Gonal-F (Follitropin Alfa)

Gonal-F is indicated for several fertility-related conditions where stimulation of follicular development is required.

• Infertility due to anovulation, such as in polycystic ovary syndrome.
• Controlled ovarian stimulation for assisted reproductive technology procedures, including in-vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI).
• Treatment of hypogonadotropic hypogonadism in women who have insufficient endogenous follicle-stimulating hormone production.
• Ovulation induction in women undergoing intra-uterine insemination (IUI) protocols.
• Adjunct therapy in donor-egg cycles to support the recipient’s endometrial preparation.

The safety profile of Gonal-F reflects its hormonal activity; side effects are reported across a range of frequencies.

Common

• Local injection-site reactions such as redness, swelling, itching, or mild pain that usually resolve within a few days.
• Headache, mild dizziness, or transient visual disturbances.
• Abdominal discomfort, bloating, or mild pelvic pressure.
• Mood changes including irritability, emotional lability, or mild anxiety.

Serious

• Ovarian hyperstimulation syndrome (OHSS), a condition that can cause rapid weight gain, severe abdominal pain, nausea, vomiting, and shortness of breath, potentially requiring hospitalization.
• Multiple pregnancy (twins, triplets, or higher order) resulting from excessive follicular response, which increases obstetric risk.
• Ovarian cyst formation or significant ovarian enlargement that may need imaging and specialist follow-up.

Before initiating Gonal-F therapy, clinicians should evaluate patient history and monitor specific clinical parameters to minimise risk.

• Confirm diagnosis of anovulation or hypogonadotropic hypogonadism and assess baseline ovarian reserve.
• Perform ultrasound monitoring of follicular development to adjust dosing and prevent ovarian hyperstimulation.
• Avoid use in patients with active ovarian, breast, or uterine malignancies, or uncontrolled thyroid disease.
• Counsel women of reproductive age about the potential for multiple gestations and the need for contraception after treatment if pregnancy is not desired.
• Review any history of allergic reactions to recombinant proteins or excipients in the formulation.
• Consider dose adjustments in patients with renal or hepatic impairment, although data are limited.

Gonal-F may interact with other medications or substances that affect ovarian response or hormone metabolism; awareness of these interactions helps optimise treatment outcomes.

Avoid

• Concurrent use of gonadotropin-releasing hormone (GnRH) antagonists that suppress endogenous FSH activity, which can diminish the intended ovarian stimulation.
• Hormonal contraceptives or estrogen-containing products during the stimulation phase, as they may interfere with follicular development.

Use with caution

• Medications that increase the risk of thrombosis, such as oral anticoagulants or selective estrogen receptor modulators, because of the estrogen rise associated with follicular growth.
• Thyroid hormone replacement therapy; dose adjustments may be needed due to altered hormone dynamics during stimulation.
• Antipsychotic or antidepressant drugs that affect prolactin levels, potentially influencing ovarian response.