Perhaps you, or someone close to you, is undergoing fertility treatment with Gonal-f and you want to learn more about it.
Here’s everything you need to know about Gonal-f: how to take it; how it works; its side effects and adverse reactions; and the duration of treatment.
We’ll also discuss the latest research done on this fertility enhancing product.
What is Gonal-f?
Gonal-f is a treatment used for certain types of infertility. It contains a product called follitropin alfa, which is relevant for ovulation induction.
Follitropin alfa is a type of human follicle stimulating hormone (fsh). This hormone plays an important role in reproduction and fertility in both men and women.
What does the Gonal-f do?
The follitropin alfa present in Gonal-f plays an important role in the creation of sperm cells and helps follicular development and the release of the egg. Gonal-f is used with assisted reproductive technologies to help in different stages of the fertility process.
Gonal-f therapy can be used differently, depending on the fertility treatment each couple needs.
What does Gonal-f do for women?
In assisted reproductive technologies (ART) Gonal-f can be used in diverse circumstances that affect women’s fertility.
It can be of help in the following ways:
- Providing adequate follicular development and ovulation induction. When the cause of the woman’s infertility is related to the creation of follicles, Gonal-f might be the best follicle-stimulating hormone product available. Gonal-f can help women to with adequate follicular development, necessary for the egg to be released and for ovulation to occur
- In primary ovarian failure. Sometimes the woman’s ovaries are not working as they should. The ovaries release most of women’s sexual hormones. If the ovaries aren’t functioning correctly, the chances of getting pregnant are greatly reduced. In some months, there might be adequate follicular development, an egg is released and it is fertilized by a sperm. If the ovaries fail to work properly, however, the pregnancy might not continue, as the ovaries are failing to provide other essential hormones for pregnancy to be maintained
- Causing the ovaries to produce several eggs at once. This is sometimes part of assisted reproductive technologies (ART). When there is to be in vitro fertilization (when the sperm and the egg meet outside the woman’s body), Gonal-f, as a follicle stimulating hormone, can be used to stimulate the maturation of several eggs at the same time. That means several eggs can be extracted in just one procedure
- Gonal-f injections also improve the odds of an embryo transfer and increase the chances of successful embryo implantation
- Gonal-f therapy can also be used for ovulation induction in women who do not suffer primary ovarian failure.
What does Gonal-f do for men?
When the cause of infertility is a problem the man is experiencing, the couple might use injections of Gonal-f (follitropin alfa) in conjunction with chorionic gonadotropin, to help develop and produce mature and healthy sperm.
Treatment with Gonal-f in men is used with good results when there isn’t primary testicular failure.
When there is primary gonadal failure or uncontrolled thyroid, adrenal or pituitary disorders, other therapies should be considered instead.
How does Gonal-f make you feel?
Gonal-f affects each person differently. Some people might not feel many changes; others, however, might suffer some or many side effects – some mild, some quite severe.
Let’s look at the most common side effects the use of follitropin alfa, or Gonal-f, might provoke.
Gonal-f side effects
The use of Gonal-f can produce common side effects in men and women who are undergoing Gonal-f treatment.
Gonal-f mild side effects
- Nausea and vomiting
- Bloating and mild abdominal pain
- Injection site reactions: injection site reactions include pain, redness and/or bruising around the injection site
- Breasts swelling or tenderness
- Sore throat
- Runny nose
- Acne or skin rash.
More serious side effects and adverse reactions from treatment with Gonal-f can affect the man, woman and any future babies.
Gonal-f – possible adverse effects for men
- Varicocele. The recombinant follicle stimulating hormone, FSH, in Gonal-f therapy can cause swelling of the veins in the testicles; this is known as varicocele
- Gynecomastia. Follitropin alfa in multi dose can also cause gynecomastia, which means the development of breasts in men
- Sex hormone dependent tumors are rare but are more common in someone using Gonal-f. Throughout the treatment with Gonal-f, hormonal levels are checked regularly to make sure they remain within safe limits. It’s especially important that men keep normal serum testosterone levels while receiving a multi dose of Gonal-f treatment.
