If you've ever had that giant box of fertility meds show up at your door and thought, "what on earth do I do with all of this?" - this episode is for you.

I'm back with Nurse Lindsay for a full walkthrough of everything IVF medications: what each one actually does, how to store them, how to mix them, how to inject without spiraling, and what the trigger shot is all about. We cover the stuff you already knew you had questions about, and a bunch you probably didn't know to ask yet.

We get into where to store your meds (and where not to), what to do if your dose changes and you don't catch it in time, how to handle needles, traveling with medications, and the emotional rollercoaster that comes with all of it - because yes, you might want to throw something at your husband, and no, that doesn't mean something's wrong with you.

Lindsay also walks us through the real "911 calls" she gets from patients - missed doses, dosing mistakes, forgetting if you already injected - so you know exactly what to do (and not panic) if it happens to you.

A huge thank you to Nurse Lindsay for bringing her expertise and calm energy to this one. If you're heading into a cycle soon, save this episode - you're going to want to come back to it.

A reminder: your own medication doses, timing, and storage instructions should always come from your fertility clinic and pharmacy. This episode is here for educational purposes only and does not replace your care team.

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Helpful Timestamps:

• 00:00 IVF Meds 101
• 00:45 Storing Your Meds Safely
• 07:07 Traveling With Meds
• 11:44 Gonal F Injection Demo
• 18:32 Sharps and Refills Planning
• 22:39 Menopur Mixing Walkthrough
• 31:38 Rotate Injection Sites
• 35:49 Cetrotide Mixing & Timing
• 42:07 Cetrotide Reactions Explained
• 43:22 Injection Mistakes And Fixes
• 47:59 Trigger Shot Timing
• 56:04 Side Effects And Safety Signs

Mentioned in this episode:

Fertility Blooms Programs

We are back with Nurse Lindsay, and we have such a good episode for you today because we are talking everything IVF meds 101.

If you have ever received that giant box of fertility medications at your door and thought, "What the heck do I do with this?" This is the episode for you.

We are walking through everything, what different medications are for, where to store them, how to store them, how to mix them, how to inject them, what the needles are for, what's the timing of them, what, the trigger shot means, traveling with your meds, and what to do if you make a mistake.

Basically, all the questions you've thought of asking before you started IVF and a whole bunch you probably didn't think of.

So Lindsay, let's start at the beginning.

You just got the big box of IVF meds.

Now what?

Okay.

So depending on where you get your medications for, your pharmacy should tell you what goes in the fridge, what doesn't.

That is… Yeah.

Okay, that's a big one.

Medication boxes should be clearly labeled if they're to be stored in the fridge.

Yep.

so I say pick a spot in the fridge, not in the very back, not at the very top, 'cause that's where you have risk of freezing.

Oh, right.

Yeah.

So you wanna… In any fridge, you need to have circulation to get proper temper- Mm-hmm

temperature control.

That's true.

So keep it roughly in the middle, not much around it, just has its own space.

make sure your fridge is temperature regulated, which most fridges are.

It shouldn't be a concern.

Yeah.

Room temperature medications, we want 'em… Any medication should be stored clean, dry, um- Dark?

Does it have to be dark?

Usually, I say dark.

Like, it doesn't- Okay … have to be, like, completely.

Okay.

But you don't want it sitting in by a window that's gonna have the heat- Okay … put on.

So that's why- That makes

sense

… Lindsay: clean, dry, somewhat dark spot, you can say.

Okay.

Okay.

So somewhere up that you're not gonna have children that's gonna…

could possibly get to it- Right … an animal, and direct sunlight.

So somewhere safe for all your medications.

Amazing.

Yeah.

So basically, They always keep their supplements in a dark cupboard, so if they can keep-

Yeah … both the supplements- Yeah … as well.

Same type concept.

Yeah.

Um-

Perfect

… Lindsay: also then when you get your medication, your nurse should have given you a list of what you're picking up so you have an idea- That's right

just to cross reference.

Okay.

The pharmacy- That's

important.

Absolutely.

Check what you have.

That is important- Mm … 'cause so many times people miss that.

Yes.

Yeah.

To make sure you have all the mixing- Yeah … supplies.

certain pharmacies, they deal with a lot of fertility meds, so they get all the supplies in.

They'll make sure you have everything.

Okay.

However, if you've chosen to try, a different pharmacy 'cause maybe your insurance is cheaper there, some pharmacies aren't able to get some of the supplies.

So- That's right … example, your Menopur mixing supplies.

That is this.

Those come directly from the drug distributor, which is Ferring, and some pharmacies aren't able to get- Yeah

that in, and that is- So you'll get- … a big thing you need … this and this.

Yeah.

Yeah.

So we get a lot of emergency line calls- … saying they don't have, all the mixing supplies.

So as I say- Absolutely … make sure, go through your checklist- Yeah … um, of what you should have, the quantity, and during your teaching, we'll kind of go through- Absolutely

exactly a timeframe of how much meds- Well,

this is technically the teaching because, Lindsay, I don't know if you know, a lot of clinics don't go through a whole teaching like you guys do at BRC.

So- We try.

We're continuously- … working to improve our teaching because I feel like, any suggestion, recommendation from patient, we use that to improve our teaching because we want it…

This is a very stressful time.

Yeah.

M- medication injections are very stressful and patients panic with them, so we wanna try and- Absolutely … keep this as easy as possible.

Yeah.

Um-

That is so true.

Yeah.

So just to recap, the Menopur, the Q caps a lot of times are not at the pharmacies, as well as the trigger shot.

So I just wanted to clarify that.

and anybody that's in the area in Halton, I usually have some, and the clinic has some as well for you.

Yeah.

Yeah, like I said, some pharmacies do stock the Menopur.

Yeah,

some.

but there's a lot that don't.

Yeah.

So always make sure you have all the supplies and enough for your whole cycle.

Yes.

Okay?

That's another big thing.

Absolutely.

So your pharmacy may only dispense A few days of meds

Yes

… Lindsay: and it's your responsibility to pick up more.

That's what you need.

You have medication refills.

Yes.

Yeah, so kind of go through, and, and again, we, during our teaching, we usually kind of go through all this, but- Yeah

we can review all that

today.

Yes, because we've been on many teaching, sessions together with the patient, and it does get overwhelming at that first time.

Oh,

when you pick up a bag with, you know- All this … 10 different things- All this.

It, it's very overwhelming.

And then even your, your embryo transfer meds is even a bigger bag.

Yeah, yeah.

So it is overwhelming.

It is.

But we're trying to keep things seamless.

I always try and say, like, we're trying to order enough that you don't have to be going back and forth, back and forth- That's right … to the pharmacy, because if you don't get your cycle dose email till 3:00 PM because it's taken a while for the doctor to review orders, then you have to quickly race out, get your medication- Hope the pharmacy's ready

yeah, and hope it's still open- Yeah … and then get back in time for you to administer at the time you're supposed to administer.

That's right.

So we would- So that's a

little tricky

… Lindsay: we try to, yeah, keep things easy for you.

So- Absolutely … I, it looks overwhelming, but it's, it's easy.

