hi my name is dr sarah bjorkman and i am a board-certified ob gyn and also a reproductive
endocrinology and infertility specialist you may have followed us through our last
pregnancy and postpartum and all of the things and now as we are trying for baby number two
find found ourselves unable to get pregnant and are now doing ivf um so the ivf doctor has
now become the patient and i thought it would be helpful to go through ivf medications how
to give them how to draw them up and so come along with me as i give myself my meds tonight
the next medications we are going to talk about are called
trigger medications and what these triggers do is they trigger the final egg maturation
so you get to a point in your stimulation where they've been measuring your follicles and often
your estrogen levels and maybe progesterone and you get to a point where your doctor says okay
these eggs follicles look big enough we are ready to trigger you
and so it's very important that these medications be taken at the very exact
time that your team tells you to take them because you want to have your egg retrieval um
36 hours after that trigger injection so very important to take it at the time they tell you
so the first one we are going to talk about is an hcg trigger there are different brands of hcg
there's novarel there's pregnyl but this is an hcg trigger is where we will start
um the dose of this can vary depending on the protocol you're on um anywhere from 1500 units
to the full 10 000 units um and so we'll just talk through how to do that so the pregnant
hcg comes again in two vials so we're going to have to mix again it's this little fine powder
kind of like the menopur um and some saline now the thing with the pregnant it doesn't have those
q-caps like the men up here so you have to draw it up so the first thing you're going to do is
get a 10 cc syringe um and this is if you are taking something other than 10
000 units all right so um what you're gonna do 10cc syringe
i'm just getting a needle here so i can draw up that saline
perfect and here is our saline now again you may take 10 000 units you may take 5 000 units you
may take 1500 units the important thing to know is the powder is there are 10 000 units in the vial
all right so if you put 10 milliliters of fluid into this powdered vial 10
10 000 units if you put 10 milliliters in to those 10 000 units that means that your concentration is
going to be 1 000 units per ml okay so if you are doing it this way where you're taking a smaller
unit so for example 1500 you're going to draw up 10 ml of fluid you're going to inject all 10
and you're going to mix the powder and then you are going to draw out 1.5 ml of that mixed fluid
to get your 1500 units now if you are going to do the full 10 000 units just to keep it easy and so
you don't have a giant shot or you have to inject 10 cc's of saline if you have to do the full 10
000 generally what we recommend is you drop two ccs of normal saline and inject those two cc's
into that powder stir it up and then draw up the full two um ml's of mix to do your injection and
that would be the full ten thousand units okay so can be a little tricky here but we are going to do
a 1500 unit injection all right so we have the pregnant normal saline vial we have our
10cc syringe with a needle on it to draw up we're gonna have just a couple cc's of
air to inject in and now we are going to get the full 10 cc's of saline out
okay let's get this to the 10 cc's no air bubbles
perfect 10 cc's i am now going to
pregnant powder we have the 10 cc's we're going to use just one a couple quick notes
about pregnant pregnant can be stored at room temp until the expiration date on the box
um it says store at 15 to 30 degrees celsius or 59 to 86 degrees fahrenheit um the reconstituted
solution so once you mix it up it says is stable for 60 days when it is refrigerated
so again once you mix this with the saline it is good in your refrigerator for 60 days
um if you're doing it at room temp give that injection right away most of the time you're
going to mix up the injection and give it right away so 10 cc's of saline our
pregnant hcg powder here we are going to inject the 10 cc's of fluid into that powder and watch
it dissolve again we're going to stir it kind of gently and this powder takes a little longer
to dissolve then the menopur can take a couple minutes so just make sure it is all dissolved
so we have our pregnant we are just swirling it around the hcg here
making sure all those little that powder is dissolved when you open these vials and you
flick off the plastic top you want to be careful not to touch the plastic kind of filter here that
you're going to pierce with a needle because it's sterile if you do touch it it's not a big deal
you're just going to use an alcohol swab to wipe off that little filter before you draw up okay
and since i've touched it i am going to do that so now we're going to draw this up if you need
1000 units you would drop 1 ml if you need 2 000 units you would drop 200 ml if you needed 3 000
