Gonal-F (Follitropin Alfa)

Gonal‑F is indicated for several reproductive‑health conditions where stimulation of follicular growth is required.

• Treatment of infertility caused by anovulation, such as in polycystic ovary syndrome, by promoting follicle growth.
• Controlled ovarian stimulation for assisted reproductive technologies, including in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI), to obtain multiple mature oocytes.
• Ovulation induction in women with hypogonadotropic hypogonadism, helping to restore normal menstrual cycles and improve chances of conception.
• Use in combination with luteinising hormone (LH) preparations for certain stimulation protocols, enhancing follicular response and luteal phase support.
• Support of follicular development in donor egg cycles, facilitating the retrieval of high‑quality oocytes for donation programmes.

The safety profile of Gonal‑F includes a range of observed adverse events that vary in frequency and severity.

Common

• Injection‑site reactions such as redness, swelling, or mild pain at the administration site.
• Headache or mild dizziness that may occur during the stimulation cycle.
• Abdominal discomfort, bloating, or mild nausea often reported in early treatment weeks.
• Mild ovarian hyperstimulation symptoms, including mild pelvic pain and transient weight gain.
• Nausea or vomiting, generally mild and self‑limiting.

Serious

• Ovarian hyperstimulation syndrome (OHSS) presenting with rapid weight gain, abdominal distension, ascites, or shortness of breath, requiring medical attention.
• Multiple pregnancy (twins or higher‑order gestations) increasing obstetric risk for both mother and fetuses.
• Severe allergic reactions such as rash, itching, swelling, or anaphylaxis that may necessitate emergency care.

Before initiating Gonal‑F therapy, clinicians should evaluate patient history and monitor specific risk factors.

• Assess for ovarian cysts, endometriosis, or uterine abnormalities that may increase complication risk.
• Perform baseline transvaginal ultrasound to determine ovarian size and follicle count prior to stimulation.
• Monitor serum estradiol levels and follicular development regularly throughout the treatment cycle.
• Adjust dose or discontinue therapy if signs of moderate to severe ovarian hyperstimulation appear.
• Counsel patients on the increased likelihood of multiple gestations and associated obstetric risks.
• Avoid use in patients with known hypersensitivity to any component of the formulation.

Gonal‑F may interact with other medications or substances that affect ovarian response or hormone metabolism.

Avoid

• Concurrent use of high‑dose gonadotropins or other FSH preparations without specialist guidance.
• Use with medications that significantly increase estrogen levels, such as high‑dose oral contraceptives, during stimulation cycles.
• Avoid simultaneous use of aromatase inhibitors that may alter estrogen synthesis during treatment.

Use with caution

• Co‑administration of clomiphene citrate or letrozole, which also influence follicular development.
• Use alongside anticoagulants, as OHSS may increase thrombotic risk.
• Concomitant use of corticosteroids, which can affect hormone levels and response to stimulation.
• Use with caution when prescribing thyroid hormone replacement, as thyroid status can influence ovarian response.