It's easier.

It's an easier process than, running all over.

Absolutely.

When you have your box as well, you're gonna properly store it as we discussed.

Yeah.

Another thing to pay attention is your box will have your prescription label- Yeah … 'cause it has to be dispensed that way.

Remember to always follow your dose instructions that you get- Ah

via email.

Very important.

Because how we sometimes order it, we just have to send a, a standard order, and it doesn't have- Right … everything because doses, route, it's all determined, Yeah … by the physician.

That's right.

So example, Prometrium, vaginal Prometrium, I believe on the box it says oral use.

It

does.

And we use it vaginally.

So-

Oh, yeah

… Lindsay: I know when people, when they open up the box and they're reading, they're like, "Oh my goodness," like, "we can't do this," or the Pregnyl HCG trigger, I think in the box it says for intramuscular use.

Oh.

Yes, I've come across this.

So-

Okay

… Lindsay: remember to always- Yeah … follow the instructions- On

the email

that, from your nurse that is given by-

Yes … the

physician.

Yeah.

Yes.

And I ju- I'll just tell a little story.

I did have one of the girls that was taking the progesterone orally, and she said, "I can't take this anymore, Crystal. I fell in front of my boss. I'm so dizzy and lightheaded," because I think she was at 600.

And she was getting super dizzy, and I'm like, "I couldn't figure it out." And so I messaged Dr. Victory, and he's like, "Is she taking it orally?" And- Yes … sure enough, that's what was going on.

Yeah.

And she felt so much better when

she did.

Anytime that's, that's one thing- So there's a reason why.

Yes.

And actually, if you ever have to use, Prometrium va- like orally- You do not feel good- No

with taking that It's

horrible

It's terrible GI side effects.

You're- Yeah … exhausted.

Yeah.

You're dizzy.

Yeah.

It's not nice- No … taken orally.

So- Absolutely … we only do that if we absolutely have to.

Ah, yeah.

It's not, it's not friendly.

And now do you need to keep the boxes and the different things like that?

Like, can I grab the box of Re- Rekovelle or Menopur or Gonal and, like, throw the boxes and just keep the medications?

And you know how they always come with that big instruction card?

Do I need to read through all of those?

'Cause those are intense, and those freak you out a little bit.

They are overwhelming.

I can assure you that- … the instructions you're getting from us is safe.

I know some people still like to look it over, but what, again, if they come across, contraindicating instructions- Yeah … follow the instructions by your physician.

Okay.

I like to keep original packaging just, to keep things tidy.

Me too.

It said… Also, if you're gonna travel, you need to keep your medications in the original packaging it came with- Yeah … because it's got your official, Prescription on it … medical prescription- Yeah … with your name.

So if you go through customs and security- They know … they need to see that to know that it is legit.

Because it is- That's right … safe to travel with medications.

Yeah.

There's no problem traveling with it because you need to stay in your carry-on.

Yeah.

You just need to have your medical information on it.

Right.

And then for extra care, we can write you a note that says- I was just gonna say … a patient is traveling, that- Yeah

you require syringes, needles, even some to be kept refrigerated, have an ice pack so we can make sure you get through security no troubles.

Absolutely.

That was my, question as well.

'Cause the, the medical note, sometimes people feel more comfortable.

And if they do need to be in the fridge, that ice pack will keep them cool until you get where you're going.

Yeah.

Yeah.

Amazing.

Hi, I'm so happy you're here listening to my show, The Fertility Fight Club.

I really need your help with something super easy.

It's a huge help for you to like and subscribe on your favorite platform so you never miss an episode.

It's a small thing, but it helps us reach more women like you who need this community.

Thank you so much for being here and supporting the work we're doing.

Now, back to the show.

Before we get into anything else about injecting or whatever, I wanna know what the medications are, are for and why.

And this is gonna be just generic because everybody is a little bit different.

So we're gonna give you the base, and most, I don't wanna say popular drugs, but mainstream drugs that, that most of the clinics use.

Yep.

So then everybody can kind of an- have an idea.

I think we should f- first start with FSH, because I think that's the one we hear about all the time.

Yeah.

That's the first one, that's the first one everybody uses.

Yep.

So let's start with

our- So your FSH drugs, they are your follicle stimulating medications.

So typical ones are your Gonal-F, which I have a demo pen.

It just looks like, like this.

You also have your Rekovelle, which comes in a box like this.

The pen is similar to the Gonal-F.

We can look at that after.

Yep.

And then we have Menopur.

Menopur is a mix of FSH and LH.

That's right.

So you need a little bit of both to stimulate those follicles.

So in general what they're gonna do is they're gonna stimulate follicle growth on the ovaries, 'cause in a typical cycle once a month we only grow and recruit one- One … follicle to get mature size and release at ovulation.

IVF, we want to stimulate and grow lots of follicles.

As

many as

we can.

Yes, so we can try and make this a one and done.

Yes.

Okay?

'Cause it's, it's a lot to go through.

Yeah.

So the purpose of these meds are to stimulate follicle growth, and then we monitor the growth so that we can retrieve at a mature size- That's it … and try and get mature eggs.

And we want, we also want them the same size roughly.

Yeah, yeah.

Like, the biggest cohort we can get.

Exactly.

And it, with a typical of when you're looking at your stim sheet, you're always gonna have a

couple- One

takes off.

Yeah.

We'll just jump that because- A couple large ones that they just take off, and that's normal.

Yeah.

But we watch those because that's what gears us to take your next medication, the antagonist- Yes

to prevent ovulation.

That's right.

So that would be used as Cetrotide, and then we also use Orgalutran.

They're just two, just two different, from drug companies.

Yeah.

But their purpose is the same.

And let's just- ' Cause you said it, and I just wanna re-say it.

Cetrotide, is used to prevent you from ovulating.

Correct.

Because a lot of people think, "Oh, I'm ready to ovulate. It's time for my retrieval." The clinic is controlling your cycle.

Yes.

So don't panic if it's, like, oh, past your whatever day you normally- Correct … ovulate on.

They control everything.

But what we don't want is you to ovulate early, so then when the doctor goes in there, there's no eggs.

So that's what, Cetrotide is for.

Correct.

And what does that look like?

So Cetrotide come… It does come in a box.

I just pulled it out.

Yeah.

in the box it comes almost mixed for you.

Comes with a syringe of liquid, the vial of powder, and two needles.

There is one large needle, one small needle.

Okay.

I always say you're not gonna mix them up, because you are not gonna wanna inject with the big- The big needle

the big scary one, okay?

That's right.

Yes.

Yeah.

So for this one, like I said, it's just partially ready to go.

You just have to push the liquid into the vial of powder.

Yeah.

Gently mix it up.

Then you're gonna pull it all back into the syringe Push out your air bubbles and then put the small needle on to inject.

Amazing.

Amazing.

Yeah, so almost mixed.

Almost mixed.

Yes.

Yeah.

And Cetrotide, just for record, it is kept in the fridge.

Orgalutran is not.

Yeah.

So sometimes we'll order based on what the patient's doing.

