Medications and Injectables

MEDICATIONS & INJECTABLES


At CACRM, the doctors will prescribe a variety of medications dependent on their clinical testing and evaluation of the patients in their care to enhance the likelihood of a successful outcome.

To the right are some of the medications that may be prescribed. Click on name for more information.

HOW TO PERFORM A SUBCUTANEOUS INJECTION

Endometrin®

Endometrin® is the new vaginal progesterone insert approved by the FDA for use in ART treatment. Progesterone is a natural hormone often prescribed following ovulation and egg retrieval (called the “luteal phase”) to help prepare the uterine lining (endometrium) to receive and nourish a fertilized egg.

Importantly, Endometrin® was shown to help achieve excellent pregnancy rates in the largest IVF trial ever conducted in the United States with 1,211 patients.

Each Endometrin® insert supplies 100 mg of natural progesterone and comes with its own specially designed, disposable applicator for clean, comfortable insertion into the vagina, 2 or 3 times a day as prescribed by your doctor.

In the vagina, Endometrin® dissolves rapidly delivering progesterone directly where it’s needed.

Your doctor will have you begin using Endometrin® starting at egg retrieval, and upon a positive pregnancy test, continue for up to 10 weeks total duration.

And here’s what women who used ENDOMETRIN in the clinical trial had to say: Nearly 80% would recommend Endometrin® to a friend, and 70% who had used other forms of progesterone believe Endometrin® is better or much better.

That’s important to know, because other forms of progesterone which have been prescribed for luteal support are often difficult for many women to use.

These include:

  • Large, intramuscular (IM) injections of progesterone in oil, which can have painful side effects and cause allergic reactions to the peanut oil; also, this has not been studied or approved by the FDA
  • Vaginal suppositories made by individual pharmacies, which can vary from dose to dose, as well as be messy to use. Again, this has not been studied or approved by the FDA
  • Oral tablets, which have side effects such as sleepiness or dizziness, and about which some doctors have a concern regarding how much progesterone gets from the digestive tract to the endometrium. Again, this use has not been studied or approved by the FDA
  • A vaginal gel designed to adhere to the vaginal walls, but causes substantial buildup and blockage that may have to be manually removed by the doctor. What’s more, Endometrin® is FDA approved; and, of all these forms of progesterone, none has been as extensively studied as Endometrin® in a clinical trial with over 1200 patients.

Another advantage: Endometrin® can be inserted while you are standing, sitting, or when lying on your back with your knees bent. Other progesterone products require you to lie down when inserting them and to remain lying down for a period of time afterwards.

We invite you to ask your doctor about Endometrin® as well as any other questions you may have about your treatment.

Please note: Endometrin® administered as a progesterone vaginal insert is indicated to support embryo implantation and early pregnancy by supplementation of corpus luteal function as part of an Assisted Reproductive Technology (ART) treatment for infertile women.

Only physicians thoroughly familiar with infertility treatment should prescribe Endometrin®. In clinical trials (n=860), adverse reactions that occurred at a rate greater than or equal to 2% included: uterine spasm (3% to 4%) and vaginal bleeding (3%). Vaginal irritation, itching, burning or discomfort, urticaria, and peripheral edema were reported at an incidence of less than 2%. Endometrin® is expected to have adverse reactions similar to other drugs containing progesterone (breast tenderness, bloating, mood swings, irritability, and drowsiness).

Estradiol Valerate (E2V)
Estrogens are hormones used for replacement in women who are no longer producing proper amounts. Estradiol Valerate (E2V) is used to treat symptoms associated with menopause and conditions in which hormone levels are low. It may also be used to prevent osteoporosis (bone loss). E2V is also commonly used in women receiving infertility treatment to prepare the uterus or endometrium prior to embryo transfer.

Estrogens given alone and with another hormone (progestin) for replacement therapy after menopause have sometimes caused rare but very serious side effects. Discuss the risks and benefits of hormone treatment and your personal health history with your doctor.

Estrogens have been reported to increase the chance of cancer of the uterus (endometrial cancer). Taking a progestin with estrogen decreases this risk. Tell your doctor immediately if you have any unusual vaginal bleeding.

Estrogens may also increase your risk of cancer of the ovaries, stroke, dementia, and serious blood clots in the legs. Estrogen given in combination with progestin can infrequently cause heart disease (e.g., heart attacks), stroke, serious blood clots (pulmonary embolism and deep venous thrombosis), dementia, and cancer of the breast. Some of these risks appear to depend on the length of time this drug is used and the amount of estrogen per dose.Therefore, this medication should be used for the shortest possible length of time at the lowest effective dose, so you can obtain the benefits and reduce the chance of serious side effects from long-term treatment. Discuss the details with your doctor and check with him/her regularly (e.g., every 3 to 6 months) to see if you still need to use this medication.

Estrogen treatment alone does not appear to increase your risk of breast cancer when used for up to 7 years after menopause. However, talk to your doctor about the risks if you need to take estrogen for a longer period.

