Side effects may include mood swings, hot flashes, and ovarian cysts.
• Gonadotropins (FSH, LH): These hormone injections directly stimulate the ovaries to produce multiple eggs. Commonly used in IVF, they may cause headaches, mood swings, and in rare cases, Ovarian Hyperstimulation Syndrome (OHSS).
• Human Chorionic Gonadotropin (hCG): This hormone triggers the final maturation and release of the eggs after their growth. It may cause mild abdominal pain, restlessness, and fatigue.
• Gonadotropin-Releasing Hormone (GnRH) Analogs: These control the production of FSH and LH, preventing premature ovulation. Side effects may include hot flashes, headaches, and injection site reactions.

Choosing the Right Drug: Factors to Consider

The choice of medication depends on various factors, such as the patient’s age, overall health, specific fertility issues, potential risks, and side effects. The cost and availability of the drugs and personal comfort with the treatment also play a role.

The Process of Ovary Stimulation in Fertility Treatment

The process begins with hormone therapy to stimulate egg production. Regular monitoring ensures optimal growth and timing for egg retrieval through ultrasounds and blood tests. The success rates vary depending on individual health factors and the specific fertility treatment used.

Risks and Side Effects of Ovary Stimulation Drugs

While these drugs are essential in fertility treatments, they can have side effects ranging from minor issues like bloating and mood swings to more serious conditions like OHSS. The emotional and psychological impact can also be significant, underscoring the importance of a strong support network during this time.

In conclusion, the drugs used to stimulate ovaries in fertility treatments are instrumental in assisting many couples to conceive. However, they come with their own sets of risks and benefits. Patients must engage in open conversations with their healthcare providers to find the treatment that best suits their needs and circumstances. As we look to the future, continued research and development promise further advancements in fertility treatments, offering hope to many more couples worldwide.

Please note: This blog is meant for informational purposes only and should not be used as a replacement for professional medical advice. Always consult your healthcare provider for any questions or concerns regarding your health.

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Actually, the gauge and length of the needles you use for your IVF injections does matter. The majority of IVF medications are injected subcutaneously, meaning they are injected into fatty tissue underneath the skin’s surface. The needles used for this are short in length and thin in diameter because they don’t have to go all the way into the muscle layer. However, if a medicine needs to get to the muscle layer these thinner needles won’t be effective.

Needle Measurement

With needles, there are two important measurements to consider.

Gauge: The diameter, or thickness, of the needle. The higher the number, the finer or thinner the needle. For example, a 30-gauge needle is smaller than a 27-gauge needle.

Length: How long the needle is. This is measured in inches.

Injection Route

The gauge and length of the needle used for each medication is determined by the injection route.

Let’s compare injection options for IVF medications:

Subcutaneous injection (SC):

• Injected into the fatty tissue under the skin
• Usually given with 27-, 28-, or 30-gauge 0.5-inch needles

Intramuscular injection (IM)

• Injected directly into the muscle
• Usually given with 21-, 22-, or 25-gauge 1- or 1.5-inch needles

The needle for your IVF medication may come permanently affixed to the syringe, or you may be able to twist or push it on and off.

Your IVF medication may come pre-mixed or require mixing. Here are some examples and what to expect for the injections:

IVF medications That Are Pre-mixed

Your medication may come packaged from the manufacturer with the syringes and needles to be used for administration. These include:

• The Leuprolide acetate (Lupron) two-week kit. This comes in a pre-mixed multi-dose vial with syringes that have 28-gauge 0.5-inch needles affixed for SC injection.
• The Follistim and Gonal-f pens. These come with a supply of the 29-gauge 0.5-inch needles that must be twisted onto the pen before each use.
• The Gonal-f Multi-Dose vials. These come with syringes with 27-gauge 0.5-inch needles affixed.
• Several medications like ganirelix acetate and Ovidrel come in pre-filled, one-time use syringes with a 27-gauge 0.5-inch needle affixed.

IVF Medications That Require Mixing

There are other medications used in IVF cycles that require mixing a diluent with powdered medication to make a solution that can be drawn up and injected. These include Menopur, Novarel, Pregynl and human chorionic gonadotropin (hCG).

In this case, your nurse will order the appropriate syringes and needles for you to use. In general, you will use a 3cc syringe with a 22-gauge 1.5-inch needle to do the mixing and drawing-up, so you have both the length and diameter to make it easy to move liquid into and out of vials and syringes.

If you are then instructed to do an intramuscular injection, you can simply leave that same needle on for the injection. If you have been instructed to do a SC injection, you will carefully recap the needle, twist it off and replace with a 28- or 30-gauge 0.5-inch needle to do the injection.

Another option is a progesterone in oil for IM injection. This comes in a 10 ml multi-dose vial with needles and syringes ordered separately. Because the progesterone in oil is thicker than the water-based medications, some nurses order 18-gauge 1.5-inch needles to withdraw it from the vial. This needle can be intimidating due to its large size, but is only used to draw up the medication. You will use a 22-gauge 1- or 1.5-inch needle to do your injection.

Melissa Bell is a nurse manager at Reproductive Medicine Associates of New York. After graduating from Our Lady of the Lake College nursing school in Baton Rouge, Louisiana, she moved to New York and fell in love with the field of reproductive medicine. Melissa is passionate about helping individuals and families meet their family planning goals. She is currently working on research for the American Society of Reproductive Medicine and strives to be an influential leader for her nurses and an advocate for her patients. 

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