If they have to travel a lot, then we order Orgalutran 'cause it doesn't have to be kept- Oh, okay- … in the fridge

that makes sense We try to keep things easier.

Yeah.

For

sure.

Okay, that makes sense.

Okay, so let's start with Gonal-f or, Rekovelle, which is one of the easier ones.

However, when people hear they have to do injections, I see them on Zoom go white as a ghost and say, "I can't do it." Sometimes… Well, most of the time the guys pass out giving blood work.

So then if they're told they're the ones that have to be the nurse for their wives, that freaks them out equally.

Yeah.

Yeah.

And so let's just show them how to actually do the Gonal-f and how tiny that needle is and how not scary it is.

Okay.

Because I think it gets in our head, and it's scarier than it actually is, and it's actually doing it.

For sure.

Yeah.

I think when anybody hears injection, needle, they, they panic.

They panic.

Which rightfully so.

Yes.

I am kind of weird like that, too.

Yeah.

Yeah.

So let's just reintegrate.

These medications, your Gonal-f, Menopur, Cetrotide, basically all of your IVF medications, like, you know, I say IVF, it's- that's your egg retrieval portion, okay- Egg retrieval

are subcutaneous injections.

Yes.

Which mean we go into the subcutaneous tissue, which is your fat tissue.

Your fat tissue.

Okay.

Yeah.

So… And we do all of our injections in the abdomen.

Other clinics might be different.

Yep.

But we stick to abdomen to keep it across the board.

Yes.

Simple, okay?

Easy to use, yeah.

Yeah.

So your Gonal-f and Rekovelle are both… I always say they're like your insulin pen.

So some people are familiar because-

Yeah … I

feel nowadays there's lots of people, have diabetes, so you kind of come across-

Right

… Lindsay: somebody who's seen it.

So the biggest thing with Gonal-f and Rekovelle, they come with preloaded cartridges inside.

Making it really easy.

Yes.

Yes.

Yeah.

So Gonal-f, they measure it in units.

There is different sizes of pen.

Regardless, we give you your dose that you- Yeah … will inject, okay?

So this one is a 900 unit pen, which is probably the most common one.

Yeah.

So when you are injecting, first off, lay everything out, I always say.

Yeah.

Wash your hands, soap, water, dry them off.

For the Gonal-f, it's gonna come in a box with needle tips and then your one pen.

Okay.

Multiple needle tips to get you through.

I'm gonna use one of the needle tips from the, um, Ovidrel, but they're the same.

They're

the same.

So clean with alcohol.

Okay And the Menopur kit has the alcohol swabs- Mm-hmm, mm-hmm

for you, right?

Yeah.

If for some reason you don't have enough or you, you need some, you can buy those over the counter- Yeah … at any pharmacy.

Yeah.

Okay?

So you're going to screw on the needle tip.

Super easy.

Oh, okay.

There's an outer shell you're gonna pull off.

Pull off.

And then in the little window, that's where you're going to crank up to your dose.

Right.

So let's just say your dose is- Your

note said 70-

Yes, follow your email … 150 today.

So let's say your dose is 150 today

So all you do is turn it 150 Amazing.

Super easy 150.

Okay.

If you go too far, you can go right back down,

okay?

Ah, that's a question I get asked.

Yes.

You can go back, ladies.

Yes.

Okay.

So you can go back.

Yeah.

So there's our dose of 150.

Okay.

Okay?

So this is now ready to go.

Okay.

Normally when you have other meds, I say have everything ready to go.

So you do it in order?

Yeah.

Okay.

Yeah.

It doesn't matter which one you're gonna do first.

Ah, okay.

You s- you set up your routine, okay?

Yep.

you do not have to inject directly over your ovary.

I've had that question before, thinking, oh, it's gonna go directly into the ovary.

Yeah, I've had that too.

No.

No.

It just, it's going into the subcutaneous tissue all around.

Yeah.

So like I said, we're gonna do the abdomen.

So and it's gonna be one inch away from your belly button, anywhere around.

Yeah.

And we were on a call the other day and w- you made a good point.

Anywhere there's fat, so if you bend over and you have that fatty tissue- Find a roll … grab it.

Okay.

Find the roll.

Most of us all should have- … a good roll.

A good roll, huh?

Yeah, so that's why it helps to sit-

Yeah

… ' Lindsay: cause then you can get-

Yeah

… Lindsay: a good roll, okay?

Exactly.

Yeah, it's harder when they lay down.

It truly is.

Yeah.

Yeah,

yeah.

Sit so you're, you're comfortable, have everything out.

Yeah.

So then you're going to- So this is my

belly

… Lindsay: yeah, this, we're gonna put this simply.

So when I say also, no closer than one inch, some places say one to two, but just don't go closer.

So that means you have everywhere else-

Around

all around to use.

Yeah.

Okay?

So you pinch.

We have our spot here.

Squeeze it.

You're going to use your alcohol, give a good cleaning.

There.

Okay.

Give it a couple seconds there to dry.

Then you're going to pull off the outer shell.

See, even looking at that needle, guys, it kind of freaked me out.

Okay.

Not

gonna lie.

And then when you inject, inject so that you're able to see the screen.

Oh, okay.

So when I inject, I wanna be able to see it, and this is only because when you're done or think you're done, you need to confirm it's at zero- Okay … because I've had patients, um- Pull

it

… Lindsay: they, thumb goes down, they think they're at the end, pull it out and realize, oh my goodness, there's 50 units left.

Oh.

And I know it doesn't seem like a lot, but it is, okay?

It is, it is.

You'd have to re-inject, okay, with, I would- A clean needle … change the needle.

Yes, clean needle, and have to unfortunately poke yourself again.

Ugh, okay.

So you're gonna inject with the screen facing up.

Your thumb is going to be fully over the pretty little- Okay

flower, okay?

Yeah.

Fully over so that you get full use to push down.

Okay.

Okay?

So you would inject in, 90-degree angle.

And you'll hear it clicking.

Click all the way down.

Yeah.

Wait a couple seconds.

Confirm on the screen it's at zero.

And then take it out

And you wait how many seconds?

I

usually count to three.

Okay.

Yeah.

Okay?

Just, you just don't want to race it out.

Yeah,

yeah.

So then you've got this needle tip.

And now what happens if there's some that drips out?

'Cause I get called, calls and messages saying, " There was some on the needle when we pulled it out."

You most likely, had your thumb still pushing and you had a little bit left and pulled it out too quickly.

Okay.

Another thing you wanna make sure that you don't do is remove your thumb from the plunger while it's still in you, 'cause sometimes you can get some backflow.

Oh.

Which you'll get a little bit of blood in there.

If that's the case, this pen is not… You cannot use it again.

Oh,

okay.

So Sirono has a drug program.

If that happens, there is an emergency number with them and they'll replace your pen-

Okay … for

you, because you cannot inject.

You can't use it again.

So keeping your thumb fully over it- Okay … then remove, let go, you're good.

Okay.

Okay?

Okay.

So then depending on what kind of sharp containers you're given, if you have a- A container

a big one.

Yeah.

