Gonal-F (Follitropin Alfa)

Gonal-F is prescribed for several fertility-related conditions where stimulation of follicle-stimulating hormone pathways is required.

• Induction of ovulation in women with anovulatory disorders such as polycystic ovary syndrome.
• Controlled ovarian stimulation for assisted reproductive technologies including in-vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI).
• Treatment of hypogonadotropic hypogonadism to restore normal gonadal function.
• Management of male infertility associated with low endogenous FSH levels to support spermatogenesis.
• Support of follicular development in women undergoing donor egg cycles.
• Use in combination with luteinising hormone analogues for multifollicular growth in certain protocols.

The safety profile of Gonal-F reflects its pharmacologic activity on the reproductive axis; side effects are reported in clinical use and may vary in frequency.

Common

• Injection site reactions such as redness, swelling, or mild pain.
• Headache or mild dizziness.
• Abdominal discomfort or bloating.
• Mood changes including irritability or mild anxiety.
• Nausea or mild vomiting.
• Fatigue or decreased energy.

Serious

• Ovarian hyperstimulation syndrome (OHSS) presenting with rapid weight gain, abdominal distension, or shortness of breath.
• Multiple pregnancy (twins, triplets, etc.) due to overstimulation.
• Severe allergic reaction (anaphylaxis) with rash, swelling, or difficulty breathing.
• Thromboembolic events, though rare, such as deep vein thrombosis.
• Ovarian cyst formation that may require monitoring.
• Severe abdominal pain indicating possible ovarian torsion.

When prescribing Gonal-F, clinicians consider several precautionary measures to minimise risks and ensure appropriate patient selection.

• Confirm diagnosis of infertility and assess baseline hormone levels before initiating therapy.
• Evaluate for contraindications such as ovarian cysts, uncontrolled thyroid disease, or active malignancy.
• Monitor ovarian response with ultrasound and estradiol measurements to detect excessive stimulation.
• Adjust dose based on individual response and avoid over-dosage.
• Counsel patients on recognizing symptoms of ovarian hyperstimulation syndrome and when to seek medical attention.
• Use caution in patients with a history of thromboembolic events or cardiovascular disease.
• In men, assess baseline sperm parameters and FSH levels before treatment.

Gonal-F may interact with other medications or substances that affect hormonal balance, ovarian response, or coagulation pathways.

Avoid

• Concurrent use of other gonadotropins or high-dose estrogen preparations that could exacerbate ovarian stimulation.
• Medications known to increase the risk of thromboembolism, such as hormonal contraceptives containing estrogen, during treatment.

Use with caution

• Anticoagulant therapy (e.g., warfarin, direct oral anticoagulants) because of the potential for altered clotting risk in cases of ovarian hyperstimulation.
• Thyroid hormone replacement or antithyroid drugs, requiring monitoring of thyroid function during therapy.
• Non-steroidal anti-inflammatory drugs (NSAIDs) that may affect prostaglandin synthesis and uterine contractility.
• Any medication that influences the hypothalamic-pituitary-gonadal axis, such as GnRH analogues, should be coordinated with the treating specialist.