Make sure you tell your doctor if you experience any side effects when you use Gonal-f.
Gonal-f – possible adverse effects for women
Ovarian hyperstimulation syndrome (OHSS):
Although there is a particular treatment with Gonal-f that looks for this effect (ovarian hyperstimulation) sometimes women have an exaggerated response to excess hormones and they suffer from ovarian hyperstimulation syndrome (OHSS).
When a woman suffers OHSS, there is ovarian enlargement that causes abdominal pain. When the ovaries swell up, they leak fluid, which then irritates the surrounding areas, causing abdominal pain.
Ovarian hyperstimulation syndrome can happen spontaneously, without the woman receiving a single dose of Gonal-f, although this is rare.
Ovarian hyperstimulation syndrome is more common in women with polycystic ovarian syndrome who are undergoing treatment with Gonal-f.
Research shows that prevention is key in the management of ovarian hyperstimulation syndrome, OHSS.
Although ovarian hyperstimulation syndrome is one of the most serious side effects, many other side effects can also be attributed to treatment with Gonal-f.
Fertility specialists make sure they carry out physico-chemical tests and check the woman’s serum estradiol levels, as well as other hormonal levels, to make sure they are kept within normal limits.
Sex hormone dependent tumors are rare but more common when undergoing fertility treatments with Gonal-f.
Do tell your doctor if you experience any side effects while using Gonal-f.
Gonal-f – possible adverse effects for the baby
- Multiple pregnancies. This is one of the risks of assisted reproductive technologies, with the associated complications of preterm multiple births. Some times the recombinant follicle stimulating hormone present in Gonal-f works fast and multiple follicles release eggs at the same time. If these eggs are then fertilised a multiple pregnancy occurs
- Birth defects. The use of Gonal-f RFF injections might increase the risk of birth defects in your baby. These risks increase according to the genetics of the parents, certain problems present in the sperm, the woman’s age and multiple pregnancies.
Make sure you only use the prescribed dose of Gonal-f. Be especially vigilant if you use a multi dose vial and ask your doctor about any worries you might have.
You can find out more in our article No Side Effects From Gonal F.
How to administer Gonal-f
Men and women undergoing fertility treatment with Gonal-f will be given specific, individualised instructions on how to self-administer their Gonal-f injections, and about the dose and duration of the treatment.
The days when couples undergoing fertility treatments had to go to the fertility clinic every day to get their daily fertility injections are long gone.
Many things made self-administration difficult: multi-dose vials; the solution for injection separated from the medicine that needed to be prepared prior to each injection; air bubbles that could appear in the process; the size of the needle; and the number of syringes used….
These problems have been solved with the development of the Gonal-f RFF pen or the single-use subcutaneous syringes with built-in needles.
The Gonal-f RFF pen is a multi-dose vial that comes with a dial to charge the right dose of Gonal-f each day (usually 150 iu). This makes it very easy to use. You just need to attach a new needle each time you’re going to use it and dispose of it safely after each use in a sharps container.
Using a Gonal-f pen also resolves the problem of air bubbles going into the solution for injection. It’s very important not to inject air into our bodies and this is the main handicap for self-administration of injections.
With a multi-dose Gonal-f pen you just need to turn the dial to the correct prescribed dose, wash your hands, attach the needle and wipe the injection site (soap and water should be all you need). Occasionally, if you don’t have access to soap and water in that moment you can use benzyl alcohol wipes.
Always make sure your skin is completely dry before introducing the needle. Pierce the skin with the needle and once it’s in, you simply need to press the button. The pen will automatically deliver the right dose of Gonal-f.
You must then dispose of the needle in the sharps container provided with the pen; this is important to avoid accidents like sharp injuries to others. If you don’t have a sharps container, ask your doctor for one.
When the container is full, take it to the fertility clinic or a chemist, for safe disposal. You will be provided with a new one.