Yeah, I've seen these yellow ones that you can put in.

Yeah.

the Menopur kit just comes with a little baggie.

Yeah.

So to keep it easy, turn your cap so it's facing you, and then gently push in your needle- Yeah … and then remove it.

This way you're not risking yourself poking-

Stabbing yourself, yeah.

And it just twists off.

And you dis-

And you discard it into the

bag … the sharps container.

Yeah.

And you put the lid and back in the fridge.

Yes.

Easy.

Okay, so that's Gonal.

Ready to go.

And then also as you dose, the plunger's gonna go down, so you can see how many units you're left with.

Yeah.

Okay.

So you know when you're getting down to, say, 300, that's the time you need to- To go get more

to know if you need to get more.

Yeah.

And it's all based on your cycle because during your teaching we talk about roughly how many days of medications you're going to need.

So-

Yeah

… Lindsay: you're gonna know, "Okay, I'm already, I'm down to 300. I've only had a few doses."

Okay.

" Lindsay: So I know I have to get another pen because-" Yeah

as I tell my patients, you're gonna need 10 to 12 days worth of medications.

Yeah.

And what happens is also, if you were doing like 150, 150 and the doctor ups it- Yes … at any time that after your monitoring, then you might be low.

So always make sure you have enough.

Yeah.

I have been asked, um, what if there's, say, 50 units left in this one and you got more in the other.

Yeah.

Unfortunately, I, I always advise use the 50- Do both,

yeah

… Lindsay: and then the both, it's an additional, injection.

However, like these are very expensive, and if you're paying out of pocket- Yeah … you don't wanna waste that little bit.

No.

So obviously- Yeah … it's patient discretion.

If they wanna th- that's perfectly fine, they can throw it out.

Yeah,

but it is expensive.

But I would say it's safe to do the 50, then you're gonna open a new pen, do the same cleaning steps.

And keep that balance.

Yes.

Yeah.

Yeah.

Yeah.

Yeah.

I get asked that as well.

So that's Gonal.

So that, that's Gonal-F.

Repovée is the same type pen, same concept, okay?

Okay.

Let's pull it out just so you can see what it looks like.

So the Gonal-F will come similar to this.

Okay.

Same type packaging inside.

Same.

Lots of needles and the cartridge.

Okay.

Okay?

Perfect.

There's always more needles than what- Than what you use … you're gonna use.

If you have leftover, needles that you haven't used, you can dispose of them in the sharps container, and any sharps container can be returned to any pharmacy- That's great

to dispose of for proper disposal.

Yeah.

Yeah.

Always make sure you have a sharps container.

If you're, if you're thinking you don't have one, there are the little ones in the Menopur kit.

Yeah.

But if you need a bigger one- A bigger one … any pharmacy can dispense a sharps container.

Those.

Mm-hmm.

Okay.

Okay?

That's good to know.

And I know a lot of the girls keep them because when their babies born, they want the picture with all the needles.

I have seen some really cool ones, yes.

I always remind the girls, like, "Keep them, keep them." Yeah.

So.

For sure.

For sure.

It's a good reminder of everything you've been through.

Yeah.

So that's Menopur and

Reprovive.

And then also of course, so- Or

sorry, Gonal-F

… Lindsay: Gonal-F and Reprovive.

Yeah.

So Reprovive is dosed in micrograms.

Yes.

Menopur is dosed in units- Yes … just in case if people question.

Yes, so, a common, I guess, dose you'll say is for Reprovive is, like, 12.5, and Menopur could be, like, 150 or whatever.

Yeah.

And people panic 'cause if they've tried Reprovive at 12.5, and then the doctor switched them over to Gonal, and it's at, like, 300, they're like, "What? I think it's too… Something's wrong on Lindsey's email."

Yes.

Yes, so-

And it's not.

It's just the units of measure for each drug.

For sure.

For sure.

Yeah.

And, like, any questions, always- Yeah

reach out because, there could be an error with the email.

So- Absolutely … always double-check if- Yeah … you're questioning anything.

Don't ever stay quiet.

Yeah.

It's… Advocate for yourself- Yeah, and that's- … and always reach out

… Crystal: we'll just say this in the middle while we set up the Menopur, is read the email and know what you're doing and the dose because that would have come up before and not- Yeah

9:00 when you're doing the dose,

so.

That is a big one.

I- Yeah … I do get a lot of calls say 9:00.

Yeah.

And then at that point- It's always 9:00 … they realize, "Oh, my gosh, I didn't go to the pharmacy- Yes … I didn't pick up meds." Yes.

So depending if that happens, your location- If you are close to one of our clinics that has a pharmacy, we can sometimes get- Sometimes

a pharmacist-

Yeah

… Lindsay: depending on the time of day.

Yeah.

If we can't, unfortunately, you will be out of a dose.

Yeah.

It's not necessarily going to ruin your cycle.

It most likely means you're gonna need an extra dose along the way because we didn't- We didn't … we didn't have consistent dosing.

Yeah.

But- So

don't panic

Don't panic.

But yeah.

But this is why it's important to know how much medication you have.

Keep a very close eye on- Yeah … what's left in your pens, what's left in your Menopur.

Yeah.

And then follow up with your, your nurse or the clinic just to check to see if you need more refills or not- Absolutely … so that you're on top of it at-

Yeah

3:00 PM versus 9:00 PM.

Exactly, 'cause we've had that all the time.

We get it

every time.

All

the time.

We get- Yeah … our lives are busy.

Yeah.

And we don't-

Yeah

… Lindsay: check.

I'm, I'm not, uh-

So- Good … okay, we have Menopur, which Menopur freaks everybody out because of the mixing, me included when I was going through this process, 'cause the mixing.

And you know what really freaked me out?

Is the air bubbles, 'cause I think the nurse at the time told me, "If you have an air bubble, you can die," or something.

And I'm like, "Oh, my God," and I like… Me and my husband were, like, fighting.

And, like, the first time, I think it was we did the Gonal-f first.

I, like, swung at him because I thought he was, like, stabbing- Goodness

me too hard and the needle, the Gonal- went flying.

We had to change the needle.

It was a whole thing.

Mm-hmm.

So that's why I think this is so important.

For

sure.

The Menopur really freaked me out because the mixing is confusing.

Both, we've been on calls.

I think we talk every night at because every day there seems to be somebody that's either overwhelmed with Menopur or whatever else is happening.

For sure.

And Menopur can be overwhelming because we're mixing.

Yeah.

So can you-

100% … go over the Menopur?

We sure can.

So like we said, when you pick up all your medications, the most important thing with Menopur is you need to have the patient kit and a box of Q- Q-caps.

Wait, let's open that.

Q-caps.

Q-caps.

So Q-caps does come actually in a, a bigger box.

I just grabbed these- Okay … just for training, okay?

So- Oh,

right.

Yeah.

That's

the- Each one of these little sleeves, there should be five Q-caps in it.

Yeah.

So when I say you need doses for 10 to 12 days- Mm-hmm … you know you're gonna need minimum- Yes … 10 to 12 Q-caps.

Having extra is not a bad thing- No … in case you're mixing, if you drop it on the floor.

