# Menopur mixing faff



## JudithS (Feb 12, 2006)

Hello,
Has anyone else found Menopur tricky to mix?
The main problem is that I always get an air bubble at the plunger end of the syringe, so once I've also sucked up the mixture into the syringe, the plunger is nearly coming out of the end! I nearly lost 225 units last night... fortunately, I somehow managed to keep the plunger in, but only just. It's impossible to get the air out until you switch to the smaller bore needle -- some kind of physics-suction thing.

Any reason I should not suck it up in two lots? This would mean four jabs (I am on 450 units) but surely that's preferable?

The other thing is I've bent two needles when putting them on the syringe and I keep breaking the water phials, even when using the snappers!
- JudithS


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## mazv (Jul 31, 2006)

Hi Judith,

It's not easy is it! The problem with the vials is that there is a vacum inside so as soon as you puncture the vial the liquid gets sucked in and it's hard to suck it back out again. I'm assuming you are using 2 vials of water (1ml per 225 units)? No reason you can't draw it up in two lots and inject it separately. So long as it all goes in.

With the air bubble if you hold the syringe upright and tap it quite hard at the plunger end the bubble should rise up to the top and you can then just squeeze it out. You really do have to hit the barrel quite hard to get it to shift but it does work.

The vials are easier to snap if you pull off the top bit facing away from the blue dot, under the blue dot you'll see a very small line, which is a small cut in the glass. In theory the vial breaks easily along this line if you pull the top away from this. Don't know if I'm managing to explain any of this very well. It's a lot easier to show someone. Does your clinic show you what to do?

Hope this helps. good luck with the stabbing!

Maz x


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## JudithS (Feb 12, 2006)

mazv said:


> I'm assuming you are using 2 vials of water (1ml per 225 units)? No reason you can't draw it up in two lots and inject it separately. So long as it all goes in.


I tried this tonight with one of them but I just seemed to get even more air in the syringe 



mazv said:


> With the air bubble if you hold the syringe upright and tap it quite hard at the plunger end the bubble should rise up to the top and you can then just squeeze it out. You really do have to hit the barrel quite hard to get it to shift


I was hitting it hard but it wouldn't shift... I was scared if I hit it any harder, the plunger would come out: it was wobbling violently. The leaflet says "press the plunger gently" and that does make the air rise but of course, you lose some liquid as well, and I am scared I have lost too much. I wish the clinic had had some dummy syringes/vials to practice with -- do they realise I am an amateur?!



mazv said:


> The vials are easier to snap if you pull off the top bit facing away from the blue dot, under the blue dot you'll see a very small line, which is a small cut in the glass. In theory the vial breaks easily along this line... Does your clinic show you what to do?


Now this bit, they _did_ demonstrate for me and I had difficulty then, too 

I think I am going to have to try to phone the clinic tomorrow (very hard when I am at work! Which is when they are in!) because this is really worrying me. I've just done tonight's -- my third night -- and it seems to be getting harder, not easier!


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## kitykat (Sep 21, 2006)

HI there, 

thought I would try to help..

So I'm not quite sure I have understood exactly what the problem is but will explain how I did it. I ended up of a huge dose of Menopur on my last cycle.

So the advice about how to snap the top off the water was good. It is easiest to draw up the water with the vial upside down. The water doesn't fall out. Put the needle in and then turn it upside down and draw it up. Don't worry if you don't get it all in one go. Inject the water into the Menopur vial and then go back for the drop of water you couldn't get.

Mix, then put the needle with syringe attached into the menopur vial. I found it easiest to keep it the right way up. If you get air in the syringe, either keeping the needle in the vial or not - it doesn't matter,so long as you don't let the needle touch anything else)  -turn it the right way up,  give it a tap ( I tapped it on the edge of the table) to make the air rise to the top. Then eject the air and start to draw up again. (If you take the needle out of the vial, make sure you draw back on the syringe to get all the liquid in the needle in the syringe) I sometimes did this three times before I could get all the liquid into the syringe. You do end up with the plunger wobbling a bit by the time all the liquid is in - it worried me too as the menopur is so expensive!! 

I hope that helps a little. Use one syringe and needle and have a practice with some tap water at getting air bubbles out.

