Mixing Instructions

Mixing Instructions

For patients who get their medications from Freedom Fertility Pharmacy. For more information, see below. 

Mixing/Injection Instruction for Stimulation Medication

Please follow these instructions for mixing and injecting your medication:

1. Clear a work area on your table or countertop and wash your hands.
2. Take out the number of vials of medication you have been instructed to use (i.e., Menopur 1 powder) and 1 vial of the diluent (water). Put aside the remaining vials so there will be no confusion as to how many vials were drawn up.
3. Check carefully for NAME and EXPIRATION DATE of each vial.
4. To open the vial, use your thumb to lift the plastic lid on top of the vial. Wipe the rubber stopper with an alcohol swab or a cotton ball soaked in alcohol. Do not remove the rubber stopper or the metal ring that holds the stopper in place.
5. Open the needle package (3cc syringe with 22G 1 ½-inch needle). Remember to tighten the needle onto the barrel of the syringe by turning clockwise.
6. Insert the needle through the rubber stopper of the vial, turn upside down and draw up 1cc of the diluent making sure the tip of the needle is in the fluid. Flick the syringe with a finger to force the air to the surface of the fluid within the syringe, then push the plunger up to expel the air from the syringe making sure you still have 1cc of fluid to mix with. Mix the diluent with the first vial containing the powder (it dissolves instantly) and draw up all of the medication mixture (1cc). If additional medication is required, add the same medication mixture in the syringe to the second vial of medication and withdraw the entire 1cc. Continue this process until the prescribed number of vials has been mixed. Draw up all of the mixture (1cc) and expel the air, cover the needle and change needle to a 27G ½- inch needle for a subcutaneous injection of Gonal-F, Follistim, or Menopur. At the end of this process, you may have a LITTLE less than 1cc for injection but not more than 1 small line less. If you have only ½ cc of fluid in the syringe, you have not removed all of the medication from the vials and are not getting the correct dose. Go back to the vials and remove the remaining fluid until you have close to 1cc.
7. Locate injection site and cleanse the skin with an alcohol swab or cotton ball soaked in alcohol. (See: Subcutaneous Injection Technique below)
8. Stabilize the skin around injection site with nondominant hand by pinching the skin up with forefinger and thumb. Insert the needle quickly in a dart-like motion (all the way in). Inject the entire contents of the syringe by depressing the plunger fully.
9. Continue holding the surrounding skin while removing the needle quickly. You may notice a small amount of blood or fluid leaking from the injection site when you pull the needle out; this is normal. Wipe with clean tissue or apply Band-Aid if necessary.
10. Dispose of the syringe properly, without recapping the needle, in a sharps container.
11. Alternate injection sites with each injection.

* If the uncovered needle touches any surface other than the inside of the medications vial prior to injection, it is contaminated. Twist off the needle and replace with a sterile needle. Use all needles and syringes for one injection only, then promptly discard carefully into a container.

Subcutaneous Injection Technique (Gonadotropins, Lupron, Ovidrel)

1. If the formulation you are using is not premixed, mix powder(s) with 1cc of diluent. Change to a 27G ½-inch needle after mixing medication.
2. Select injection site.
3. Cleanse the area with sterile alcohol wipe.
4. Insert the needle briskly into site while pinching skin up with the other hand.
5. Release skin.
6. Inject medication slowly.
7. Remove needle.
8. You may gently massage area to promote medication absorption.
9. If a small amount of bleeding occurs, do not be alarmed. Gently wipe clean and apply a Band-Aid.

Mixing instructions for hCG

You will be given specific instruction as to when you are to take your infertility medication. Your dosage is 10,000 units of hCG.

The proper timing of this medication is critical! Do not give hCG earlier than you are instructed to!

hCG comes in a glass vial with a rubber stopper. The package contains a vial of diluent with 10cc of water and a vial of powder that contains hCG. You will need only 2cc of the water to mix the hCG. Remember to use only 2cc of the diluent.

Do not use the whole vial of water or you will have to get multiple IM injections to receive the correct dose!

Please follow these steps to mix and inject hCG:

1. Clear a clean work area on your counter or table to mix your medication.
2. Wash your hands.
3. Open the box and remove both vials (medication vial and water vial) from the box.
4. Check carefully the NAME, DOSAGE and EXPIRATION DATE of all the vials.
5. Using the thumb to lift the plastic lid or thumbnail to lift the tab off of the vials, wipe the rubber stopper with an alcohol swab or cotton ball soaked with alcohol. Do not remove the metal ring that holds the stopper in place.
6. Remove a 3cc syringe with a 22G 1½-inch needle attached from the package. Tighten the needle onto the barrel with a twisting motion.
7. Pull back on the plunger to the 2cc mark to draw air into the syringe. Then insert the needle through the rubber stopper of the vial of the diluent (sterile water). Push the air into the vial, turn the vial upside down and keeping the needle below the fluid level, withdraw 2cc of water into the syringe. Pull the needle out.
8. Inject 2cc of diluent into the vial of hCG (powder). Swirl or tilt (DO NOT SHAKE) the vial until the medication is mixed. It takes 2–4 minutes to completely dissolve. The mixture is completely clear when ready to use. Draw all of the mixture into the syringe, flick the syringe with your finger to force air to the surface of the mixture and slowly expel the air out of the syringe. Remember to invert (turn the vial upside down) and keep the tip of the needle in the medication to draw it into the syringe.
9. Give the entire injection INTRAMUSCULARLY at the exact time you are instructed to do so. (See: Intramuscular Injection Technique below)

* If the uncovered needle touches any surface other than the inside of the medications vial prior to injection, it is contaminated. Twist off the needle and replace with a sterile needle. Use all needles and syringes for one injection only, then promptly discard carefully into a container.

Intramuscular Injection Technique (hCG and Progesterone)

1. For hCG reconstitution, mix powder with 2cc diluent. Change needle after mixing is complete.
2. Select injection site at the upper, outer quadrant of the right or left buttock.
3. Cleanse area with sterile alcohol wipe.
4. Insert needle briskly into site while holding skin taut with other hand.
5. Hold syringe with one hand and pull back slightly on plunger with other hand. If blood does NOT return, inject medication at slow, steady pace. If blood appears in the syringe when plunger is pulled back, DO NOT INJECT THE MEDICATION, and PULL SYRINGE OUT, CHANGE TO A NEW NEEDLE AND REINJECT INTO THE OPPOSITE BUTTOCK.
6. After medication is injected, remove needle.
7. Massage area to promote absorption.
8. Do not be alarmed if a small amount of blood or fluid appears. Wipe the site clean with a dry cotton ball, and apply slight pressure for a minute.