Absolutely.

You need to get a fresh new one, okay?

So that's why very important to have this.

Yes.

I'm gonna get you to open that up- Okay … while I get my Menopur.

So my Menopur training kit- Oh my gosh.

… is a little different than what it's going to look like when you get it.

Okay.

So Menopur the box is, it's a blue and white box.

Each box contains five vials of powder- Just like this … and five vials of liquid.

You will be given your dose by your clinic's nurse.

So you know what you're using.

I, for my emails, I do specifically write out their dose.

So example, we use Menopur 150 units for most cases, but again, every case is different.

Okay, so in your patient kit, you should have … You're gonna have a whole bunch of syringes.

We got lots of stuff here.

We do.

I know.

You're going to have alcohol swabs

Ah.

Okay?

Handy.

We have our injecting needles.

Okay.

And

You've got your sharps container The

sharps

container.

So open everything up, lay it all out, like what I-

Okay

… Lindsay: always say for everybody.

With Menopur, I said you had five vials of powder, five vials of liquid.

Yes.

We will let you know how to mix.

The typical is you're gonna use one vial of liquid to mix your entire dose.

Each vial of liquid, these are my training ones, they're not labeled.

Each vial of liquid comes with two mils in it.

Okay.

We use one mil for injecting.

Always one mil.

Yeah.

Okay?

Regardless how many vials-

Of powder

… Lindsay: you need.

Yes.

Okay?

If your dose is higher, then we'll specifically say you need to add an extra half mil, one mil- Okay

and we give you instructions.

But our standard we use is 150 units for most IVF cases, so we're just gonna go with 150.

Okay.

Okay?

So you've got your vial of liquid, and then each vial of powder, we're gonna pretend these are powder, each vial is 75 units.

Right.

Okay?

So depending on your dose, we're doing 150 units, that means we need two vials of powder.

Two

vials.

Okay?

Your emails- Into one

liquid.

Yes.

Your emails should be very clear.

We try to write them out very clear.

Sure.

Yeah.

So, for mine, I'll write, "Menopur 150 units to be injected in the evening."

Yeah.

I'll make a note that we advise all of our medications to be done in the evening.

Every clinic is different- Yeah

but ours are the evening.

Yeah.

So I say across the board, any time after 5:00 PM.

Okay.

And we remind you they are subcutaneous.

Yeah.

And then we give you the dates that we do it.

What does subcutaneous mean, for all those that don't know?

Subcutaneous- ' Cause I

get that, that… I get asked that question when it's on the email too.

So, yeah.

Subcutaneous is your fat tissue.

Okay.

Okay?

That's easy, ladies.

It is.

And you know, now that you say that, I, I maybe should start writing-

Yeah … because patients are- 'Cause that's one thing.

I don't know what Lindsey means by this, right?

So that's… Sorry, that's why I wanted to ask you that.

Nope.

So I've had a patient ask that they weren't sure what, B HCG, your beta HCG- Yeah

is.

So 100%.

It's all the same.

But it's nice to know these… Yes, because I need to-

Yeah

… Lindsay: I can better my teaching- Yeah, yeah … doing that.

So subcutaneous is your fat tissue.

Your fat tissue.

Yes.

Your fat tissue.

Just

a nicer

way of saying- Yeah, into your rolls … your fat

tissue.

Yes.

Into your rolls.

Yes, exactly.

Okay.

okay, so we're mixing our dose here.

So we have our two vials of powder, one vial of liquid.

We're gonna need one syringe.

Okay.

So we're just gonna set that out.

We have our sharps container-

Okay

… Lindsay: or little baggie that we have set out.

And the needle.

We need the needle.

Are we gonna open

it?

That's for injecting.

Sure.

Okay.

So I'm opening-

Then-

… noise: the syringe

… Lindsay: we have our Q-caps that we use with the Menopur We need one Q-cap.

I'm gonna pull out a fresh new one so we can see.

Whoo.

So when we open it up, you'll see it comes like this.

Yeah.

All looking okay?

So we need one.

Okay, so we have everything ready to go.

I'm gonna open

this.

We have our alcohol swab.

Always clean.

We have our syringe.

We have our needle.

Actually, we'll leave the needle in for now.

Okay.

Okay?

Because we wanna make sure everything stays, sterile and clean.

Okay.

So first thing we're gonna do is we're gonna open the Q-cap.

Easy.

Sorry, actually, the very first thing is we wanna wash our hands- Mm-hmm

dry them, have everything ready to go.

Yes.

Okay?

So our vial of liquid The Q-cap just snaps- Like that … right on.

So easy.

This is done so that you're minimal risk for any-

Infection

… Lindsay: poke- Well, if you use a needle to go between, you're, you're at higher risk to poke yourself.

Oh.

Okay.

Yeah.

Okay.

So this just makes it easy so we're not using a sharp-

Okay

to mix them in.

Okay.

Okay, so the Q-cap on.

We're gonna take our syringe.

Easiest thing to do is to pull out one ml of air.

Okay.

You can see the one ml.

Yeah.

One ml. So every syringe, um, a three ml syringe will, it's clearly marked one ml, two ml, three ml, okay?

So you're gonna pull to the one ml. Screw it on.

There you go.

If you push in the one ml of air, it automa- it will pull back without me even having to-

Using

it or having to do anything.

Yeah … no resistance.

It just pulls in.

Okay, so you want one ml. This has a little bit of air, so I'm gonna push the air back in, 'cause I want all liquid.

So that was the air bubbles?

Yeah.

Okay.

It's not so concerning right now, 'cause we're just using this to mix.

Yeah.

So we just wanna make sure we have- Okay … one full ml.

One, okay.

Yeah.

Then you're going to-

Pull it out

… Lindsay: pull it off with the Q-cap.

Oh,

okay.

Okay?

Yeah.

So now we're gonna put it on our first vial of powder.

Snap it on.

Push the liquid in gently.

Swish it

around.

Gently swirl.

Do not go aggressively, Shanae.

Okay.

That's gonna cause more air bubbles, okay?

So just gently- Swirl … swish.

Okay.

Swirl around, sorry.

And then once you'll notice it's all mixed, there's no more particles, which Menopur does mix fairly easy.

Yeah.

Then we're gonna flip it back up.

Draw it out.

Pull out all our medication.

So we're not looking for the one anymore-

Just pull

it … 'cause it will

be more.

Pull it all.

We're pulling

it out.

Yeah.

Yeah.

Okay.

So pull it all back out.

With the cap.

Snap it with the cap.

Bring it off.

So now that one ml, we've just made 75 units of Menopur.

Okay.

So

we want- But we want 150.

That's right.

So we need to mix one more vial in there.

So we snap it back on, push that 75 units.

Mix it all

together.

Mix it all together.

Okay.

And we're only using one vial of liquid.

Yep.

I just

wanna

say that

again, 'cause- The one ml- One ml, yeah … of the vial, because the vial of liquid actually has two mls in it.

So as I pull it out, this is, again, the, these are the training ones.

Like, there's some- Yeah … drips of liquid.

