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During controlled ovarian hyperstimulation with menotropins the medications generally need to be mixed and injections need to be administered. Completion of these tasks is usually not difficult for couples as long as they have been appropriately trained.
I generally review the mixing and administration procedures for these medications with a couple on the first day of controlled ovarian hyperstimulation, after a transvaginal ultrasound has confirmed that there are no large ovarian cysts within the ovaries.
Basic aseptic (sterile) technique is reviewed. The need to preserve the sterility of the injection needle and containers is discussed.
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A clean uncluttered workspace is created or identified, hands are cleaned with soap and water, and the medication to be administered arranged on the workspace. If a bottle with rubber stopper is encountered then removal of the aluminum cover, wiping the rubber stopper with an alcohol gauze pad, and withdrawing liquid with a syringe and needle is illustrated. If a glass ampule is encountered then one snaps the ampule open by holding both ends of the ampule (with the colored dot on the ampule away from you) and applying pressure so that the top snaps off away from you (an alcohol wipe can be wrapped around the neck of the ampule to further avoid being cut with glass). Then a syringe and needle can withdraw liquid directly.
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The sizes of the needle and syringe can vary tremendously.
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The syringe must be large enough for the volume of dissolved medication (generally a 3cc syringe for intramuscular medications and a 1cc syringe for subcutaneous injections). The volume of liquid within the syringe is determined by the location of the central plunger and volume markings on the side of the syringe.
The needle used to mix the medication may be different than the needle used to inject the medication. The needle used for the injection should (ideally) be the thinnest diameter needle possible for the task, understanding that as the gauge of the needle decreases the thickness of the needle increases. Therefore, a 25 gauge 1 1/2 inch needle is the same length as a 22 gauge 1 1/2 inch needle but the 25 gauge needle is much thinner. I always recommend the 25 gauge 1 1/2 inch needles for intramuscular injection. Note that many pharmacies carry 22 gauge needles as their regular stock and often try to push these thicker needles onto (at least my) patients stating that they are the same thing as the 25 gauge needles. Alternatively, some patients are given 25 gauge 5/8 inch needles rather than the 1 1/2 inch needles ordered. You should always confirm that your pharmacy has filled your order properly and if not then you should consider using another pharmacy for your supplies.
Mix the menotropin medication (using the volumes) as directed by your doctor or pharmacist. Usually, the menotropin powder (the medicine) goes into solution (dissolves) immediately on contact with the diluent. The hCG powder usually takes 30-60 seconds to completely dissolve (it looks “snowy” until fully dissolved, when it becomes clear)
Once the appropriate amount of medication is dissolved in the desired volume of diluent, the dissolved powder is drawn up into the syringe (that is to be used for injection) and the needle that was used for mixing is carefully exchanged for a fresh (often thinner) needle for injection.
Intramuscular injections are most often given in the rear end while subcutaneous injections may be given under the skin of the abdomen or thigh. The upper outer quadrant of the rear end is used for the intramuscular injections to avoid the sciatic nerve (travels through the rear and down the leg but rarely in this quadrant). The injection sites are changed (rotated) daily so that the exact same areas are not used repeatedly.
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Needles and syringes should be disposed of in a safe manner, generally in a “sharps container” or a heavy plastic container (like a bottled drink container) and discarded as directed by the local township or city.
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