Instructions for

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Instructions for Ovulation Induction Center for
Infertility and Reproductive Surgery
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Table of contentsClick on an item below to go
directly to that page. Once there, hit the arrow
on the page to get back to the table of contents.

1. What is Ovulation Induction.3
2. Ovulation Induction and IUI.4
3. Medications Stimulation....7
4. Medications Prepare for IUI..8
5. Medication Administration...9
6. Monitoring11
7. Daily Cycle Instructions...16
8. Complications ..17
9. Cycle Cancellation ...18
10. Emergencies..19
11. Nurse Appointment...20
12. Other Medications.21

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What is Ovulation Induction?

• Injectable medicine to stimulate a womans
  ovaries to mature more than one egg in a month
• Monitoring with blood tests and ultrasound
• A different injectable medicine to mature the
  egg(s) and cause ovulation
• Sperm insemination (IUI) or timely intercourse

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Ovulation Induction and IUI

• Start instructions
• Call with your period day 1
• Have an ultrasound on day 2 or 3
• Start stimulation medicine after instructed to -
  day 3 between
• 6-9pm
• Day 7 or 8 have an estradiol blood test and an
  ultrasound
• More testing based on the response to the
  stimulation medicine

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Ovulation Induction and IUI

• Ready for Ovulation
• MD orders trigger shot HCG medicine
• HCG shot at midnight
• Partner in to the Reproductive Endocrinology Lab
  2 days later between 8-9a to produce a sperm
  specimen
• IUI at noon the same day
• (For example HCG midnight Monday, IUI Wednesday)
  

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Ovulation Induction and IUI

• Whats next?
• If you have
• No period 2 weeks after the IUI, call your nurse
  to schedule a pregnancy test
• An abnormal period, call your nurse
• A normal period, call your nurse and begin the
  next cycle with an ultrasound on day 2 or 3

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Medications

• Stimulation Therapy
• Gonal-F, Follistim, Bravelle Repronex, Menopur
• Maturing of many eggs
• Once or twice a day injection
• Side Effects/risks
• Mood swings
• Bloating
• Ovarian hyperstimulation

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Medications

• Preparation for IUI trigger shot
• HCG, Pregnyl, Novarel
• Final maturing of eggs in preparation for
  ovulation
• Given at midnight
• Risks
• Early ovulation
• Ovarian hyperstimulation

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Medication Administration
Subcutaneous (small needle) injection Clean the
injection site with an alcohol wipe by rubbing in
a circular motion. Remove the needle cap.
Pinch the injection site with one hand. Using
the other hand, quickly insert the needle
straight in as far as it will go. Inject the
medication by pushing the plunger down to empty
the syringe. Remove the needle. Rub the area
in a circular motion to massage the medication.
Dispose of the syringe in a sharps container.
If you see blood or a small amount of fluid at
the injection site, simply wipe the site with the
alcohol wipe and apply light pressure.
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Medication Administration

• Intramuscular (big needle) injection
• Clean the injection site with an alcohol wipe by
  rubbing in a circular motion. Remove the needle
  cap.
• Stretch the injection site with one hand and
  using the other hand, quickly insert the needle
  straight in as far as it will go.
• Release the skin. With that hand draw back very
  gently on plunger if no blood flows into the
  syringe, inject the medication. If blood is
  seen, the needle is probably in a vein - remove
  the needle and apply pressure to the needle site.
  Repeat the injection at another site after
  putting on a new needle.
• Remove the needle. Rub the area in a circular
  motion to massage the medication. Dispose of the
  syringe in a sharps container. If you see
  blood or a small amount of fluid at the injection
  site, simply wipe the site with the alcohol wipe
  and apply light pressure.

