Follitropin alfa

Treatment must be initiated under the supervision of a physician experienced in fertility disorders. Doses, regimens and monitoring should be individualised to optimise follicular development and minimise unwanted ovarian hyperstimulation. ANOVULATION (incl. PCOS): in menstruating women commence within the first 7 days of the menstrual cycle; registration-trial regimen commenced at 75-150 IU FSH daily. The starting dose can be adjusted stepwise (a) lower than 75 IU/day if an excessive ovarian response is anticipated from the patient's clinical profile (age, BMI, ovarian reserve), or (b) higher than 75 up to a maximum of 150 IU/day if a low ovarian response is anticipated. If an excessive response occurs, stop treatment, withhold hCG and recommence the next cycle at a lower dose. OVARIAN STIMULATION FOR IVF/ART: commonly 150 to 225 IU daily commencing on day 2 or 3 of the cycle; if excessive response is expected the starting dose may be decreased below 150 IU. May be given alone or, to prevent premature luteinisation, with a GnRH agonist or antagonist. SEVERE LH AND FSH DEFICIENCY: give as daily injections simultaneously with lutropin alfa; recommended regimen commences at 75 IU lutropin alfa daily with 75 to 150 IU FSH; if an FSH dose increase is appropriate, adapt preferably at 7 to 14-day intervals and preferably by 37.5 to 75 IU increments; it may be acceptable to extend stimulation in any one cycle to up to 5 weeks. If amenorrhoeic with low endogenous estrogen secretion, treatment can commence at any time. Luteal phase support may be considered. FINAL FOLLICULAR MATURATION (all female indications): when an optimal ovarian response is obtained, a single injection of 250 micrograms recombinant human choriogonadotropin alfa (r-hCG) or 5 000 IU up to 10 000 IU hCG is administered 24 to 48 hours after the last follitropin alfa injection; coitus is recommended on the day of and the day following hCG, or intrauterine insemination may be performed. Monitor response by follicle size and number on ultrasound and/or estrogen secretion. MEN WITH HYPOGONADOTROPHIC HYPOGONADISM: the fetched eMC extract is truncated mid-sentence ('Follitropin alfa should be given at a dose of ...') so the UK male dose is NOT available and must be sourced separately — for cross-reference only, the US Gonal-f label in the same bundle states that after serum testosterone is normalised with hCG pre-treatment, 150 International Units is given subcutaneously three times a week together with 1,000 USP units hCG three times a week. Patients must be provided with the correct number of pens and taught proper injection technique.