Female Sex Hormones- Fertility Drugs

Name of the Fertility Drugs

1. Cetrorelix
2. Chorionic Gonodotropin
3. Clomiphene
4. Follitropin Alpha
5. Follitropin Beta
6. Ganirelix
7. Menotropins

Therapeutic Action

The desired and beneficial actions of fertility drugs are as follows:

• Can be used by women without primary ovarian failure who cannot get pregnant after 1 year of unprotected sexual intercourse.
• Work either directly stimulate follicles and ovulation or stimulate the hypothalamus to increase FSH and LH levels, leading to ovarian follicular development and maturation of ova.

Mechanism of Action:

Gonadotropin releasing-hormone (luteinizing hormone-releasing hormone) antagonist; delays luteinizing hormone surge, which in turn prevents ovulation until follicles are of adequate size.

Indications:

Cetrorelix is used to prevent premature ovulation during controlled ovarian stimulation.

Contraindications & Cautions:

• Known or suspected pregnancy
• Hypersensitivity to cetrorelix acetate, extrinsic peptide hormones or mannitol
• Hypersensitivity to GnRH or any other GnRH analogs
• Breastfeeding
• Severe renal impairment

Cautions

• May cause elevations of hepatic enzymes: ALT, AST, GGT, AP
• Exclude pregnancy before initiating therapy
• Monitor closely for hypersensitivity following first injection

Metabolism and Half- Life:

• Half-Life: 20-63 hr; Onset: within 12 hr
• Peak Plasma Time: 1 hr (0.25mg dose); 1.5 hr (3 mg dose)
• Bioavailability: 85% (SC); Protein Bound: 86%
• Duration: 4 days (3 mg dose)
• Absorption: Rapid
• Excretion: Feces; urine

Drug Interactions:

No formal drug-drug interaction studies have been performed with cetrorelix acetate 

Side- Effects:

• Ovarian hyperstimulation syndrome
• Hepatic enzyme elevation
• Nausea
• Headache
• Local site reactions (eg, redness, erythema, bruising, itching, swelling, pruritus)

Nursing Considerations 

• Special care should be taken in women with signs and symptoms of active allergic conditions or known history of allergic predisposition. Treatment with Cetrorelix is not advised in women with severe allergic conditions.
• Should not be prescribed if a patient is pregnant.
• Prior to therapy with Cetrorelix patients should be informed of the duration of treatment and monitoring procedures that will be required.
• The risk of possible adverse reactions should be discussed 
• Monitor hepatic enzymes: ALT, AST, GGT, AP
• •Monitor closely for hypersensitivity following first injection.

Patient education:

• Educate the patient about the method of self-administration of the medication as per doctors’ advice.
• Cetrorelix Acetate for Injection is for injection under the skin of the lower abdominal area, preferably around, but staying at least one inch away from the belly button. Choose a different injection site each day to minimize local irritation.
• Dissolve Cetrorelix Acetate for Injection powder only with the water contained in the prefilled syringe.
• Do not use a Cetrorelix Acetate for Injection solution if it contains particles or if it is not clear.
• Teach the patient/ family member about the proper usage and disposal of needles and syringes after injection.
• Advice to store the medication in refrigerator between 36 F to 46 F (2 C to 8 C).
• Educate the importance of follow up visits and need for Ultrasonography for further management.
• Teach the possible side – effects and inform when to seek medical help.

Mechanism of Action:

The action of human chorionic gonadotropin (hCG) is virtually identical to that of pituitary LH, although hCG appears to have a small degree of FSH activity as well. It stimulates production of gonadal steroid hormones by stimulating the interstitial cells (Leydig cells) of the testis to produce androgens and the corpus luteum of the ovary to produce progesterone.

