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Ask a Fertility Nurse: Why Do I Need Lupron/Leuprolide Acetate

Image of Lupron/Leuprolide Acetate

by Gina Paoletti-Falcone, RN, BSN, Freedom Fertility Pharmacy, November 15, 2010

Question:

What strength does Lupron/leuprolide acetate come in and why do I need it in my IVF cycle?

Nurse Gina Says:

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 used to manage endometriosis
  • An 11.25 mg 3 month IM depot injection used to manage endometriosis

For IVF protocols:

  • 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 “lupron down regulation” or “luteal phase lupron” IVF protocols. Many patients worry that there is not enough leuprolide acetate in the vial because it isn’t filled to the top. 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 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 commonly used when there is a concern about response to stimulation.
  • 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). It can only be used if the stimulation protocol used Cetrotide or Ganirelix acetate in place of leuprolide acetate during stimulation. If leuprolide acetate was already used during stimulation it will not work. 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 a either a 1 ml/cc syringe or a syringe marked in units and a 27, 28 or 30 gauge ½ inch needle for a SC injection.

Leuprolide acetate, Cetrotide and ganirelix acetate are used in IVF cycles is to prevent a premature LH surge that would cause ovulation of the eggs from the follicles on the ovaries before egg retrieval. These medications suppress the ability of the anterior pituitary to release the surge of LH that would “trigger” ovulation. Leuprolide acetate is a GnRH Agonist and takes longer to suppress the pituitary. Cetrotide and Ganirelix acetate are GnRH Antagonists and cause rapid but short term suppression. Because the suppression with the GnRH antagonists is short lived, the “trigger” shot of leuprolide acetate can cause an LH surge by stimulating the anterior pituitary to release LH.

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Gina Paoletti-Falcone, RN, BSN is a graduate of Northeastern University and has worked in Women’s Health since 1978. In 2004, Gina joined Freedom Fertility Pharmacy as the Clinical Educator responsible for developing infertility educational content for employees, patients, nurse, and managed care plans in print and online. Gina writes a fertility blog on the Freedom Fertility Pharmacy website and enjoys educating and empowering patients to take an active role in their fertility treatment.

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