Hello. I think what I'm about to write might sound too over-cautious, but I want to ask because I am anxious.
Last night I did my pregnyl "trigger" injection at the correct time. I got most of the drug in, and all went smoothly. I noticed afterwards that there was some left in the syringe, partly because of the syringe design itself, and partly perhaps because I had not pressed the plunger as hard as I could. It was a very small amount. There had been just under 1.2ml of liquid when I began, and I reckon at least 1ml had gone in. maybe .1 or at most .15 was left. I had two choices - let it go, or draw off the tiny remainder and inject that too with a fresh, sterile needle. I did the latter, reasoning that it was best to get the fullest possible dose, and not to waste even a tiny drop. My dose was 5000iU. I used only one vial/ampule - so I'm not saying that the second injection added any to the dosage.
Does this sound OK? I've irrationally got the idea that this second injection, which was very close in location to the first, will have somehow disturbed the absorption of the medication, by inserting a needle into the area where the first lot of medication was settling in. I also figure that companies leave a little extra to play with in case of the loss of droplets, but hope that this means I haven't had more than the average person would out of the 5000 vial. Sorry if this sounds unduly paranoid - I have found the responsibility for mixing these injections and having had it drilled into me not to waste a drop of another drug cetrotide, difficult to manage, and consequently am beating myself up over things that I suspect are irrelevant. The bottom line here is that I got the full dose of medication, at the right time, and didn't waste any. I used two injections to do it. Is that OK?
Thanks, much appreciated.
Hello Amelie from the U.K.,
You did great. You needn't worry about it. Most companies put a little extra in the syringes any way in case the patient pushes to much out when they are clearing the air in preparation for injecting. In addition, when I use HCG (generic form), I use 10,000 units which is standard in the U.S. I've seen that in Europe they tend to prefer 5,000 units. I'm sure your dosage was adequate and you didn't overdose yourself.
The "baseline" is just that and only to confirm that everything is ready to start for the stimulation. The blood test is to show that the ovaries are now in their base state and there is little to no hormonal function. The ultrasound is used to make sure that there are no cysts in the ovaries but not all doctors check for this as long as the estradiol is low.
The day to start stimulation is a designated day and not actually related to your normal cycle because IVF is an artificial cycle. So whether a doctor calls the start day#1, day #2 or day#3 is irrelevant. By convention in the U.S. (and I can't explain why it is like this), we designate the start of the stimulation cycle as day#2.
Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com
check me out on twitter with me at @montereybayivf and facebook @montereybayivf. Skype and internet comprehensive consultations now available via my website for those who want a more extensive evaluation that this site can accommodate. I also now provide an Email Concierge Advisory Service with a 1 year subscription for patients that want easy access to me to answer questions along their journey (women's health, infertility, pregnancy). Contact me at email@example.com if you are interested in continuous access to me.