Indications:

Male:

• Prepubertal Cryptorchidism (not due to anatomical obstruction)
• Delayed Adolescence
• Dwarfism (pituitary)
• Hypogonadotropic Eunuchoidism
• Selected Cases of Hypogonadotropic Hypogonadism (hypogonadism secondary to a pituitary deficiency) in Males

Female:

• Ovulation Induction
• Abortion (habitual)
• Infrequent Scanty Bleeding (functional)
• Functional Sterility

Contraindications:

• Pituitary tumour, ovarian tumour, prostatic carcinoma and androgen-dependent neoplasms, uncontrolled endocrine disorders (e.G., Hyperprolactinemia, thyroid and adrenal dysfunction);
• In female, primary ovarian failure (ovarian dysgenesis and premature menopause), tubal occlusion unless the patient is undergoing superovulation for in vitro fertilization.
• Urinary-hcg (u-hcg) will not be effective in men, in cases where the FSH level is raised as this is indicative of primary testicular failure.
• U-hcg is not effective and is not indicated for weight reduction.
• Precocious puberty.
• Active thrombophlebitis or thromboembolic event.
• Allergy to u-hcg;
• Malformations of sexual organs incompatible with pregnancy.
• Fibroid tumours of the uterus incompatible with pregnancy.
• Prepubertal boys with signs of anatomical obstruction.
• Known or suspected sex hormone-dependent tumors, such as ovary, breast and uterine carcinoma in female and prostatic or breast carcinoma in the male.

Metabolism and Half- Life:

HCG has a mean half-life of 2.32 days and so stability is achieved in approximately ten days.

Circulating hCG is metabolized primarily by the liver with approximately 20% of circulating hCG excreted by the kidneys

Drug Interactions:

Chorionic gonadotropin may interfere with radioimmunoassay for gonadotropin, particularly luteinizing hormone. Following administration, Chorionic Gonadotropin for Injection may interfere for up to ten days with the immunological determination of serum/urinary hCG, leading to a false positive pregnancy test.

Side Effects:​

• Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing. ​
• Chest pain, or coughing up blood ​
• Numbness or weakness in your arm or leg, or on one side of your body
• Pain in your lower leg (calf) ​
• Severe nausea, vomiting, or pain in your pelvis (in women) ​
• Sudden or severe headache, problems with vision, speech, or walking ​
• Sudden weight gain or bloating (in women)​
• Feeling nervous, restless, or sad
• Headache
• Pain where the shot is given
• Swelling in your hands, ankles, or feet
• Tiredness

Nursing Considerations

Monitoring:

• Cardiovascular: Signs/symptoms of thrombotic events
• Endocrine: Estradiol levels
• Genitourinary: Ovarian response to treatment (via transvaginal ultrasound)
• Musculoskeletal: Skeletal maturation in patients treated for delayed puberty
• Use may aid in predicting whether orchiopexy will be needed in patients with prepubertal cryptorchidism.
• Self-administration should be limited to patients who are motivated, adequately trained, and have access to advice.
• Prior to administration, patients should be instructed on proper administration techniques, including the principles of sterile techniques.
• Once administered, needles and syringes should be placed in a sealable, puncture-resistant container.

Patient/ Family Education:

• Patients should be told to report signs/symptoms of ovarian hyperstimulation syndrome, thrombotic events, and ovarian torsion.
• Patients should be told that use of this drug requires monitoring of ovarian response with/without estradiol levels.
• Patients should be instructed to properly dispose of used needles and syringes.
• Advise patients to speak to their healthcare provider if they become pregnant, intend to become pregnant, or are breastfeeding.

Mechanism of Action:

Binds with estrogen receptors in cytoplasm, increasing secretion of follicle stimulating hormone, luteinizing hormone, and gonadotropin in hypothalamus and pituitary gland. These actions induce ovulation.

Indications:

• Ovarian failure
• Used in the treatment of male hypogonadism as an alternative to testosterone replacement therapy
• Treatment of gynecomastia.

Contraindications and Cautions:

• Hepatic disease
• Organic intracranial lesions
• Uncontrolled thyroid or adrenal dysfunction
• Ovarian cyst
• Abnormal uterine bleeding or bleeding of undetermined origin
• Pregnancy

Metabolism and half- life:

• Half-Life elimination: 5-7 days; Onset: Within 5-10 days
• Peak plasma time 6.5 hours
• Bioavailability: Readily absorbed from GI tract
• Metabolism: Enterohepatically circulated
• Excretion: feces 37-51%; small amount in urine

Drug Interactions:

Drug interactions with clomiphene have not been documented.

