Gonal-F (Follitropin Alfa)

Gonal‑F is prescribed for several fertility‑related conditions where stimulation of ovarian follicle development is required.

• Anovulatory infertility, such as in polycystic ovary syndrome, to induce ovulation.
• Controlled ovarian stimulation in assisted reproductive technology (ART) procedures, including in vitro fertilisation.
• Treatment of hypogonadotropic hypogonadism to restore normal gonadal function.
• Preparation of the endometrium for embryo transfer in selected protocols.
• Adjunct therapy in donor‑egg cycles to optimise follicular response.

The safety profile of Gonal‑F includes a range of observed adverse reactions, which are generally classified by frequency.

Common

• Injection‑site reactions such as redness, swelling, or mild pain.
• Headache or mild dizziness.
• Nausea, abdominal discomfort, or bloating.
• Mild ovarian enlargement with multiple follicular cysts.

Serious

• Ovarian hyperstimulation syndrome (OHSS), which can be moderate to severe.
• Multiple pregnancy (twins or higher order).
• Thromboembolic events, including deep‑vein thrombosis or pulmonary embolism.

Before initiating Gonal‑F therapy, clinicians should evaluate patient history and monitor specific parameters to minimise risks.

• Confirm diagnosis of infertility and rule out contraindications such as ovarian cysts or malignancy.
• Perform baseline ultrasound and hormone assessments to guide dosing.
• Monitor follicular growth regularly to detect excessive response.
• Adjust dose or discontinue if signs of ovarian hyperstimulation appear.
• Counsel patients on the increased likelihood of multiple gestations.
• Advise against use in uncontrolled thyroid disease or uncontrolled diabetes.
• Ensure pregnancy testing before starting treatment.

Gonal‑F may interact with other medications or substances that affect ovarian response or coagulation pathways.

Avoid

• Concurrent use of other gonadotropins or high‑dose estrogen preparations without specialist guidance.
• Medications that significantly increase the risk of thrombosis, such as hormonal contraceptives containing estrogen.

Use with caution

• Anticoagulant therapy (e.g., warfarin, direct oral anticoagulants) – monitor coagulation status.
• Thyroid hormone replacement – adjust dose based on thyroid function tests.
• Insulin or oral hypoglycaemic agents – monitor glucose control during treatment.
• Aromatase inhibitors – may alter estrogen feedback and require dose adjustment.