By Zaira Salvador BSc, MSc (embryologist).
Last Update: 08/02/2018

Gonal-f injection is a fertility drug that contains gonadotropins, which are used for ovarian stimulation cycles in fertility treatment cycles, like IVF. Dosages available range from 75 IU to 1050 IU, although the most common are Gonal-f 300, Gonal-f 450, and Gonal-f 900.

Some dosages of Gonal-f are preassembled in a disposable delivery pen designed for subcutaneous injection. Depending on the dosage, it may be used in IVF or IUI cycles.

Description & price

Gonal-f contains a type of hormone called recombinant FSH (r-FSH). Its function is to promote the growth and development of ovarian follicles. Recombinant FSH has not a human origin (as in the case of Menopur), but is created using genetic engineering techniques in the lab. Gonal-f contains the active ingredient follitropin alfa.

Gonal-f is available in different pack sizes, and each one has a different strength.

Each type of Gonal-f contains a different amount of follitropin alfa. Your doctor will prescribe the one that matches the amount of FSH you need for your fertility treatment cycle. The following are the dosages available and their prices:

Gonal-f 75
75 IU/0.5 ml (5.5 microgram). $100/per unit approximately.
Gonal-f 300
300 IU/0.5 ml (22 microgram). $160/per unit approximately.
Gonal-f 450
450 IU/0.75 ml (33 microgram). $260/per unit approximately.
Gonal-f 900
900 IU/1.5 ml (66 microgram). $490/per unit approximately.
Gonal-f 1050
1,050 IU/1.75 ml (77 microgram). Price varies.

When to start treatment with Gonal-f

Treatment with Gonal-f should be started under the supervision of a physician experienced in the treatment of fertility disorders. The following are the most common indications:

Anovulation
As in the case of women with PCOS (Polycystic Ovary Syndrome) and those who lack ovulatory cycles in spite of having used clomiphene citrate (Clomid) or Letrozole (Femara) previously.
Stimulated IVF cycles
To induce ovarian follicle growth in women undergoing in vitro fertilization.
Hypogonadotropic hypogonadism (HH)
The purpose of using Gonal is to promote sperm production in males with issues with the production of sperm, either congenital or acquired.

Precautions

Before administering this drug, you should tell your doctor or pharmacist if you are allergic to it, other products that contain FSH, or if you have any other allergies.

Gonal-f may contain inactive ingredientes that can cause allergic reactions or other problems in some patients. Talk to your pharmacist before using it.

Also, tell your doctor or pharmacist about your medical history, especially if you have experienced or are experiencing other fertility or health problems.

Self-administration of Gonal-f should only be performed by patients who are very well motivated and adequately trained. Access to expert advice is crucial to this end. Special attention should be given to specific instructions for the use of the pre-filled pen.

In patients with known hypersensitivity to gonadotropins that do not contain FSH, there is a high risk of cross-sensitivity. For this reason, the first injection of Gonal-f should be performed under direct medical supervision.

How to use

Although Gonal-f is available in different pack sizes, the preparation and application is exactly the same in all cases.

In the case of women undergoing an IVF cycle, the staff at the clinic will teach you how to use Gonal-f step by step. In any case, you should read the information pamphlet carefully before using it.

These are the steps to follow to use Gonal-f correctly:

  1. Reconstitute the product by mixing the liquid with the medication until it looks homogeneous, without suspended particles. Do not use it if particles are present.
  2. Place a new needle into the pen and adjust it to the dose prescribed.
  3. Clean the injection site with rubbing alcohol before injecting each dose. The lower abdomen is a recommended injection site.
  4. Inject Gonal-f under the skin or into a muscle as indicated by your doctor.
  5. Discard the needle and medical supplies each time.

Gonal-f should be administered once a day at the same time each day. We recommend that you change the injection site each time to lessen injury under the skin.

This information will not replace, in any case, the instructions given by your physician. Contact your doctor immediately if you are concerned that you have given yourself too much Gonal-f or in case of misuse.

