Gonal-F (Follitropin Alfa)

Gonal‑F is indicated for several fertility‑related conditions where stimulation of the ovaries is required.

• Treatment of infertility caused by anovulation, such as in polycystic ovary syndrome.
• Controlled ovarian stimulation in assisted reproductive technology cycles, including in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI).
• Induction of ovulation for women with hypogonadotropic hypogonadism.
• Use in combination with other gonadotropins or luteinising hormone preparations as part of a comprehensive fertility protocol.

Side effects reported with Gonal‑F vary in frequency and severity; they are generally related to the drug’s action on ovarian tissue and the hormonal changes it induces.

Common

• Mild abdominal discomfort or bloating.
• Local injection site reactions such as redness, swelling, or itching.
• Headache or mild fatigue.
• Ovarian hyperstimulation syndrome (OHSS) in its mild form, presenting with abdominal distension and mild nausea.
• Nausea or mild vomiting.

Serious

• Severe OHSS, characterized by rapid weight gain, significant abdominal pain, and shortness of breath.
• Ovarian cyst formation that may require surgical intervention.
• Allergic reactions including rash, urticaria, or anaphylaxis.
• Thromboembolic events, though rare, have been observed in patients with severe OHSS.

When prescribing Gonal‑F, clinicians consider several safety factors to minimise risks and optimise treatment outcomes.

• Evaluate baseline ovarian reserve and monitor follicular response throughout therapy.
• Use the lowest effective dose and adjust based on ultrasound and estradiol measurements.
• Counsel patients about the signs of ovarian hyperstimulation syndrome and advise prompt medical attention if symptoms develop.
• Avoid use in patients with known hypersensitivity to any component of the formulation.
• Exercise caution in women with uncontrolled thyroid disease, adrenal insufficiency, or pituitary disorders.
• Consider postponing treatment in pregnancy or while breastfeeding, as safety has not been established.

Gonal‑F may interact with other medications or substances that affect hormone levels, ovarian response, or fluid balance.

Avoid

• Concurrent use of high‑dose estrogen‑containing oral contraceptives, which can blunt the ovarian response to FSH.
• Co‑administration of drugs that significantly increase the risk of thromboembolism in patients predisposed to severe OHSS.

Use with caution

• Gonadotropin‑releasing hormone (GnRH) agonists or antagonists used in assisted reproduction protocols; dosing may need adjustment.
• Anticoagulants, because severe OHSS can predispose to clot formation.
• Diuretics, which may mask early signs of fluid shift associated with OHSS.
• Thyroid hormone replacement, requiring monitoring of thyroid function during stimulation.