Although the Gonal-f pen is a multi-dose vial, a single dose of Gonal-f is dispensed with every shot. Whether you use it every day or three times a week, the pen will give you the right dose each time.
The follistim pen is just another way of self-administering follitropin alfa.
Gonal-f versus Follistim
Gonal-f and follistim are both follitropin alfa hormones, tested on Chinese hamster ovary tissue and used for exactly the same procedures. They’re just made by different manufacturers.
The Gonal-f treatment comes in a prepared, pre-filled pen and follistim comes in pre-filled, multi dose cartridges, which are then inserted into the pen.
With follistim you discard the cartridges when they are empty; with Gonal-f you discard the whole pen and get a new one, when needed.
How long does Gonal-f take to work?
Whether you’re taking Gonal-f treatment for sperm quality improvement or for follicular development to induce ovulation, it takes several cycles of treatment to work.
Results can usually be seen any time between six and twelve months. Sometimes, and in some cases of long-lasting low serum testosterone levels or serum estradiol levels, it can take as long as 18 months of treatment with Gonal-f to see any results.
If your treatment involves other hormones complementary to follitropin alfa, such as human chorionic gonadotropin (HCG), visible results can take longer than a year.
Gonal-f dosage and treatment length
Your doctor will prescribe the correct dose of Gonal-f for you and will also indicate the treatment duration.
Depending on the treatments with Gonal-f, there might be different dosages and different lengths of treatment.
Dosing for ovulation induction
When Gonal-f RFF injections are used for ovulation induction, the initial dose tends to be 75-150 iu of follitropin alfa; this might be increased, depending on the levels of serum estradiol. Gonal-f injections will be given daily for 14 days. The Gonal-f prescribed dose will be adjusted accordingly in the next cycles, depending on the woman’s response to the initial dose of Gonal-f.
In the following cycles of treatment with follitropin alfa, dose adjustments will be made following an adequate ovarian response.
In general, treatment with Gonal-f for ovarian induction shouldn’t exceed 35 days. Once the woman reaches preovulatory conditions, HCG hormone should be given to help with egg maturation and for ovulation to occur.
Always make sure you tell your doctor about any side effects you might experience or ask any questions you have about your treatment.
Dosing for multiple follicle development as part of ART
The starting dose tends to be 150 iu of follitropin alfa. Injections will be administered daily until the follicular development is appropriate. This will be checked by ultrasound scan and by checking the serum estradiol levels.
Scans are frequent during this process – not only to check follicular development but also to make sure that Gonal-f treatment isn’t causing ovarian enlargement.
In general, treatment duration for ART shouldn’t take longer than 10 days.
Always ask your doctor if you have any doubts about your treatment with Gonal-f.
Dosing for men with low serum testosterone levels
Although your doctor will tailor every treatment to your specific needs, the general dose of follitropin alfa for male infertility tends to be 150 iu three times a week.
It usually takes a minimum of 4 months following this treatment of 450 iu of Gonal-f weekly, in addition to HCG, to achieve normal serum testosterone levels to produce viable and healthy sperm cells.
Although there are single dose vials, usually a multi dose vial of 450 iu of follitropin alfa is provided for each weekly treatment.
In some cases of male infertility, treatment might need to continue for 18 months.
Make sure you always administer yourself the prescribed dose and tell your doctor about any side effects you might be experiencing or any queries you have.
What is the best time to inject Gonal-f?
Gonal-f injections are best administered in the evenings, between 6 and 10 pm. It’s a good idea to do it every day at approximately the same time.
Gonal-f is a very expensive treatment. On average, 450 iu of follitropin alfa costs around 1,225 USD.
The overall cost of your Gonal-f treatment can be very high as it’s usually a lengthy process. Most fertility clinics have packages where they can get discounted prices for injectable hormones.
Make sure you ask your doctor about the total cost of your treatment, including any hidden costs. Always ask about any financing plans that might be available.