Dosage

The dose of Gonal-f varies on a case-by-case basis as well as on the treatment it has been prescribed for. The ultimate goal of using this medicine is not the same in IVF and IUI cycles, as one shall see below:

Gonal-f injection for IUI

In IUI cycles, patients usually undergo mild ovarian stimulation. In fact, the goal is not stimulating the ovary but to induce ovulation, since is is required that at least 2-3 follicles develop.

For this reason, the dose of Gonal-f required in Intrauterine Insemination cycles is typically 75 IU or 150 IU. The daily dosage is rarely greater than 225 IU.

Gonal-f injection for IVF/ICSI

Contrary to what happens in IUI cycles, IVF patients do undergo controlled ovarian stimulation (COS). In this case, the goal is to obtain between 8 and 15 mature follicles that can be harvested later via follicle puncture. To this end, the recommended dose of Gonal-f can range between 150 and 450 IU once a day.

Irrespective of the the infertility treatment, your physician will schedule a series of monitoring visits to evaluate the estradiol levels and growth of the follicles. The dose administered can be adjusted depending on what your doctor sees with each visit.

Whether you need to undergo IUI or IVF to become a mother, we recommend that you use "The Calculator". In 3 simple steps, it will show you a list of clinics that fit your preferences and meet our strict quality criteria. Moreover, you will receive a report via email with useful tips to visit a fertility clinic for the first time.

Contraindications

Do not use this drug if you are allergic or hipersensitive to follitropin alfa, FSH, or any of the excipients this medication is composed of.

Also, Gonal-f is contraindicated for safety reasons where the following exist:

  • Tumours of the hypothalamus or pituitary gland
  • Large ovarian cysts that are not caused by PCOS
  • Vaginal bleeding of unknown origin
  • Ovarian, uterine or breast carcinoma
  • Lactation or pregnancy
  • Primary ovarian insufficiency or primary testicular failure
  • Developmental abnormalities of the female reproductive organs that are incompatible with pregnancy
  • Uterine fibroids that prevent pregnancy

Also, one must keep in mind that Gonal-f should not be used in children or the elderly.

Interactions & side effects

First of all, it should be clear that no clinically significant drug interactions have been reported during Gonal-f therapy.

However, Gonadorelin or GnRH is a product that may interact with Gonal-f by increasing the dosage of Gonal-f needed to achieve an adequate ovarian response.

Many patients have no side effects during or after using Gonal-f, whereas others may develop mild side effects or adverse reactions, including injection site reactions (e.g. bruising, irritation, pain, swelling…), headaches, or develop ovarian cysts.

Severe side effects are very rare (< 1/10,000), but can include the ovarian hyperstimulation syndrome (OHSS), allergies, or episodes of thromboembolism.

FAQs from users

Do Gonal-f injections hurt?

By Zaira Salvador BSc, MSc (embryologist).

No, the sensation of this type of injection is generally a quick pinching, tingling or stinging type of sensation, but they are not painful. In general, it is pretty easy to give yourself a subcutaneous injection in the belly.

Does Gonal-f have to be refrigerated?

By Zaira Salvador BSc, MSc (embryologist).

Yes, Gonal-f should be stored at 2°C to 8°C (do not freeze) and protected from light (store the pen with the cap on to this end). In case refrigeration is unavailable, the Gonal-f pen can be stored below 25°C for up to 3 months. After piercing the Gonal-f pen with a needle for the first time, it may be stored below 25°C for up to 21 days, though.

Suggested for you

Gonal-f is a medication used usually in IVF stimulation protocols to cause the production of multiple eggs in one cycle. Check out this for information: Ovarian Stimulation Protocols for IVF – Process & Medications Used.

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Authors and contributors

 Zaira Salvador
BSc, MSc
Embryologist
Bachelor's Degree in Biotechnology from the Polytechnic University of Valencia (UPV). Embryologist specializing in Assisted Procreation, with a Master's Degree in Biotechnology of Human Assisted Reproduction from the University of Valencia (UV) and the Valencian Infertility Institute (IVI). More information
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