Menopur: A Photo Essay

So this is the "kit" for our morning Menopur injection:

It's actually very ad hoc, being an amalgam of new drugs and old (from the Ainsleigh cycle) paraphernalia. Clockwise from top left, we have: sterile alcohol pads to clean the vials and injection sites; the syringe, prepackages with a needle that's much too big and so never used; a Q-Cap (see below); the vials of medicine and diluant (ditto); and the actual needle we'll use (in the center).

This particular medicine comes as a powder.  I'm not totally sure why.  It seems likely that the drug is not stable in solution; both the Follistim and Lupron have to be refrigerated to keep from decaying, so perhaps the crystalline form can be stored longer and cheaper, saving the manufacturer and distributors money.  Also, this packaging makes the concentration of the injected solution adjustable.  When you buy solutions like Follistim, the only way to get a bigger dose of the drug is to inject a larger volume of the solution.  With the Menopur, you can get a larger dose by dissolving multiple vials of crystalling drug in a single dose of the saline diluant.  Of course, the flip side is that the volumes we're dealing with here are much greater; 1 mL of Menopur solution vs. 0.05mL of Lupron or some similarly small volume of Follistim.  So it seems like the stability thing is the most likely explanation.

In any case, the technique here is to use this little doodad called a Q-Cap to mix the saline solution (brown label) with the powdered drug (white label).  First, the needle that came with the syringe is removed and the Q-Cap screwed on in its place:

It's hard to see, but the Q-Cap has an outer shell that clips over the lip of the drug/diluant vial, and an inner spike that punches through the rubber top of the sterile vial.  So, the syringe clips over the vial like so:

One draws 1mL or so of the saline back into the syringe, then unclips the Q-Cap from the diluant vial:

and clips it to the drug vial:

Even the tiniest amount of diluant dissolves the drug powder completely:

the resulting mixture is then drawn back up into the syringe, and the Q-Cap unscrewed and discarded:

The injection needle is attached, and we're ready to go.

For scale, here's what the shot looks like in my hand:

Note that this needle is actally much too big.  The shot is subcutaneous, which is a fancy way to say it goes into the fat just under your skin.  For this the needle really only neds to be a half inch long.  However, we had these 1.5 inch needles laying around, and we're trying to cut costs wherever we can.  So we decided to just go with it.  My brilliant plan?  Only stick the 1.5in needle a third of the way in.  Presto, a half-inch needle.  How do you like them apples.

Anyway the shot goes lickety-split, but because of the volume it hurts Sarah more and causes more bruising.  The poor girl has quite the pattern of bruises across her belly, but she's hanging in there.