Side- Effects:

• CNS: nervousness, insomnia, dizziness, light-headedness
• CV: vasomotor flushing
• EENT: visual disturbances
• GI: nausea; vomiting; abdominal discomfort, distention, and bloating
• GU: breast tenderness, ovarian enlargement, multiple pregnancies, birth defects in resulting pregnancies, ovarian hyperstimulation syndrome, uterine bleeding

Nursing Considerations

Patient monitoring

• Monitor patient for bleeding and other adverse reactions.
• Reassess diagnosis after 3 courses if ovulation has not occurred or if menses does not occur following ovulatory response
• Prior to initiating therapy and each subsequent course of therapy, perform a thorough pelvic examination and rule out pregnancy, ovarian enlargement, or ovarian cyst.
• Prior to initiating therapy, evaluate for adequate endogenous estrogen levels (e.g., from vaginal smears, endometrial biopsy, urinary estrogen assay, and bleeding response to progesterone).
• Prior to initiating therapy, evaluate liver function.
• If abnormal vaginal bleeding is present, evaluate carefully to rule out neoplastic lesions.
• Perform endometrial biopsy prior to initiating therapy in women with increased risk of endometriosis or endometrial carcinoma (e.g., older women).
• Possible enlargement of existing uterine fibroids; use with caution in women with uterine fibroids.

Patient/ Family Teaching:

• Instruct patient to immediately report signs and symptoms of ovarian hyperstimulation syndrome, including nausea, vomiting, diarrhea, abdominal or pelvic pain, and swelling in hands or legs.
• Tell patient to report bleeding.
• Advise patient not to take drug if she is or may become pregnant.
• Inform patient that drug increases risk of multiple births, which heightens maternal risk.
• Importance of discussing purpose and risks of therapy and required monitoring procedures.
• Risk of multiple pregnancy; importance of informing patients about potential complications and risks associated with multiple pregnancies.
• Importance of properly timed sexual intercourse (i.e., coinciding with expected time of ovulation). Importance of using a basal body temperature graph or an appropriate ovulation predicting test to determine if ovulation has occurred.
• Risk of visual disturbances (e.g., blurring, diplopia, photophobia); importance of informing clinicians if any adverse visual symptoms occur. Use caution when driving or operating machinery, particularly under conditions of variable lighting.
• Importance of informing clinicians if pelvic or abdominal pain, weight gain, discomfort, or distention occurs.
• Importance of advising women of risk of fetal harm if administered during pregnancy, importance of excluding pregnancy before each course of treatment.
• Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, as well as any concomitant illnesses.

Mechanism of Action:

Recombinant follicle stimulating hormone (FSH); stimulate ovarian follicular growth in women who do not have primary ovarian failure.

Stimulates spermatogenesis in men with hypogonadotrophic hypogonadism

Indications:

• Induction of ovulation and pregnancy in oligo-anovulatory infertile women for whom the cause of infertility is functional and not due to primary ovarian failure.
• Development of multiple follicles in ovulatory infertile women as part of an assisted reproductive technology (ART) cycle.
• Induction of spermatogenesis in infertile men with azoospermia and primary or secondary hypogonadotropic hypogonadism in whom the cause of infertility is not due to primary testicular failure.

Contraindications and Cautions:

• Prior hypersensitivity to recombinant FSH preparations
• High levels of FSH indicating primary gonadal failure
• Presence of uncontrolled non-gonadal endocrinopathies (thyroid, adrenal, or pituitary disorders)
• Sex hormone-dependent tumors of the reproductive tract and accessory organs
• Tumors of pituitary gland or hypothalamus
• Gonal-F: Women with abnormal uterine bleeding of undetermined origin; ovarian cyst or enlargement of undetermined origin

Metabolism and Half- Life :

• Onset: 2.7-18 months (spermatogenesis); within cycle (females);  Vd: 10 L
• Bioavailability: 66-76% (healthy female volunteers)
• Half-life: 50 hr (IM in healthy female volunteers); 24 hr (SC in healthy female volunteers)
• Peak plasma time: 8-16 hr (SC in females); 25 hr (IM in females); 11-20 hr (IM in males)

Drug Interactions:

There are no known significant interactions.