OK - I have to admit I am a doctor and I don't do a lot of this drawing stuff anymore, but I did it a lot as a junior doctor. I found drawing up Menopur fiddly even with some practice years ago, so I am always stunned at how well all you ladies cope with it. Keep trying - you might just get your BFP!!!


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## JudithS (Feb 12, 2006)

Dear KityKat,
Thanks for your attempts to help! It is interesting to hear that even a doctor finds it fiddly -- glad to know it's not just me being daft.


kitykat said:


> It is easiest to draw up the water with the vial upside down. The water doesn't fall out.


I have never tried turning the vial upside down -- the opening is really quite wide, about half a centimetre across -- am I snapping it wrong or are my vials different to yours?!


kitykat said:


> put the needle with syringe attached into the menopur vial. I found it easiest to keep it the right way up.


By "right way", do you mean with the needle end at the top and plunger end at the bottom? I found then that the liquid just fell to the bottom of the vial so there was only air where the needle is (Er... this is really hard to explain in words!)


kitykat said:


> If you get air in the syringe... turn it the right way up, give it a tap... to make the air rise to the top. Then eject the air and start to draw up again.


But it just doesn't rise until I press the plunger 


kitykat said:


> If you take the needle out of the vial, make sure you draw back on the syringe to get all the liquid in the needle in the syringe


Sorry, I can't visualise this bit at all  Where is a webcam when you need one? 


kitykat said:


> Use one syringe and needle and have a practice with some tap water at getting air bubbles out.


Now, _that's_ not a bad idea!

Thanks, KityKat! I'll ring the clinic anyway and see if they can help, but thanks for trying to explain


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## Abdab (Nov 2, 2006)

Hi there
I found it easier to hold the plunger when I pierced the menopur bottle so it didn't suck in all the water in an uncontrolled way.
Also another thought - can you get bigger syringes from your clinic?  My pharmacy sent me 1ml ones so the syringe was right up at the top and wobbling around, but my clinic had 2ml ones so there was no danger of that.  Possibly worth asking.
Don't worry about finding it tough, I had all sorts of things go wrong like glass bottles shattering all over the floor, syringes full of bubbles, but I got there in the end.
Abdab


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## kitykat (Sep 21, 2006)

Hi again 

Feel like I just confused yoou. Don't have a webcam. I am not sure I can explain any better without adding to confusion as I don't understand what you mean either!!!

Hope your clinic were able to help today.  

Love Kitykat


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## pobby (Jun 2, 2005)

Hi Judith
I have been nursing for 18 years and still got in a pickle with a 1ml syringe and 4 vials of menopure! It is perfectly acceptable to draw up into a 2ml syringe. I found this to be a lot easier and you dont end up loosing any .
good luck
pobby x


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## JudithS (Feb 12, 2006)

Abdab said:


> can you get bigger syringes from your clinic? My pharmacy sent me 1ml ones so the syringe was right up at the top and wobbling around, but my clinic had 2ml ones


Thanks -- that occured to me today, too. I might ask when I go in on Monday.

Thanks to *Jillypops * and again to *Kitykat*, too! 

I rang the clinic today and the woman I spoke to suggested that I should only draw HALF the mixture into the syringe first, withdraw the syringe from the Menopur vial, THEN knock out the air bubble. Because the plunger is firmly halfway up the syringe, there is no danger of it being knocked off the end. Then I should put the syringe back into the Menopur vial and draw up the rest of the mixture.

I tried it tonight and it worked! I hadn't tried it before because the leaflet says "do not withdraw the syringe until you have drawn up all the liquid". When you draw it up in two lots, you do still get an air bubble, but it is much smaller and it's easier to knock it up without risking losing your plunger.

Phew! I got my full dose tonight, unlike last night. 
Still having water vial difficulties but at least I got the full dose!


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## ♥JJ1♥ (Feb 11, 2006)

Judith I was on 8 vials so 600 units of Menopur and my clinic told me for 1 vial of water I could mix up to 4 vials of Menopur, so it was 2 injections in total.  

