When you’re going through fertility treatments, there are a few different types of injections that need to be given at specific times during the process. One of those is called Lupron (leuprolide acetate), a synthetic gonadotropin-releasing hormone that is often prescribed for endometriosis, as well as in vitro fertilization (IVF) cycles. It works to lower estrogen levels by regulating the body’s production of follicle stimulating hormone (FSH) and lutenizing hormone (LH).
You might be wondering, what strength does Lupron/leuprolide acetate come in, and why do I need it in my IVF cycle?
Lupron/Leuprolide acetate comes in several different presentations to manage endometriosis and for IVF protocols.
To Manage Endometriosis
- A 3.75 mg monthly IM depot injection is used to manage endometriosis.
- An 11.25 mg 3-month IM depot injection is used to manage endometriosis.
For IVF Protocols
For IVF protocols, there are a few different preparations:
Lupron Down Protocol
A two-week kit containing a 2.8 ml multi-dose vial of Leuprolide acetate (5 mg/ml) and 14 disposable syringes for daily subcutaneous injection. This kit is commonly used in the “lupron down regulation” IVF protocol. Many patients worry that there is not enough leuprolide acetate in the vial because it isn’t filled to the top. But rest assured, the vial contains enough leuprolide acetate to take 20 units for 14 days. Some IVF protocols start with 20 units and then decrease to 10 units once stimulation begins, while others start at 10 units and decrease to five units when stimulation begins. For that reason, additional syringes marked in units rather than ml/cc are usually ordered, since the vial will actually last longer than the 14 days.
Micro Dose Lupron
Micro-dose leuprolide acetate, which is compounded in the pharmacy. This involves taking the full-strength leuprolide acetate and diluting it to the strength specified by the physician. The most common dilutions are either 40 mcg or 50 mcg in 10 units. This dilution is often used when there is a history of or concern for low response.
Single Dose Lupron
A Lupron “trigger,” which is compounded in the pharmacy to the specific strength and volume that the physician wants. Leuprolide acetate can be used to “trigger” or mature the eggs for retrieval instead of HCG, Novarel, Pregnyl or Ovidrel in IVF cycles where there is concern about potential ovarian hyperstimulation syndrome (OHSS). If leuprolide acetate was already used during stimulation, then it cannot be used as a trigger medication. The most common orders are 1 mg in 0.2ml or 20 units; 2 mg in 0.4ml or 4 mg in 0.8 ml or 1 ml. The leuprolide acetate is in a one dose vial and most often accompanied by either a 1 ml/cc syringe or a syringe marked in units and a 27, 28 or 30-gauge ½ inch needle for a subcutaneous injection. Some fertility pharmacies will send the Lupron as a prefilled syringe.
Melissa Bell, RN is a nurse manager at Reproductive Medicine Associates of New York. After graduating from Our Lady of the Lake College nursing school in Baton Rouge, Louisiana, she moved to New York and fell in love with field of reproductive medicine. Melissa is passionate about helping individuals and families meet their family planning goals. She is currently working on research for the American Society of Reproductive Medicine and strives to be an influential leader for her nurses and an advocate for her patients.