Side- Effects:

GONAL-f

• Intermenstrual bleeding
• Ovarian hyperstimulation
• Abdominal pain
• Acne
• Flatulence
• Diarrhea
• Back pain
• Emotional lability
• Thromboembolism

Gonal-f RFF Pen​

• Diarrhea​
• Dizziness​
• OHSS (for ovulation induction)​
• Flatulence​
• Acne​
• Toothache​
• Intermenstrual bleeding​
• Breast pain, Injection site reactions, Ovarian cyst, Nausea, Sinusitis​
• Asthma exacerbation 

Nursing Considerations

• To minimize risks, use only at the lowest effective dose. Monitor ovarian response with serum estradiol and vaginal ultrasound on a regular basis.
• These medications should only be used by physicians who are thoroughly familiar with infertility problems and their management.
• May result from the use of these medications; advise patient of the potential risk of multiple births before starting the treatment.
• Monitor sufficient follicular maturation. This may be directly estimated by sonographic visualization of the ovaries and endometrial lining or measuring serum estradiol levels. The combination of both ultrasonography and measurement of estradiol levels is useful for monitoring for the growth and development of follicles and timing hCG administration.
• The clinical evaluation of estrogenic activity (changes in vaginal cytology and changes in appearance and volume of cervical mucus) provides an indirect estimate of the estrogenic effect upon the target organs and, therefore, it should only be used adjunctively with more direct estimates of follicular development (ultrasonography and serum estradiol determinations).
• Monitor urinary or serum luteinizing hormone (LH) rise, rise in basal body temperature, increase in serum progesterone, and menstruation following the shift in basal body temperature.
• Monitor for signs and symptoms of OHSS for at least 2 weeks following hCG administration.
• Monitoring of hospitalized patients should include abdominal circumference, albumin, cardiorespiratory status, electrolytes, fluid balance, hematocrit, hemoglobin, serum creatinine, urine output, urine specific gravity, vital signs, weight (all daily or as necessary), and liver enzymes (weekly)
• Monitor serum testosterone levels, sperm count in males.

Patient/ Family Teaching:

• Teach the proper usage of the injection like self-administration of the medication and sites.
• Do not shake the vial. Once mixed, use the liquid right away. Before injecting each dose, clean the injection site with rubbing alcohol. Change the injection site each time to lessen injury under the skin.
• Stop using this medication when you become pregnant. This medication must not be used during pregnancy.
• Instruct the client for  Gonal-f RFF Rediject: Allow to warm to room temperature prior to use. Do not attempt to mix any other medications inside of the device.
• Advise women and men to discontinue GONAL-F and seek immediate medical attention if any signs or symptoms of a hypersensitivity reaction occur
• Inform women regarding the risks of OHSS and OHSS-associated conditions including pulmonary and vascular complications and ovarian torsion 
• Inform women regarding the hazards associated with abnormal ovarian enlargement that may occur with GONAL-F therapy. If the ovaries are abnormally enlarged on the last day of GONAL­F therapy, inform women not to administer hCG and to avoid intercourse
• Advise the woman and her partner of the potential risk of multi-fetal gestation and birth before beginning therapy.
• Inform women that the incidence of congenital malformations (birth defects) after some Assisted Reproductive Technology [(ART) specifically in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI)] may be slightly higher than after spontaneous conception​
• Inform women undergoing ART that the incidence of ectopic pregnancy may be increased with these procedures, particularly for women with tubal abnormalities. Advise women who become pregnant and have: abdominal/pelvic pain (particularly on one side); shoulder, neck or rectal pain; and nausea and vomiting to seek immediate medical attention​
• Advise women not to breastfeed because the secretion of prolactin during lactation can result in inadequate response to ovarian stimulation​.