You'll probably have a little bit less than a ml, but it's easiest if you pull, pull it all-

Yeah

… Lindsay: and pull some air in there.

Okay.

Okay?

That way you're not, losing medication along the way.

So pull it all.

It's not gonna hurt.

And this point, we're going to unscrew-

Okay

… Lindsay: our syringe.

We're gonna have our needle ready to go.

Okay.

You wanna open it

so

it's- So it's clean … yeah, so I'm not touching it.

You're not touching that.

Not touching it.

Ah, okay.

'Cause this is all sterile, okay?

Then we're going to screw our syringe- There we

go

on, and we have our needle tip on.

Now's the point where we wanna get the air bubbles out.

So you see on the TV shows, movies, they're, they're flicking.

Yes.

This is going to hurt your finger- … very quickly.

I like to use, if I have a pen- Oh, just do it … I give it, I do a little tap, okay?

Okay.

But we can use our finger.

Okay.

Flicking it, but you will start hurting your nail bed, so I, I will gently tap sometimes with- Okay,

with the pen

… Lindsay: with the pen, yeah.

Okay, so we push all the air bubbles out.

So all the

air bubbles

went.

Yeah.

Okay.

And then we're gonna just slowly push the plunger up until we see a drop.

The

liquid in there.

Yeah.

Okay.

Okay?

When we see a little drop, then we know the line's- It's ready … primed, it's ready to inject.

This injection is the exact same as the Gonal-F and Reprovai.

Goes in the abdomen, in the fat tissue, in the roll.

In the roll.

In the roll.

In

the roll.

Now, if I just did my Gonal on this side, do I wanna do the Menopur on the opposite side or do I wanna stay-

So keep rotating sites.

Don't… If you injected, say, your left side-

With

Gonal … just

a

couple minutes ago with Gonal, you should do a different location, okay?

Okay.

if you do repeated spots, that's how you get bruising, okay?

Okay.

So to help save on the bruising- Let's do that … try to just keep, just keep rotating- Okay … okay?

So if you did on this side for the Gonal-F, use the other side for,

Okay

your Menopur.

Okay.

Okay?

So clean with the alcohol swab.

Yeah.

You're gonna pull the cap off and inject Inject slowly.

Okay.

Wait a couple seconds.

Remove it.

Okay.

Menopur, one of the side effects with this one is it can burn.

Yes.

Okay?

So that's why I say just inject-

Yes

… Lindsay: slowly-

Yes

… Lindsay: and then remove it, okay?

And I know we're gonna get to that after, but let's just talk about it now.

Can they ice?

I get asked this all the time.

Can they use numbing agents?

So some patients have asked if they could use numbing.

You can buy, I think it's called Emla-

Yeah

… Lindsay: little patches, but it's gonna get real expensive.

Okay.

Keep buying those, putting them on.

Yeah.

They have to sit on the skin for 30 to 60 minutes for it to work.

Yeah.

I just advise just inject.

Just it, yeah.

Just inject.

Ice, definitely not, because it's cooling the skin, it's constricting your blood vessels, and it can affect the absorption.

Okay.

Say that

again.

So I say- Stay away from ice.

Stay away from ice.

Yes.

Okay.

So after you inject, it's… You, if it's really sore, just kinda just, you can apply a little bit of pressure.

Yeah.

But we say just don't rub aggressively with it- Yeah, no … okay?

Because you can get bruising.

It's… And I'm talking from experience of taking Menopur.

It's less of a burn and almost feels, like, itchy, kind of.

Like burning, itchy.

Like a tingling?

Yeah.

But it's gone in 15 minutes, ladies.

It's not, it's not horrible.

Yeah.

But if you are on any of those Facebook groups, which none of my Fight Club girls are on 'cause they're on our group, but I know I see it all the time.

And the groups kind of, like, psych you guys out, and they tell the girls, like, "Oh my God, Menopur burns so much." And it's, it doesn't last, and it's not that horrible.

Yeah.

So if you can get through all of this and the ultrasounds- You can do this For

sure.

For sure I know you

can.

And, and y- and yeah, like it is gonna burn a little bit, but it also is affected, like how quickly, if you just aggressively-

Yeah

push in that- Yeah … that medication, it's gonna burn more.

Exactly.

So just- Yeah … take your time, go slow.

With all of them, just take your time-

Yeah

… Lindsay: because that's gonna affect how, how you feel with it- Yeah … if you get bruising, things like that.

Yeah.

So try and keep it easy.

Yeah.

Don't rush- Yeah … and just take your time.

Absolutely.

Okay.

So that's Menopur.

Hey, so glad you're here listening to The Fertility Fight Club podcast.

If you're loving what you're hearing and wanna go even deeper, I want you to know this podcast is just the very beginning.

If you wanna see what it's actually like inside The Fertility Fight Club, you know, the coaching program that this podcast was named after, check out the link in the show notes or head over to fertilityblooms.com/fertilityfightclub for more information.

And if you're looking for extra support on your fertility journey, I've got a few different ways you can work directly with me.

The Fertility Fight Club, that's our main hub, so everything happens in there.

We have menus, we have coaching programs, we have resources, we have mini programs in there that you get access to.

But the best part of that is the girls share.

We do challenges, we do fun activities together, share their food pictures, what they're doing, lots of dog pictures.

So that's The Fertility Fight Club.

Then we have The Fertility Spark.

That's if you wanna dip your toes in the water.

You can do some challenges.

You can hear some of the guest speakers that we offer in the Fight Club.

You get one of those a month and a group coaching call.

Third thing you can do with me is you can work one-on-one with me, which I really get really in deep from your blood work, to finding you the right fertility doctor, to walking through your nutrition and diet plan and stress management and all the things, until you actually have the baby.

So that's my favorite way to work with everybody 'cause I get to see the baby in your arms.

You don't have to figure this out alone.

Head over to the show notes for all the details on the fertility programs and let's get you closer to a positive test

So our medications, every clinic is different again, our follicle-stimulating medications start on cycle day three.

Yes.

Some clinics start cycle day two.

It's whatever your clinic- Yes … their protocol is, okay?

So there's, there's no right or wrong.

It's whatever your clinic protocol is.

So our clinic, we do cycle day three.

Yeah.

So cycle day three, you started your Gonal-F and Menopur or your Reprolut and Menopur, we'll say.

And those are gonna keep going.

Eventually, you're going to have to start your Cetrotide- Cetrotide … or your Lutran, your antagonist, to prevent ovulation.

So we base that on blood work and ultrasound measurements.

Yep.

Generally, when you've got your lead follicle is around 13 millimeters, again, every physician's different, but we usually aim around that time.

That's when we have to start Cetrotide.

Okay.

So when you're in your email, you'll get… You always have your doses for Menopur and your Gonal-F or Reprolut.

Yeah.

And then all of a sudden you're gonna see-

Cetrotide

… Lindsay: new medication starting.

So I write a lot of asterisks- … try to say no new medications.

There's asterisks and bold letters- Yeah … and everything.

Anything to catch your attention because- Yeah … some people, they just quickly read the emails.

Yeah.

