Gonal-F

Indications

Follitropin Alfa is a fertility medicine. In women it is used to stimulate the ovaries to develop eggs, either to bring on ovulation in women who do not ovulate (for example with polycystic ovary syndrome) or to produce several eggs for assisted reproduction such as IVF. It is sometimes combined with luteinising hormone (LH) in women with very low LH. In men with certain hormone deficiencies, it is used with human chorionic gonadotropin (hCG) to stimulate sperm production.

How It Works

Follitropin Alfa is a man-made form of follicle-stimulating hormone (FSH), made by recombinant technology. FSH is the natural hormone that tells the ovaries to grow follicles (small fluid sacs that contain eggs) and, in men, helps the testes produce sperm. Giving extra FSH under close monitoring helps one or more follicles mature; a separate trigger injection then releases the egg.

Dosage and Administration

Use only under the supervision of a fertility specialist. The dose and length of treatment are worked out for each person and adjusted according to ultrasound scans and hormone blood tests, so it is used as prescribed. It is injected under the skin, usually once a day, using a pen or prefilled syringe. A doctor or nurse will train you to give the injection yourself. Keep all monitoring appointments.

Interactions

It is commonly used with other fertility medicines such as Clomifene, GnRH agonists or antagonists and hCG, and the doctor will adjust doses accordingly; using it with Clomifene or after GnRH agonists may change the amount of FSH needed. No other important drug interactions are known, but tell your doctor about all medicines you use.

Contraindications

Do not use if you are allergic to FSH or any ingredient; have tumours of the hypothalamus or pituitary gland; have enlarged ovaries or ovarian cysts not caused by polycystic ovary syndrome; have unexplained vaginal bleeding; have cancer of the ovary, womb or breast; are pregnant or breastfeeding; or have early menopause or a condition that makes pregnancy impossible (such as absent womb or blocked tubes in the case of ovulation induction). In men, it is not used when the testes have failed completely.

Side Effects

Common side effects include headache, stomach pain or bloating, nausea, and pain, redness or bruising at the injection site. Ovarian cysts can form. Treatment increases the chance of twins or more babies and of ectopic pregnancy. Ovarian hyperstimulation syndrome (OHSS), in which the ovaries over-respond, can occur. Rarely, blood clots or allergic reactions develop. Men may notice breast swelling, acne or weight gain.

Get urgent medical help for severe stomach pain or swelling, rapid weight gain, vomiting or diarrhoea, passing very little urine, shortness of breath, leg pain or swelling, chest pain, or signs of a serious allergic reaction, as these may be signs of OHSS, a blood clot or anaphylaxis.

Pregnancy and Lactation

It is not used once pregnancy is established and must not be used while breastfeeding.

Precautions and Warnings

• Regular ultrasound scans and blood tests are needed to reduce the risk of overstimulation and multiple pregnancy.
• Thyroid, adrenal or pituitary problems should be treated before starting.
• Tell your doctor if you or your family have had blood clots.
• Follow advice about sexual intercourse and the trigger injection timing exactly.
• Never share your pen, even if the needle is changed.

Overdose

Too much may cause ovarian hyperstimulation syndrome. Contact your fertility clinic straight away; treatment depends on symptoms and may require hospital care.

Therapeutic Class

Gonadotropin (recombinant follicle-stimulating hormone), fertility agent

Storage

Store in a refrigerator at 2 to 8°C, do not freeze, and keep in the original pack to protect from light. Some pens may be kept at room temperature for a limited time; follow the directions on the pack. Keep out of the reach of children.