Mechanism of Action:

Follicle-stimulating hormone (FSH), the active component in follitropin beta injection, is required for normal follicular growth, maturation, and gonadal steroid production; stimulates ovarian follicular growth in women who do not have primary ovarian failure; when administered with hCG, stimulates spermatogenesis in men with hypogonadotropic hypogonadism.

Indications:

• Assisted Reproductive Technology
• Ovulation Induction
• Spermatogenesis

Contraindications & Cautions:

Contraindicated in men and women

• Prior hypersensitivity to recombinant hFSH products
• High levels of FSH indicating primary ovarian failure
• Uncontrolled thyroid or adrenal dysfunction
• Hypersensitivity reactions to streptomycin or neomycin (may contain traces of these antibiotics)
• Tumor of ovary, breast, uterus, testis, hypothalamus, or pituitary gland

Contraindicated in women

• Pregnancy
• Heavy or irregular vaginal bleeding of undetermined origin
• Ovarian cysts or enlargement not due to polycystic ovary syndrome (PCOS)

Metabolism and Half- Life:

• Half-Life: 43.9 hr (single IM dose); 26.9-30.1 hr (7-day IM treatment)
• Absorption: 77.8% (SC); 76.4% (IM); Vd: 8 L
• Peak ptime: 27 hr (IM); 13 hr (SC)
• Peak plasma concentration: 5.41 IU/L (SC); 6.86 IU/L (IM)
• Metabolism: Recombinant FSH in product is biochemically very similar to urinary FSH and is anticipated to be metabolized in the same manner

Drug Interactions:

No drug-drug interaction studies have been performed.

Side –Effects:

Side Effects in Males:

• acne
• hardening of the injection site
• headache
• rash
• some breast development
• testicular cyst

Side Effects in Females:

• Vaginitis
• Stomach Pain And / Or Bloating
• Nausea, Diarrhea, Constipation or Stomach Discomfort
• Urinary Tract Infection
• Ovarian Cysts or Enlargement of the Ovaries
• Headache
• Vomiting
• Laboured Breathing, Nasal Congestion, Sore Throat, Upper Respiratory Tract Infection
• Nervousness
• Reactions At the Site of Injection: Bruising, Pain, Redness, Swelling and Itching
• Hypersensitivity Reactions Including, Rash, Redness, Hives and Itching ​
• Pelvic Pain ​
• Breast Complaints (Including Tenderness) ​
• Enlargement of the Uterus ​
• Feeling Sick ​
• Vaginal Bleeding ​
• Hemoperitoneum​
• Ectopic Pregnancy​
• Miscarriage And Multiple Pregnancies​

Nursing Considerations

• Prior to therapy with follitropin beta, patients should be informed of the duration of treatment and monitoring procedures that will be required.
• Should be used only by physicians who are experienced in infertility treatment
• The risks of Ovarian Hyperstimulation Syndrome and multiple births and other possible adverse reactions should be discussed.
• Blood and urine tests, semen testing, and ultrasound examinations are needed to check for any unwanted effects caused by this medicine.
• In order to minimize the hazards associated with abnormal ovarian enlargement that may occur with follitropin beta therapy, treatment should be individualized, and the lowest effective dose should be used. Intercourse should be prohibited in patients with significant ovarian enlargement after ovulation because of the danger of hemoperitoneum resulting from ruptured ovarian cysts.
• Multiple dose injection pens: According to the Centers for Disease Control and Prevention, pen-shaped injection devices should never be used for more than one person (even when the needle is changed) because of the risk of infection. The injection device should be clearly labeled with individual patient information to ensure that the correct pen is used.
• To minimize risks, use only at the lowest effective dose.
• Females: Monitor follicular growth by transvaginal ultrasound to determine adequate ovarian response and timing of human chorionic gonadotrophin (hCG) administration. Concurrent measurement of estradiol levels may also be useful.
• The clinical evaluation of estrogenic activity (changes in vaginal cytology and changes in appearance and volume of cervical mucus) provides an indirect estimate of the estrogenic effect upon the target organs and, therefore, it should only be used adjunctively with more direct estimates of follicular development (ultrasonography and serum estradiol determinations).
• Monitor for signs and symptoms of ovarian hyperstimulation syndrome (OHSS) for at least 2 weeks following hCG administration. Initial symptoms of moderate to severe OHSS may include a sensation of bloating, abdominal pain, rapid weight gain, and decreased urine output.
• Monitoring of hospitalized patients should include albumin, degree of ascites, cardiorespiratory status, electrolytes, fluid balance, hematocrit, hemoglobin, serum creatinine, urine output, urine specific gravity, signs of thromboembolism, vital signs, weight (all daily or as necessary), and liver enzymes (weekly)
• Males: Monitor for sufficient spermatogenesis. This can be directly estimated by semen analysis or indirectly estimated by serum testosterone level. Semen analysis is recommended 4 to 6 months after starting treatment. Therapy should continue for 3 to 4 months before improvement in spermatogenesis can be expected.
• Evaluate pregnancy status as well as the fertility of the male partner prior to ovulation induction.
• Evaluate fertility status of the female partner prior to induction of spermatogenesis.