So again, I always say please read- Read

very carefully, okay?

Yeah.

Yeah.

We have to start Cetrotide.

So Cetrotide does prevent ovulation, so with this, it is a short-acting drug, so you, it's very important to take this at the same time every day.

Okay.

Okay?

If you miss a dose, you could potentially ovulate, and with IVF, if you start to release, cycle's done.

And it's time-sensitive, ladies.

Like it's- It is … time-sensitive.

Yeah.

So- I can't stress that enough.

Yeah.

So say you've picked your time, let's say you did it at 7:00 PM.

9:00. Yep, no- 7:00 … it doesn't matter, that you're just gonna incorporate this.

Just do it the same time as the other ones- Okay … unless we spifi- specifically say otherwise.

Yeah.

Just add it to the time you do the other ones, just to keep it easy-

Okay

… Lindsay: for you, okay?

So Cetrotide comes in a little white box.

It's stored in the fridge, just a little reminder.

You are going to-

Open up

… Lindsay: open up the packaging, and like I said, we've got our syringe with your mixing liquid, your diluent.

You're gonna have your vial of powder, and you've got your two needles.

So this one's almost mixed ready for you.

So again, start this one, always best practice, wash your hands with soap and water, have everything ready to go.

So we have to make sure we have an alcohol swab, so-

Okay

… Lindsay: you can use the one from the Menopur kit.

If you get low, you can get more- Got some … from the pharmacy.

Yeah.

Okay?

So we have that out ready to go.

So get rid of our stuff here.

I'm

gonna move some of this stuff- Yeah … here, so we have more room.

And then we'll pull everything out, just so it's easy

Okay.

Pull this aside

I like to have everything kinda cracked a little bit.

Okay.

Keep it easy.

So looking through these, like I can see through, you can see the difference.

Yeah.

Okay?

Yeah.

The small one, you can tell this is a big one.

We're gonna pop the cap off- Off … the vial.

So technically it is sterile under there.

I still use an alcohol swab.

You still…

Okay.

Just-

So you still clean it

… Lindsay: because my thumb rubs over.

Again, everyone's different with that.

Yeah.

But technically it is sterile under there.

It does not hurt-

Okay

… Lindsay: to clean it.

Extra clean's always better.

So you clean the vial of powder.

Then you're going to

There we go.

Twist the-

Twist it off so that we can put on our big needle

Screw it on

The word just big needle

I know.

The larger needle.

The larger guy.

Oh my God, that makes me wanna

pass out.

Okay, so big, big needle.

I feel like that's… We met that.

Okay.

Oh, God.

So then we're going to-

I would literally

die … thread it, push it into the vial of powder

Okay?

So the liquid's already in there.

Makes me nauseous thinking about it

So gently rotating it.

Again, don't aggressively shake.

Yeah.

So if you can see-

Yeah, it's-

… Lindsay: there's no more- No more particles … no

particles.

Yeah.

Yeah.

So then pull it back up, and you wanna pull all the medication back.

Ah.

You want to keep an eye on… See where the needle tip is in the vial?

Yeah.

I have some patients, the, the needle tip's too high, and it's just gonna pull air.

Okay.

You need to keep it down-

That's good to

know … low to pull all the liquid.

Okay, so pull all the liquid out, 'cause there's medication- Yeah … at the bottom, yeah.

Okay, so we have it all out.

Okay.

Oh my God, that needle's making me nauseous.

It is,

it is very scary.

So then our safety to- Okay … 'cause we have to switch our needles.

Yeah.

If you put your

cap- You put your s-

… Lindsay: on the table-

Right, okay

… Lindsay: then you can just guide your needle in.

Okay.

Push on and unscrew it, okay?

Okay.

So I still left the air all in- Okay … because if I had it, if I pushed all the air out, there's now gonna be some-

Medication in

there … medication in there.

Okay.

Yeah,

and we wanna make sure we get everything for this one.

We

want it all.

So now we're gonna unscrew.

Small needle.

Screw it on.

Easy.

Easy.

Yeah.

Now we're gonna push out the air.

Yeah.

Okay?

Small little- So with the plunger- We don't want

the air, air bubbles

… Lindsay: gently-

Yeah, we push it up and just watching until we see the drip

Okay, yeah

At the top

All right

See it come out there.

See?

Okay.

So this is ready to go now.

Okay.

Okay?

Some people- So- … will have all their injections all ready to go and lined up

So then they go bang, bang, bang.

Yeah.

Yeah.

It doesn't, it doesn't matter.

Whatever's easy for you.

Yeah, if you wanna prepare.

You wanna do one, administer, put it away, next one.

Whatever is easy for you.

Okay.

Okay?

'Cause you're just, you are still being consistent with the time.

Okay.

So now this is ready to inject.

It is subcutaneous, so like we said, it's going into- In our fat … the fat tissue, into the roll.

Okay.

Okay?

So you're going to use, use another alcohol swab.

Right there?

Yeah, it- Right … you clean

your skin.

Have… It doesn't matter if you use a couple.

Yeah.

It's better to be safe.

I literally, ladies, bought a box of the swabs a few weeks ago, and it was like 1,000 swabs for, like, $3.

So they're not expensive, yeah.

Yep.

It's the only thing that's not expensive

in fertility . Oh, exactly.

Exactly.

So.

you can ask your clinic to send a prescription through if you're able to put it through benefits.

Okay.

It is very cheap, though.

Yeah, it's

cheap.

Okay.

So again, you're gonna clean with alcohol, and then this is ready to inject.

Okay.

One main side effect with Cetrotide is it can be red, a little bit raised, almost a little bit itchy.

It's like- Okay … almost like you're having a reaction.

Okay.

That is a very common side effect with Cetrotide.

Don't panic.

No.

Okay.

It'll be gone.

It's usually gone within a few hours.

Okay.

Okay?

Very common.

I get a lot of calls saying, "Oh my gosh, I'm reacting." Yeah.

Yeah.

And- I've

got that too

… Lindsay: it goes away.

However, there are some people that can have reactions, so we just monitor it.

Okay.

If it was still very red, hot to touch, itchy 24 hours later, I'd be concerned that maybe you are reacting to this, and we'll switch you.

We'll try the Orgalutran.

Okay.

We'll try a different one.

But that's usually a common, kind of like a mosquito bite almost.

Okay.

That type of thing.

And it's a good thing.

And it's- Yeah

… Lindsay: and then it's, it's gone.

Okay.

Okay?

Perfect.

Can we see how big that needle is?

Oh.

Okay.

Not that big, ladies.

Not as big-

No

as that one.

No.

So yeah, you can do it.

Okay.

And how far do they go into the skin?

All the way down?

Pretty close- Okay … all the way.

Yep.

You wanna make sure- 'Cause I've had that

question too

… Lindsay: you get in.

Yeah.

Great.

Good.

Because if you're too close to the surface, you, you'll find you'll get a couple drips back out.

Okay.

Okay?

Perfect.

Yeah.

All right.

Any questions with any of this?

No, I think that's good.

