Oops, Shoot, Sh-t: What to Do When You Have a Medication Error

No matter how you choose to say it, either PG or double-X rated, medication errors can make you nuts. Depending on when and where they happen in your cycle, they can cause major anxiety. The fear of knowing if you tanked your IVF cycle can be overwhelming, to say the least! And while some errors can be cycle ending, most are no more than a minor blip (and one that we can fix pretty easily). The best advice we can give you is to take a deep breath, gather your thoughts, WRITE down what you took and when you took it, and contact your doctor’s office. Going on the Internet to see how serious of a snafu it was or panicking is not going to solve any problems. Letting us know and letting us help you fix it will.

As fertility doctors, we give A LOT of medications—both oral and injectable. While the orals are pretty straightforward (most of us have been swallowing pills for the entirety of our adult lives), the injectable ones can get a bit dicey. Sure, you can miss a pill, and that can set you into a panic. But most of the time, we tell you to double up or simply skip what you missed. No harm; no foul. With the injectable ones, there is a little bit more to it. First, you have to learn how to not only inject but also mix medications. Problems on both ends can result in a medication error. Most fertility centers will have you sit through a class or take an online course to review the process. And while there are no grades and no pop quizzes, we recommend that you don’t snooze through this class. It will be important down the road. Often, when something seems to go awry or you are having a memory lapse, going to an online source, be it the fertility clinic site, YouTube, or a Facebook group, can be helpful. It can get you back on course. But again, take it from girls in the know…call your doctor!

Although we don’t want to raise your blood pressure, we don’t want to give you a preview into what might go wrong. Here are the six most common mistakes we have seen:

1. I gave myself the wrong dose (too much or too little).
2. I gave myself the wrong medication.
3. I left my medication out on the counter overnight.
4. I didn’t mix the medication correctly.
5. I injected, but a lot of the water leaked out.
6. I took my medication at the wrong time.

Again, we are not sharing them to stress you out (if you on the verge of doing IVF) but to bring you solace. You are not alone if you mess up—you are certainly not the first to have done it and definitely won’t be the last.

Although we likely won’t be the ones to pick up the phone when you do make that mistake, here is what we would say (in the order we wrote them above):

1. Most over- or under-dosing (if caught quickly) can be remedied without so much as a hiccup. And while no one wants to be running at half-mast, the ones that make us cringe are the dangerous-, you-can-get-seriously-sick ones—women who have ovaries with tons of follicles are generally put on a low dose of hormones to prevent ovarian hyperstimulation syndrome (OHSS). If they accidentally triple their dose, they are seriously increasing their risk for OHSS.We can usually remedy the problem by reducing the dose, but it’s VERY important to call once you identify the mistake. Most of the times dosage errors happen when you didn’t get the right instructions or dialed up the pen incorrectly (for those formulations using a “pen” to administer). The best way to solve this is to write your instructions down in a SAFE place (not on your crumpled napkin from lunch) and to carefully set that dial. If you are getting an “I dunno type of feeling” when you are about to dial in the dose, phone a friend (a.k.a. your doctor) before you inject.
2. Many of the medication names read like foreign languages. Most of us have never heard of Follistim or Gonal-F, let alone human chorionic gonadotropin (hCG). Swapping Follistim for Menopur or Gonal-F for Follistim is NO big deal (it’s like drinking Coke instead of Pepsi). However, giving yourself hCG instead of Ganarelix can be a big no-no. Our suggestion to ensure that this doesn’t happen is the following: become acquainted with all of your medications BEFORE the cycle starts. Open up those many boxes, and lay all of the contents out on your kitchen counter. While it may sound overwhelming, it will let you know what you have (and what you don’t have). Check it like you would a packing list with the list of instructions you got at the outset of the cycle. If something is missing, let your doctor know ASAP. Knowing what you have and what you are missing will not only let you prepare for the cycle in its entirety, but it will also make interpreting the daily medicine instructions a bit easier. It will be like hearing a foreign language a couple of times before traveling to that country!
3. There are a lot of medications that come with an IVF cycle. They can turn your fridge into a pharmacy! Some medications need to be kept in a cold place. Make sure you are aware of which prefer the hotter climates and which like colder ones before you run out and leave all of the drugs on the counter. In reality, unless you are in the Deep South in the dead of summer, even if you left the “cold-blooded” ones out of the fridge for a night or two, you would be totally fine. However, prepping for what goes where will make the organizational aspect of things a whole lot simpler.
4. Mixing can get people all mixed up! IMs, ccs, syringes, and needles; it’s like a baking experiment gone wrong. And unfortunately, more than one of the medications we use needs to be mixed. Our solution to this is practice—a test run before the big day. It will alleviate a lot of anxiety and clear up some of the confusion. If you are confused by what to mix with what and how much to pour where, make sure to ask before the oven timer goes off!
5. The leakage effect is all in effect when it comes to shots. There will be water going in and going out after you administer a shot. The out part is usually what gets people freaked out and thinking that they must have done something wrong. Let the leaking go! It is highly unlikely that you lost a substantial amount of the medication in that trickle. Focus on what you did get in and how fierce you are to take shots two, sometimes three times, a day!
6. Set an alarm clock. Set two alarm clocks. Set three if you need to! Timing for fertility medications is important, particularly for the last shot (a.k.a. the trigger shot). That final injection is timed to precede the retrieval by about 34–36 hours. While being off in the grand finale by minutes is nothing to lose sleep over, being off by hours can be pretty dramatic. Although we can usually match your time to ours, it’s best to be as in sync with our show time as possible.

There are medication errors that matter and those that don’t mean all that much. You won’t know what’s yours is unless you ask. Take copious notes when you get your instructions, and if something is unclear, press pause and ask the person on the other end to repeat. It may save you a major error and some major anxiety. And even if you do make the error of all errors, it was an accident. We all make mistakes—how we handle them is what determines the outcome. Think of it this way: you certainly won’t make that same mistake again!