Pergonal

menotropins

HMG

Menopur

Pergonal

Repronex

Indications

Action

Pharmacokinetics

Time/action profile (effects on reproductive function†)

Contraindications/Precautions

Adverse Reactions/Side Effects

Cardiovascular

• thromboembolism (life-threatening)
• edema
• thrombophlebitis

Gastrointestinal

• abdominal pain (most frequent)
• bloating (most frequent)
• diarrhea
• nausea
• vomiting

Genitourinary

• pelvic pain (most frequent)
• multiple births
• ovarian enlargement

Endocrinologic

• gynecomastia (men)

Miscellaneous

• fever

Interactions

Drug-Drug interaction

Route/Dosage

Availability

Nursing implications

Nursing assessment

• Female Infertility: Gynecologic and endocrine examinations to determine the cause of infertility should be completed before therapy. The patient’s partner should also be evaluated for possible decreased fertility. An endometrial biopsy should be performed in older patients to rule out the presence of endometrial carcinoma.
• Ultrasound exams are recommended during menotropin therapy and before administration of chorionic gonadotropin.
• Male Infertility: Urologic and endocrine examinations to determine the cause of infertility should be completed before therapy.
• Lab Test Considerations: In female infertility, cervical mucus volume and character, serum estradiol levels, serum or urine progesterone concentrations, and ultrasound may be used to determine whether follicular maturation has occurred.
  • In male infertility, serum testosterone, sperm count, and motility should be evaluated before and after course of therapy.

Potential Nursing Diagnoses

Implementation

• Female infertility—chorionic gonadotropin is usually administered 1 day after course of human menotropins. Male infertility—chorionic gonadotropin is administered alone until secondary sex characteristics develop, then administered concurrently with menotropins.
• Subcutaneous: Alternating sites in the lower abdomen should be used for subcut injection.
• Intramuscular: Reconstitute powder with 2-mL vial of 0.9% NaCl for injection provided by manufacturer. Use immediately; discard any unused portion of dose.

Patient/Family Teaching

• Instruct patient in correct technique for medication reconstitution and administration of IM injection. Ensure that patient understands medication administration schedule.
• Female Infertility: Instruct patient in the correct method for measuring basal body temperature. A record of the daily basal body temperature should be maintained before and throughout course of therapy.
  • Reinforce physician’s instructions regarding timing of sexual intercourse (usually daily beginning 1 day after administration of chorionic gonadotropin).
  • Emphasize the importance of close monitoring by the physician throughout course of therapy (daily pelvic examinations are indicated after estrogen levels rise and for 2 wk after chorionic gonadotropin therapy).
  • Inform patient before therapy of the potential for multiple births.
  • Instruct patient to notify physician immediately if pregnancy is suspected (menses do not occur when expected and basal body temperature is biphasic).
  • Advise patient to report to physician signs and symptoms of fluid retention (swelling of ankles and feet, weight gain), thromboembolic disorders (pain, swelling, tenderness in extremities, headache, chest pain, blurred vision), or abdominal or pelvic pain or bloating.
• Male Infertility: Inform patient that breast enlargement may occur. Physician should be consulted if this is problematic.

Evaluation/Desired Outcomes

• Follicular maturation in women. Menotropin therapy is followed by human chorionic gonadotropin, which should lead to ovulation with subsequent pregnancy. If ovulation does not occur after any cycle, therapeutic regimen should be re-evaluated. If ovulation does not occur after 3 cycles, appropriateness of continuation of menotropin therapy should be reconsidered.
• Increased spermatogenesis after 4 mo of therapy in men.