Products that contain estrogen should not be used to prevent heart disease or dementia.

Follistim® Beta
Follicle stimulating hormone (FSH) is a naturally occurring hormone. FSH is important in the development of follicles (eggs) produced by the ovaries. Follistim is a brand of follicle stimulating hormone.

Follistim® is used to stimulate a follicle to develop and mature. It is used when a woman desires pregnancy and her ovaries can produce a follicle but hormonal stimulation is not sufficient to make the follicle mature. Follistim is also used to stimulate the development of multiple eggs for in vitro fertilization.

The Follistim® AQ Cartridge (follitropin beta injection), for use with Follistim Pen®, or Follistim® AQ Vial are prescribed for women undergoing assisted reproductive treatments (ART) such as in vitro fertilization (IVF) and for the induction of ovulation to achieve pregnancy. Follistim® AQ Cartridge was the first follicle stimulating hormone (FSH) treatment available in a pre-filled, pre-mixed solution, approved in the U.S., eliminating the need for patients to mix one or more vials of medication.

Follistim® AQ Cartridge is designed to be used only with the Follistim Pen®, an innovative pen device that facilitates accurate delivery of individualized doses of pre-mixed follitropin beta injection, a highly effective and widely used prescription fertility medication made from state of the art recombinant DNA technology.

Follistim® AQ Cartridge for use with the Follistim Pen®, provides women with a discreet, convenient method to self-administer fertility treatment with ease and confidence using the unique dial-a-dose feature. Click here to see the full press release.

Follistim® AQ Vial (follitropin beta injection) is the only FSH available in single-use 0.5 ml pre-mixed vials administered by an injection under the skin (subcutaneous injection) or into a muscle (intramuscular injection) using a conventional syringe and needle. Available in 75 & 150 IU vials.

Ganirelix® Acetate Injection
Ganirelix® Acetate Injection is a gonadotropin-releasing hormone (GnRH) antagonist that is used to suppress premature luteinizing hormone (LH) surges in women during assisted reproductive technology (ART) treatment. This prevents eggs from being released prematurely.

Women who are using Follistim® AQ Cartridge may also be prescribed Ganirelix Acetate Injection because Follistim® AQ Cartridge stimulates the growth of multiple follicles, which can cause an early rise in LH.

Like a GnRH agonist, Ganirelix® Acetate Injection (a GnRH antagonist) is as effective in preventing LH surges very rapidly after its initial injection.

The gonadotropin-releasing hormone (GnRH) antagonist Ganirelix® Acetate Injection, contains the active ingredient ganirelix acetate, which has a low incidence of side effects.

Ganirelix® Acetate Injection is given four to five days mid-cycle gonadotropin stimulation. This translates to several benefits:

  • Shorter treatment days.
  • Lesser total medication is used.
  • Fewer injections are needed.
  • Low incidence of side-effects are experienced.

Ganirelix® Acetate Injection is the only GnRH antagonist in a ready-to-use pre-filled syringe, which means it is easy to administer because mixing isn’t required. One pre-filled syringe of Ganirelix® Acetate Injection contains 250 micrograms of ganirelix acetate. Ganirelix Acetate Injection can be stored at room temperature.

Gonal-f®
Gonal-f® RFF Pen (follitropin alfa injection) is indicated for the induction of ovulation and pregnancy in the oligo-anovulatory infertile patient in whom the cause of infertility is functional and not due to primary ovarian failure. Gonal-f® RFF Pen is also indicated for the development of multiple follicles in the ovulatory patient participating in an Assisted Reproductive Technology (ART) program.

Gonal-f® should only be prescribed by doctors specializing in infertility or reproductive health. Gonal–f® can cause serious side effects including: ovarian hyperstimulation syndrome (OHSS), with or without blood vessel and lung complications and multiple births. Gonal-f® should not be used in patients who are allergic to recombinant FSH products, have primary gonadal failure, have uncontrolled thyroid or adrenal problems, have cancer of the sex organs, have a pituitary tumor or other tumor in their brain, have abnormal bleeding from the uterus or vagina or are pregnant or think they may be pregnant. The most common side effects in patients taking Gonal-f® include headache, upset stomach, breast discomfort and injection discomfort.

HCG (Novarel®)
Human chorionic gonadotropin (HCG) is a hormone that supports the normal development of an egg in a woman’s ovary, and stimulates the release of the egg during ovulation.

HCG is used to cause ovulation and to treat infertility in women, and to increase sperm count in men. HCG is also used in young boys when their testicles have not dropped down into the scrotum normally. This can be caused by a pituitary gland disorder.

Lupron®

Lupron® is a man-made form of a hormone that regulates many processes in the body. Lupron overstimulates the body’s own production of certain hormones, which causes that production to shut down temporarily. It reduces the amount of testosterone in men or estrogen in women.

Lupron® is used in men to treat the symptoms of prostate cancer. Lupron treats only the symptoms of prostate cancer and does not treat the cancer itself. Use any other medications your doctor has prescribed to best treat your condition.

