Pulsatile GnRH Administration
Infertility patients who are not ovulating may be treated with subcutaneous or intravenous administration of GnRH (Gonadotropin Releasing Hormone). The purpose of this drug is to induce ovulation.

Description
GnRH is administered either subcutaneously (a small needle inserted into the abdomen) or intravenously (a small needle inserted into a vein in the arm). The needle is attached to a long plastic tubing which attaches to a syringe inserted in a pump. Multiple doses of the drug are injected by use of a battery-powered infusion pump. The pump is set to administer a set dosage of GnRH every 90 minutes. The pump will make a small noise when each dose is given. The pump is worn during the entire period of drug administration. This period of time usually begins on day 3 of your menstrual cycle and ends at the time you ovulate.

Procedure
1. You will need an ultrasound appointment on the day of pump insertion (the third day of your menstrual cycle). This is necessary to check that your ovaries are normal size. This appointment is made by calling Georgia Reproductive Specialists at (404) 843-2229. All pump appointments are scheduled between 7:30 and 9:30 a.m.

2. At this appointment, the doctor will begin the GnRH therapy by inserting the needle and setting the proper dosage of GnRH for you.

3. You will have to return to our office to have the pump refilled. This is usually 7 days. During these visits, the doctor will check the needle site to make sure it is working properly and that there are no signs of infection. You will need to return more frequently to have the needle changed if there is any redness or soreness surrounding the site.

4. Beginning approximately Day 10 of your cycle, you will need to be scheduled for ultrasounds during your visits. This is done to monitor the growth of your follicle and to determine the time of ovulation. You may also have a blood test for estradiol - a hormone in your blood that rises as ovulation time nears. We will schedule repeat ultrasound examinations and estradiol levels will be tested depending upon how rapidly your follicle is growing and how high your estradiol levels are.

5. When it has been determined by an LH surge and ultrasound that you have ovulated, the pump will be discontinued. You will return to the office every three to four days for injections of a drug called hCG (Human Chorionic Gonadotropin) which is given to maintain proper hormone levels to support a pregnancy. If you do not ovulate spontaneously, we may give you an injection of hCG to induce ovulation. This is done when you have a follicle that is large enough to ovulate (about 20 mm. in diameter).

CARE OF THE PUMP
1. The pump is an expensive piece of equipment and must be treated carefully.

2. Pumps can be carried in your pocket or worn strapped to the waist with a narrow belt. If you strap it to your waist, you are less likely to forget that it is there and you are less likely to drop it accidentally.

3. During sleep, the pump can be set on a bedside stand or strapped to the bed with a belt. Do not forget to take it with you if you get up during the night!

4. We do not recommend tub baths, swimming or other water sports while the pump is in, especially if the needle is inserted in the abdomen. If you do not have a shower, keep the water level in the tub below the injection sight or sponge bathe at the sink. When showering, the pump can be hung from the shower rod or shower head encased in a plastic bag. Otherwise, you can place it on a stool outside the shower curtain. The important thing is to keep the pump dry at all times.

5. The plastic tubing attached to the pump will be securely taped down at the time the pump is started. This tubing will not collapse if pressure is applied to it. Be careful around pets and children, however, because the tubing can come apart.

6. Check the needle site every day, looking for bleeding, redness, soreness, or drainage. If any of these symptoms appear, make an appointment for a pump check by calling the office at 843-2229.