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Anovulatory infertility
Adult: For cases in women (including polycystic ovarian syndrome [PCOS]) who are unresponsive to clomifene citrate: Start treatment within the 1st 7 days of the menstrual cycle in menstruating women. Initially, 75-150 IU daily, increased by 37.5 IU or 75 IU at 7 or 14 days intervals if needed to achieve adequate (not excessive) response. Max: 225 IU or 300 IU daily (depending on the product being used). If the patient fails to respond adequately after 4 weeks, abandon that cycle and patient must undergo further evaluation after which she may restart treatment with an initial dose higher than in the abandoned dose. If optimal response is obtained, hCG must be given 24-48 hours after the last follitropin alfa dose. If an excessive response is attained, discontinue treatment and withhold hCG administration; restart therapy in the next cycle at a dose lower than the previous cycle. Doses should be individualised according to patient response (based on follicle size measurement by ultrasound and/or estrogen secretion). Use the lowest effective dose to obtain optimal response. Dosing recommendations may vary among individual products and between countries (refer to specific product guidelines).
Subcutaneous
Multifollicular development during assisted reproductive technology
Adult: Beginning on days 2 or 3 of the cycle, administer 150-225 IU daily until sufficient follicular development is achieved (based on ultrasound and measurement of serum estrogen or estradiol levels); adjust dose according to response. Max: 450 IU daily. Generally, adequate follicular development is attained within 10 days. Thereafter, hCG may be given to induce final follicular maturation. Pituitary downregulation with gonadotropin-releasing hormone (GnRH) agonist or antagonist may be used in other protocols; in this case, start follitropin alfa approx 2 weeks after initiating the GnRH agonist, then both are continued until follicular development is adequate. In women with suppressed endogenous gonadotropin levels: Initially, 225 IU daily, adjusted after 5 days based on ovarian response; subsequently adjust dose every 3-5 days by ≤75-150 IU additionally at each adjustment. Max: 450 IU daily. Continue therapy until adequate follicular development is evident, then administer hCG to induce final follicular maturation in preparation for oocyte retrieval. Doses should be individualised according to patient response. Use the lowest effective dose to obtain optimal response. Dosing recommendations may vary among individual products and between countries (refer to specific product guidelines).
Subcutaneous
Spermatogenesis induction
Adult: In men who have congenital or acquired hypogonadotropic hypogonadism; or with primary or secondary hypogonadotropic hypogonadism in whom the infertility is not caused by primary testicular failure: Before starting concomitant therapy with hCG, pretreatment with hCG alone is needed to normalise serum testosterone levels (may take 3-6 months). Thereafter, initiate follitropin alfa at 150 IU 3 times weekly in combination with hCG for at least 4 months. If azoospermia persists, dose of up to Max of 300 IU 3 times weekly may be necessary. Treatment may be continued for up to 18 months. Doses should be individualised according to patient response. Use the lowest effective dose to induce spermatogenesis. Dosing recommendations may vary among individual products and between countries (refer to specific product guidelines).