Okay, Lindsay, let's talk about some of the most common things that we get calls for, like the 911 emergency things.

my girls have, like, an urgent thing that they can send me- as soon as I get the urgent, I'm on the phone with you.

Yeah.

That's

good.

So let's try to clear up some of those urgent things that we get called at nine o'clock at night for.

Okay.

So one is, I don't think the full dose went in.

What do I do?

Okay.

So that is sometimes a common question we get, and that is why it depends… Well, this one, you need to make sure you look at the screen, okay?

So if, like I said, you pull it out thinking, "Yeah, it's in," and you look and… Where is?

Oh my goodness, there's 25 units.

Yeah.

Oh my goodness.

Now what?

So w- we need to inject that.

Okay.

So you'd have to remove everything, put a fresh new needle- Okay … and inject again.

You don't want- Okay … to miss it because you wanna have your full dose to make sure you're getting the full stimulation, okay?

Absolutely.

If it was Menopur, like, I, unfortunately, I wouldn't know if you got your full dose- Yeah … or not.

Like, you'd have to look at your syringe.

So at that point, we do not advise you mix up another dose-

Okay

… Lindsay: and you inject.

I've had questions, um, saying, "I can't remember if I injected." Yeah.

They're so tired.

They're going through everything, and they're like, "Oh my goodness, I don't remember if I injected." I get

that too.

So unfortunately, my, my recommendation is you cannot just inject it again.

If you're not 100% sure-

Yeah

… Lindsay: we don't want, we don't wanna advise because if you did-

Yeah

… Lindsay: you'd be double dosing.

You would be overdosing yourself.

So we would say-

What happens if they do overdose?

Because that's another thing that happens, and they usually don't catch it until the following day.

Maybe, say they were on 300- Yeah … of Gonal-F, and the doctors brought it down 'cause they were stimming too fast, or the eggs or the follicles were growing too fast.

So they brought it down to, say, 150, but they didn't read the email, which- Yeah … is all the time.

We're all guilty of that, ladies.

We're not- For

sure.

I get that, and then I get asked, should I cut the dose even further?

Yeah.

And so say you went from- To, like,

make a-

Yeah … yeah … two pounder.

They

try to do the math.

Yes.

Okay.

So I always say, like, if that happens- Yeah … notify, notify the clinic-

Yeah

… Lindsay: just so that we, we can add it to our documentation.

Yeah.

But typically we don't.

Yeah.

We change.

We just say it, it's, it, so it is okay.

Like, you gave yourself-

Absolutely

… Lindsay: the higher dose.

We'll, just we'll monitor you again.

So we may adjust when your next blood work and ultrasound is-

Yeah

… Lindsay: but you did not ruin your cycle.

You didn't ruin your

cycle.

You didn't ruin your cycle.

Yes.

So I just try and give that bit of reassurance.

' Crystal: Cause I do.

We get a lot of calls.

The girls are in tears 'cause they missed a dose, or they were out, like, at a concert or a ball game or something, and they come home, like, three hours late, and now what happens?

They are now three hours late for their, their stim.

Yep.

So if we get that, that you're late, if you haven't injected, like, at all that day, you need to inject.

Do it as soon as you can.

So if it's three hours, do it as soon as you can.

Yeah.

I've gotten calls the next morning saying, "Oh, my gosh, I forgot to take my Gonal-F last night.

Should I take a dose now and again tonight?"

Yeah.

And advise them no.

No.

Okay.

You'll wait until the evening- You're okay … and get back onto schedule.

Yeah.

What if they forgot the Cetrotide?

If they forgot Cetrotide- Whether,

whether it be three hours for Cetrotide or the next morning?

'Cause I guess that would be too-

If it's been three hours, administer it.

Yeah.

If it's supposed to be administer it.

If you realize you completely forgot it that night, please call your clinic- Okay … and get your… Every clinic might be dinner- different what they advise.

Yeah, okay.

most would probably say please take a dose immediately-

Yeah

… Lindsay: and then carry on.

But again, each clinic will-

Okay

advise.

Because we don't want your LH to start rising, so that's why we want to stick with the consistent time-

Okay

… Lindsay: with Cetrotide.

Okay.

And what happens, I guess that would be the same, if they took too little of a dose and didn't realize that the doctor wanted to double the dose?

To

increase it?

Yeah.

To increase it?

We would just- Continue … either, if it was, if it was that night- Yeah … okay, and, say your Gonal-F was 150 but we upped it to 225- Yeah … and you didn't look at the email and they administered 150, I would recommend you're gonna have to take that missing dose- Yeah … add it so it's an extra injection, unfortunately.

Okay.

But still add it on.

So then, then you would just crank up your pen to, 150 to 200, so 75 units.

Yeah.

Sorry, yeah, 75 units.

so just crank the pen to 75 units and add that additional dose.

Okay.

Yeah.

If it's the same night.

If you've missed the next day, like you, it, you didn't realize till the next day, then ever again, contact your clinic, but typically you'll just resume your new dose that night.

And the last medication we're gonna talk about today, and we're not gonna talk about progesterone oil- Mm-hmm … and, and all those things for transfer.

Let's leave that for another day.

Mm-hmm.

But I think we should finish this part on the trigger shot- Okay … and the importance of it, and the timing And the importance, let me say that again.

Yes.

Yes.

The trigger

injection- This one is very critical that you take at that time.

Yes.

Critical, critical.

So-

We base the trigger, so our clinic, we do a 36-hour trigger, unless we've deci- we've done something different with your protocol.

Yeah.

So that's determined by your physician.

They'll let you know what your, what your trigger time is, okay?

Absolutely.

But typical, we usually do a 36-hour trigger.

Okay.

So we know the time retrieval's gonna be.

We backtrack it, and we'll know 36 hours from there, that's when you have to do your trigger.

Okay.

So we do a double trigger.

We do hCG and decapeptyl.

Okay.

Do we have a sample of what it looks like?

I've got decapeptyl.

Yeah.

It's two syringes.

They come preloaded, ready to go.

Okay.

Super easy.

Pull the cap off- Right … and you inject.

Clean with alcohol, inject.

Okay?

Timing is critical.

Timing's

critical.

your hCG you do have to mix, and you'll be given those instructions for when you get your trigger instructions- Okay

okay?

Because everyone's dose is different- Yeah … which is why I don't have anything here, okay?

But-

Now-

Sorry, go ahead.

Let's just talk hCG.

And what is hCG?

And if they do a pregnancy test three days after their transfer or after they've taken these medications, what is that gonna show them?

You will get a positive pregnancy-

Pregnancy

test … yes.

Yeah.

Yes.

So, with embryo transfer, if you do the hCG wash, you can get a positive test.

Yeah.

So that's why we say don't, don't test too early.

Don't test early.

No.

No.

Okay?

That's why we're so- So, like if you do the trigger and you're doing an IUI, for an example, the girls are testing so early and they get so excited, and I know right then it's the trigger 'cause you're testing- Yes

three days after you did it.

Yes.

Yes.

And-

For sure

… Crystal: so I just wanted to clarify that, 'cause that's a misconception, and people get so excited, and I don't want to burst their bubbles.