Urofollitropin

Indications

Urofollitropin is used for: Female infertility, Hypogonadotrophic hypogonadism

Adult Dose

Injection Polycystic ovarian syndrome; Female infertility Adult: Initially, 150 IU daily SC/IM for the first 5 days. Adjust subsequent dosing based on clinical monitoring (e.g. serum oestradiol levels and vaginal ultrasound). Dose adjustments should not be made more frequently than once every 2 days and be ?75-150 units per adjustment. Max dose: 450 units daily and max course of treatment: 12 days. Stop treatment when adequate response obtained as determined by oestrogen monitoring or ultrasonic visualisation of follicles. A single dose of chorionic gonadotrophin 5000 to 10 000 units is given to induce ovulation after 1-2 days. Urofollitropin treatment may be tried again in future cycles. Injection In vitro fertilisation procedures or other assisted conception techniques Adult: In conjunction with other agents: 150-225 units of FSH daily SC/IM from day 2 or 3 of menstrual cycle. Alternatively, begin therapy with clomifene citrate and continue with urofollitropin; or urofollitropin may be given after gonadorelin analogue is given to suppress gonadotrophin release. Continue treatment until an adequate response is obtained and admin 5000 to 10 000 units of chorionic gonadotrophin 1-2 days after final injection of urofollitropin. Oocyte retrieval is performed 34-35 hr later. Injection Male infertility Adult: In conjunction with chorionic gonadotrophin, 150 units of FSH SC/IM 3 times a wk, continue for at least 4 mth.

Child Dose

Safety and efficacy not established

Renal Dose

Administration

Contra Indications

Pregnancy, ovarian cysts or enlargement not due to polycystic ovary syndrome, primary ovarian failure, organic intracranial lesion e.g. pituitary tumour, uncontrolled thyroid and adrenal dysfunction, presence of any cause of infertility other than anovulation, abnormal bleeding of undetermined origin.

Precautions

May result in multiple pregnancies. Abnormal genital bleeding, hormone sensitive malignancies, ovarian cysts not caused by polycystic ovary syndrome. Exclude and treat other causes of infertility e.g. pituitary or hypothalamic lesions, adrenal or thyroid disorders and hyperprolactinaemia.

Pregnancy-Lactation

Pregnancy Category: X Lactation: Not known if excreted in breast milk, avoid using in breast-feeding women

Interactions

Increased risk of ovarian hyperstimulation syndrome with drugs with luteinising hormone activity.

Adverse Effects

Side effects of Urofollitropin : >10% Headache (11.1%), OHSS (11.1%; severe pelvic pain, N/V, weight gain) Frequency Not Defined Nausea, vomiting, joint pain, ovarian hyperstimulation syndrome, adnexal torsion, mild to moderate ovarian enlargement, abdominal pain, ovarian cysts, local reaction at inj site, headaches, haemoperitoneum, benign and malignant ovarian neoplasms, ascites, pleural effusion, hypovolaemia, thromboembolic disorders. Weight gain, acne and gynaecomastia in men. Potentially Fatal: Ovarian cysts rupture, intraperitoneal haemorrhage.

Mechanism of Action

Urofollitropin, a gonadotrophin obtained from postmenopausal women's urine, possesses follicle-stimulating hormone (FSH) activity but almost no luteinising activity. Admin for 7-12 days results in follicular growth and maturation in females. When sufficient follicular maturation has occurred, human chorionic gonadotrophin should be given to induce ovulation.