Also you could ask for some 2 ml syringes instead of 1 mls,as less likely to loose the plunger- this is what my friend and I found easier (we are nurses so have an endless supply to different sized syringes etc) but you can't use an autoinjector with a 2 mls syringe
Good luck
L x


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## JudithS (Feb 12, 2006)

JJ1 said:


> you could ask for some 2 ml syringes instead of 1 mls,as less likely to loose the plunger... but you can't use an autoinjector with a 2 mls syringe


Thanks  I don't use an autoinjector anyway as I consider them an unnecessary complication


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## JellyR (Feb 9, 2007)

I hope you don't mind me joining in this thread but I have been mixing 4 vials of menopur for the last couple of weeks and not really had any problems.  The one difference i think i have from you guys is that i was told i only needed to use enough water to disolve the powder so i was only using about 0.5ml of water.

This meant that i didn't have any of the problems with the plunger coming out of the syringe as you seem to have had, and when i injected this into the menopur it didn't create enough of a vacuum to cause a problem with drawing it up either.  I then used to tap the air to the top and change the needles before pushing the air out of the smaller needle which seemed to work much better than trying to push it out of the large one.

Hope this has helped a bit!


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## JudithS (Feb 12, 2006)

JellyR said:


> i was told i only needed to use enough water to disolve the powder so i was only using about 0.5ml of water... when i injected this into the menopur it didn't create enough of a vacuum to cause a problem with drawing it up either.


Isn't it funny that different clinics tell different ladies different things?! Thanks for your comments, and I see you've just had some eggs collected -- good luck!


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## JellyR (Feb 9, 2007)

Jillypops said:


> Glad you got it sorted xxxx
> oH jellyhead.. see we had EC a day apart.. how did it go?


Hi Jillypops - egg collection was horrible! They collected 8 eggs from 16 follicles but i didn't come out of the anaesthetic very well and was on oxygen for a couple of hours and in really bad pain. Still in loads of pain now and am a bit worried that i have OHSS as a lot of the symptoms i have match - supposed to be having ET tomorrow so will find out one way or the other then. The embryologist called yesterday and said that 3 had fertilised but didn't give me any more details - so again i have to wait until tomorrow.

How did yours go?


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## JudithS (Feb 12, 2006)

JellyR said:


> egg collection was horrible! They collected 8 eggs from 16 follicles but i didn't come out of the anaesthetic very well and was on oxygen for a couple of hours and in really bad pain. Still in loads of pain now... The embryologist called yesterday and said that 3 had fertilised but didn't give me any more details


Well done for getting three fertilised! I hope they are good grades -- I bet you are nervous waiting to find out how they are? Hope you sleep OK -- good luck.


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## JellyR (Feb 9, 2007)

Hi Jillypops - good news on the embies.  I have 2 on board too - put back yesterday - 1 x 8 cell grade 2 and 1 x 2 cell.  They said they wouldn't normally put the 2 cell back if they had a choice but my third fertilised egg failed to divide so they figured they had nothing to lose.  Quite pleased about my 8 cell though!

Needed the loo before we left the hospital and freaked DH out - didn't want me to flush them away (bless!) 

Are you managing to rest on the 2ww?  I was back at work today and feeling a bit jealous of people that are able to take time off - still, at least it will take my mind off any 'symptoms'!

Sending you lots of    Take care of those embies xx


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## JellyR (Feb 9, 2007)

Hi Jillypops

Not been on for couple of days as working late Wednesday and DH took me out for dinner yesterday.  Hope you managed to get through your paperwork OK.

Had EC on Friday and ET on Monday so think that's a 3 day transfer.  Have really high hopes for my 8 cell - I've already decided it's a 'he' and have told DH that he'll be finding his nice cosy place to settle down in soon - think i've gone a bit  !!

Feeling a bit better today - finally the EC pain has gone and the bloatedness is going down so am getting back to normal - still can only fit into my 'fat' clothes though  

Don't know how I'm going to cope at work for a full week next week - had some time off with flu a couple of weeks ago then off for EC last week and ET this week so haven't done a full week in ages!  Decided going to take the day of the test off though as don't think I'll be able to face work whatever the outcome.

Do you have to go to your clinic for your test?  Mine is a home pee stick so will have to resist the temptation to test early!  DH is acting as the  

Anyway, hope all is well with you - it's a bit early yet but here's a little mantra for us both 
            

Take care, chat soon xxxxx


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