Lupron® is used in women to treat symptoms of endometriosis (overgrowth of uterine lining outside of the uterus) or uterine fibroids.

The most common non-FDA approved indication for Lupron is its use an adjunct treatment during IVF cycles. The purpose of Lupron in this instance is to prevent the premature release of the follicles containing the eggs before the physician is able to retrieve them. Typically, 10-12 days of Lupron daily injections are necessary for this effect to take place.

Leuprolide Acetate (Lupron®) is administered as a subcutaneous injection using insulin syringes. Insulin syringes are used because the measurement on the syringe is in units (i.e.: 10 units is equivalent to 0.1ml/cc). For the role it plays in assisted reproductive technologies, Leuprolide Acetate is used to reduce the amount of estrogen and testosterone in the body. This decrease in estrogen production will prevent ovulation and stop menstrual periods.

Potential Side Effects: Side effects that may occur includes hot flashes or sweating, mood swings, vaginal dryness, decreased libido,nausea, vomiting, breast tenderness, insomnia, headaches, and injection site reaction (redness, itching, and swelling at the injection site).If you experience an allergic reaction – difficulty breathing; closingof your throat; swelling of your lips, tongue or face; or hives; seekemergency medical attention immediately. And if at any time you experience bone pain, difficulty urinating, numbness, tingling or weakness in the arms or legs contact your physician immediately. PLEASE NOTE: If these or any other side effects occur, contact your physician.

Menopur®
Menopur®, the only gonadotropin approved by the FDA on the basis of pregnancy rates. Menopur® is the most widely used and extensively studied reproductive hormone, proven to be both safe and effective.

As part of an Assisted Reproductive Technology (ART) program, Menopur® is administered by subcutaneous (SC) injection only and is used to induce the development of multiple eggs and pregnancy in women who are able to produce and release eggs (ovulate). Its unique purity is also associated with less discomfort at the injection site, an important point for many women.

Menopur® is a highly purified preparation of naturally derived gonadotropins, called hMG. Menopur® contains equal amounts (75 IUs) of 2 kinds of hormonal activity: follicle-stimulating hormone (FSH), which helps stimulate egg production; and luteinizing hormone (LH), which helps the eggs mature and release (ovulate). Menopur® helps stimulate eggs to mature in women whose ovaries are basically healthy but are unable to develop eggs. It is not used for women who suffer from ovarian failure.

Menopur® is usually used together with human chorionic gonadotropin (hCG), and is indicated for the development of multiple follicles and pregnancy in women participating in an Assisted Reproductive Technology (ART) program.

In the largest trial of its kind, more than 700 women took part in a study to examine the efficacy and safety of Menopur® compared to previously available treatments in patients undergoing IVF/ICSI. While prior gonadotropin treatments were approved based on number of oocytes, due to the results from this study, Menopur® became the first and only gonadotropin treatment approved by the FDA on the basis of pregnancy rates, the true measure of clinical efficacy. Results also suggested that treatment with Menopur® may make a difference in the quality of the developing embryo.

Menopur® is available by prescription in 5 mL vials containing 75 IU FSH and 75 IU LH activity with accompanying diluent.

Q•Cap™ is the only available vial adapter for needle-free reconstitution. It provides a convenient way to mix your medicines in just 1 syringe, for just 1 injection a day. There are no extra injections to worry about or additional administration methods to learn. Q•Cap™ eliminates stress, anxiety, and accidental needlesticks associated with traditional reconstitution, which increases your comfort level and that of your partner. And, importantly, Q•Cap™ helps build your confidence about reconstitution.

Q•Cap™ can only be used with Ferring fertility products, including Bravelle®, Menopur®, and Repronex®.

Ovidrel®

Ovidrel® PreFilled Syringe is used in fertility treatment cycles to help follicles mature and to trigger the release of mature eggs from a woman’s ovaries following treatment with products containing human follicle stimulating hormone.

Ovidrel® PreFilled Syringe is the first and only recombinant human chorionic gonadotropin (r–hCG) approved in the world. Ovidrel® PreFilled Syringe is available in a ready–to–inject, prefilled syringe, eliminating the need for reconstituting.

Ovidrel® PreFilled Syringe is the only hCG available for subcutaneous (just under the skin) injection in the United States. Other hCG products available in the U.S. are extracted from human urine and may require deeper, intramuscular injections.

Progesterone In Oil
Progesterone is a hormone that helps to prepare the lining of the uterus for implantation of the fertilized egg. Supplemental progesterone is sometimes prescribed to ensure that the uterine lining is adequately prepared. Previous warnings concerning progesterone use in pregnancy apply to synthetic progesterone preparations. Progesterone that is prescribed during pregnancy is a natural preparation.

Side effects could include: a possible delay in the onset of your period; nodules (small, hard bumps) in the skin; allergic reactions to the progesterone but more commonly to the particular oil used (sesame, olive, cottonseed or peanut). Storage: Progesterone should be stored at room temperature. Do not refrigerate.