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Monitoring Instructions

• U/S and Blood work
• Vaginal probe U/S to check size and number of
  follicles (fluid sacs in the ovary containing the
  eggs)
• Male and female U/S technicians
• Blood test for estradiol and/or progesterone

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Monitoring Instructions

• Where/when
• Weekdays
• 645-730a in Ultrasound Department L-1 for
  ultrasound and blood
• 7-9a 3rd floor for blood only
• Weekends/Holidays
• 7-730a in Ultrasound Department L-1 for
  ultrasound and blood

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Monitoring Instructions

• Standing order lab slip
• Do not write on it
• Filed in lab for 1 year
• Tell lab tech what test you need
• Ultrasound slips
• Given to you in ultrasound

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Monitoring Instructions

• Fill out a call back sheet each time you test
• Name and phone numbers
• Voice messages Y N
• Have identifiers on your answering machines
• Leave room on the answering machine for the
  longest incoming message available

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Monitoring Instructions

• Satellites
• 850 Boylston (weekdays only)
• Use BWH testing slips (see Instruction booklet
  for times)
• Patriots Place, Foxboro (weekdays only)
• Use BWH testing slips (see Instruction booklet
  for times)

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Daily Cycle Instructions

• Daily orders are done by the doctors by 2p
• Nurses call with new instructions by 5p
• If there is no call by 5p, page the FE Fellow on
  call 617-732-6660

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Possible Complications Click on a complication
below to go directly to an explanation. Once
there, hit the arrow on the page to get back to
this page.

• Multiple pregnancy
• Ovarian Hyperstimulation Syndrome
• Infection at injection site
• Ectopic (tubal) pregnancy
• Ovarian torsion (twisting)
• Medication side effects

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Cycle Cancellation

• Why?
• Poor response to medicine
• Few or no follicles low estradiol
• Estrogen level and follicle number not similar
• Missed testing or medicine error
• Ovulation before IUI
• Over response to medicine (cancel vs. change to
  IVF)
• Too many follicles high estradiol

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EMERGENCIES

• If an emergency arises
• If you have an emergency
• Call 617-732-6660
• Ask for the F E fellow on call
• Stay on the line or leave a call back number and
  the physician will return your call

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Nurse Appointment

• If you need more assistance, call your secretary
  to make an appointment with your nurse to
• Review your individual protocol
• Discuss medications and pharmacies
• Learn how to do injections

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Other Medication - sometimes in OI

• After the IUIs
• Progesterone vaginal suppository or Crinone
  vaginal gel
• Supports the lining of the uterus
• May delay period
• Continue even if bleeding starts
• Side effects similar to pregnancy
• Breast tenderness
• Nausea

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• Multiple pregnancy - Because several follicles
  containing eggs can mature and ovulate at the
  same time, it can result in a multiple pregnancy.
  Thus multiple implantation of embryo can occur.
  Usually, the number of fetuses can be determined
  by ultrasound at 6-7 weeks gestation (4 -5 weeks
  after the IUI). Fetal reduction may be possible
  in high order multiple gestation pregnancies.

Complications
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• Ovarian Hyperstimulation Syndrome (OHSS) - After
  ovulation, the follicles fill up with fluid and
  form cysts. This can lead to lower abdominal
  discomfort and bloating. Symptoms of OHSS may
  include nausea and vomiting, shortness of
  breath, weight increase 2-3 pounds a day, low
  urine output. These can happen within 2 weeks
  after the HCG injection. The symptoms usually
  resolve within 1-2 weeks without treatment.
  Pregnancy can make it worse and last longer.
  Treatment may include cancelling the cycle before
  the HCG and in severe cases hospitalization for
  fluid management.

Complications
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• Infection at the injection site - Symptoms of
  injection site infection can include redness
  and/or extreme tenderness at the site and fever
  (rare). You may be instructed to apply warm
  soaks to the site and/or be given antibiotic
  treatment.
• Ectopic pregnancy (tubal pregnancy) - You will
  have an early ultrasound to rule out ectopic
  pregnancy. Approximately 5 of Assisted
  Reproduction pregnancies become ectopic and
  resolve on their own or are treated with
  medication or surgery. Symptoms may include
  abdominal pain and/or irregular bleeding.

Complications
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• Ovarian torsion (twisting) - In less than 1 of
  cases, the enlarged ovary can twist on itself.
  This can decrease the blood supply to the ovary
  and result in significant lower abdominal pain.
  Surgery may be required to untwist or possibly
  remove the ovary.
• Medication side effects - Read the package
  inserts of your medications and discuss any
  possible side effects with your physician.

Complications