units you would draw up 3 mls okay i am going to do 1500 units so i'm going to do 1.5 mls
again if you had to do the full 10 000 units you can really just dissolve all this in about
2 ml of saline draw it all up and inject it but when we're doing these different
um smaller volumes that is what's going on so we're going to clean the top here
we are going to draw up
our needed amount
and then we are ready to go
so after you get that all drawn up with that drawing needle you are going to switch it um to
a good nice sterile needle this is a 25 gauge one and a half inch needle because the kicker about
this pregnant hcg injection is it is intramuscular as opposed to all of the other medications we have
been doing this one goes into the muscle so you need a much longer needle and you may want your
partner to help you do this i will certainly be recruiting mine because it's a long needle
the next trigger medication we are going to talk about is called lupron lupron is a gnrh
agonist so it's kind of the opposite of what that um ganirelix or the antagonist was this
is an agonist and so lupron is another medication that triggers that final egg
maturation okay and so lupron comes in different ways it's a medication that has to be compounded
at the pharmacy i am at so it comes in a lovely little pre-filled syringe and it is very easy
it is 40 units um in this syringe all you have to do is um screw off this shield
attach one of your little tiny um needles one of the 27 gauge half inch needles because lupron is a
subcutaneous injection so just like those most of the medications you've been giving yourself every
day lupron is sub-q so things with lupron you're going to want to refrigerate it until you use it
it is good for nine days in the fridge you may also have a lupron vial a multi-dose
one vial of medication that has medication in it so
if you are using one of the vials then you draw that up kind of like we have with all
of our other medications and if it's a 40 unit kit you then inject that all of that
that you've drawn up the vials if you're using one of the lupron files it expires 28 days after you
puncture it so it unfortunately couldn't be saved for a future cycle if you are using it for trigger
again i mentioned how important it was to take these trigger medications at the time your
doctor or nurse team tells you it's time to take those medications we want them to happen 36 hours
before your retrieval so it is time um i'm going to start with my lupron injection again it's sub-q
so belly button a smile under the belly button i am going to use an alcohol swab to clean a spot
pinch
push
hold in one two three and out lupron done so this is a dual trigger i'm doing two triggers
lupron plus hcg and now i'm going to get kurt in here all right it is time for the hcg trigger shot
again this is an intramuscular injection and these go in the ventro gluteal site it's basically a
spot kind of on your hip that is a safe spot away from all the important nerves and vessels kind of
in your glute so um my clinic uh kindly drew this nice circle um where it will go and i have
recruited kurt to help because it's a long needle and you have to go in at 90 degrees
and hub it so things my pharmacist suggested um again we have this thing called a shot
locker that you can use um it's kind of like a distractor there's little
um kind of prickly things on it that are supposed to distract we'll still maybe try that tomorrow
um other things she said it's like clicking a pen not throwing a dart okay not throwing a dart
into my hip here okay and one other important thing is this hcg trigger will make a home
pregnancy test positive okay um so just so you know that all right we doing this
yeah i guess so and so the big things is i'm going straight in in a 90 degree angle not
like a dart yep not going forward not you kind of like spread like this with your hands you kind of
spread the tissue out so that it is and then all of the nerves and vessels that are kind
of important or more over here in this part of the glute so being up here high into the the
lateral side of the hip is a nice safe spot for this injection so again alcohol swab to the spot
you're going to use your non-dominant hand to spread the skin so that you are pushing
in because again we want to get this to the muscle i'm not really excited about this but here we go
you good i'm as good as i'm gonna be okay here we go okay
oh okay this isn't so bad i was actually
thought it was gonna be worse but it was it's fine i'm fine we're good
you're also way tougher than me so right okay one two three and out yeehaw hcg trigger done
lupron trigger done hopefully that helps you as you guys are figuring out your trigger
ivf medications more meds coming soon we've still got progesterone it's kind of the injection
that's left and then we can cover um some of the other looper lines different injections for you
we're doctors but not your doctors anything we've said in this video
is for education or entertainment purposes only it is not medical advice
any specific medical questions you have should be directed to your provider