Patient/ Family Teaching:

• Teach the proper usage of the injection like self-administration of the medication and sites. ​
• Stop using this medication when you become pregnant. This medication must not be used during pregnancy.
• Inform women regarding the risks of OHSS and OHSS-associated conditions including pulmonary and vascular complications and ovarian torsion 
• Follistim® AQ cartridge or injection in a refrigerator or at room temperature for 3 months or until expiration date. If the Follistim® AQ cartridge has been pierced by a needle, you may store it up to 28 days. Keep the cartridge away from light. If the medication is stored in the refrigerator, allow the medication to warm to room temperature before use.
• Do not mix this medicine with other medicines in the same cartridge, vial, or syringe.
• Check the solution in the cartridge or vial. It should be clear and colorless. If it is cloudy, discolored, or contains large flecks (particles), do not use it.
• Keep track of where you give each shot to make sure you rotate body areas. This will prevent skin problems. Do not inject into skin areas that are tender, red, bruised, or hard.
• Inform the patient regarding the possible side effects of the medication and when to seek the medical attention.

Mechanism of Action:

Gonadotropin releasing-hormone antagonist; blocks endogenous LHRH in pituitary with high antagonistic activity & inhibits premature LH surges in patients undergoing controlled ovarian hyperstimulation; prevents ovulation until follicles are of adequate size.

Indications:

• Female Infertility
• Prostate cancer

Contraindications & Cautions:

• Hypersensitivity to drug, its components, GnRH, or GnRH analogs
• Known or suspected pregnancy
• Use cautiously in:
• GnRH sensitivity
• latex sensitivity (packaging contains natural rubber latex)
• breastfeeding patients.

Metabolism and Half- Life:

• Absorption: Peak plasma concentration 14.8 ng/mL (single-dose); 11.2 ng/mL (multiple-doses)
• Peak plasma time: 1.1 hr
• Bioavailability: 91.1%; Distribution: Vd: 43.7 L (IV); Protein bound: 91.1%
• Elimination
• Half-life: 12.8 hr (single dose); 16.2 hr (multiple doses)
• Excretion: Feces (75.1%); urine (22.1%)

Drug Interactions:

• Hematocrit, total bilirubin: decreased values
• Neutrophils: altered count (8.3/mm3 or greater)

Side- Effects:

• CNS: headache
• GI: nausea, abdominal pain of GI tract origin
• GU: abdominal pain of gynecologic origin, vaginal bleeding, ovarian hyperstimulation syndrome
• Other: injection site reaction, fetal death

Nursing Considerations

Patient monitoring

• Monitor patient for adverse effects, especially ovarian hyperstimulation.
• Monitor total bilirubin level and CBC with white cell differential.
• Obtain ultrasound to assess Follicle size.
• Verify pregnancy status prior to initiation of treatment.
• Monitor for signs and symptoms of Hypersensitivity.

Patient teaching

• Inform patient about possible adverse reactions.
• Teach patient about duration of treatment and required monitoring procedures.
• Urge patient to tell prescriber if she is pregnant before starting drug.
• Ganirelix should NOT be kept in the refrigerator

Mechanism of Action:

LH & FSH are pituitary gonadotropins that stimulate gonadal function, including spermatogenesis & ovulation.

Indications:

• Ovulation Induction
• ART (Assisted Reproductive Technology)
• Spermatogenesis

Contraindications & Cautions:

• Pregnancy; may cause fetal harm
• Hypersensitivity
• High levels of FSH indicating primary ovarian failure
• Presence of uncontrolled nongonadal endocrinopathies (eg, thyroid, adrenal, or pituitary disorders)
• Sex hormone dependent tumors of the reproductive tract and accessory organ
• Tumors of pituitary gland or hypothalamus
• Abnormal uterine bleeding of undetermined origin
• Ovarian cysts or enlargement of undetermined origin, not due to polycystic ovary syndrome

Metabolism and Half- Life:

Following 6 doses of 150 IU/day SC/IM, serum concentrations of FSH

• SC: 1.7-15.9 mIU/mL
• IM: 0.5-10.1 mIU/mL

LH serum concentrations were 0-3.2 mIU/mL for both routes of administration

Half-Life: Initial phase

• FSH: 4 hr
• LH: 20 min

Final phase

• FSH: 70 hr
• LH: 4 hr

Elimination

Excretion: Urine (8% unchanged)

Drug Interactions:

A product that may interact with this drug is: gonadorelin.

Side Effects:

• Heachache
• Abdominal pain
• Nausea
• OHSS
• Injection site pain 
• Flushing
• Dizziness
• Malaise
• Migraine
• Breast tenderness
• Hot flashes  
• Menstrual irregularities ​
• Abdominal cramping/fullness ​
• Constipation ​
• Diarrhea ​
• Ovarian disease ​
• Vaginal hemorrhage ​
• Back pain​
• Cough increased ​
• Respiratory disorder​
• Flu-like syndrome ​ Ovarian enlargement & hyperstimulation

Nursing Considerations

• Should be prescribed by clinicians experienced in infertility treatment. Appropriate monitoring facilities required for gonadotropin treatment.
• Prior to initiating treatment with menotropins, perform a complete gynecologic and endocrinologic evaluation to assess pelvic anatomy and rule out early pregnancy. Exclude a diagnosis of primary ovarian failure. Evaluate male partner’s fertility potential.
• Administer menotropins daily until follicular maturation (as determined by serum estradiol concentrations and ovary ultrasound examinations) occurs.
• When ultrasound assessment and serum estradiol concentrations show sufficient follicular maturation, discontinue menotropins; administer human chorionic gonadotropin (hcg) after (generally 1 day after) the last dose of menotropins to complete final follicular maturation and induce ovulation.
• Do not administer hcg if the ovaries show an excessive response to treatment with gonadotropins because of an increased risk of ovarian hyperstimulation syndrome (OHSS). (See OHSS under cautions.)
• Individualize dosage of menotropins based upon patients’ ovarian response. Administer lowest possible effective dosage to minimize risk associated with abnormal ovarian enlargement.

Patient/ Family Teaching:

• Importance of patient informing clinician prior to beginning menotropins treatment about a personal or family history of thrombosis or history of ovarian torsion or ovarian cyst.
• Importance of instructing patients on the correct use and dosage of menotropins. Advise patients not to change the dosage or schedule of administration unless told to do so by a clinician.
• Importance of advising patients that if a dose is missed, the next dose should not be doubled; the clinician should be contacted to provide further dosing instructions.
• Importance of patient understanding and following instructions regarding reconstitution of menotropins, duration of treatment, and required monitoring procedures.
• Importance of informing patient of potential adverse effects (e.g., OHSS). Advise patients of the risk of OHSS-associated symptoms, including pulmonary and vascular complications and ovarian torsion.
• Importance of informing patient regarding the risk of multifetal gestation and birth with the use of menotropins treatment.
• Importance of patients informing a clinician if severe stomach or pelvic pain, stomach bloating, nausea, vomiting, diarrhea, difficulty breathing, decreased or absent urination, or sudden weight gain occurs.
• Importance of patient informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, as well as any concomitant illnesses.
• Importance of informing patient of other important precautionary information.

REFERENCES

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