Recombinant human chorionic Gonadotropin is a Luteinizing hormone analog that is produced by recombinant DNA technology, unlike the urine-derived human chorionic gonadotropin.

It is used to induce ovulation in infertile women who have been pretreated with follicle-stimulating hormone as part of an assisted reproductive technology program.

It induces ovulation and pregnancy in functionally infertile females without any anatomic defect.

Gonadotropin Dose in Adults

Assisted reproductive technologies and ovulation induction in females:

• 250 mcg subcutaneously given one day after the last dose of the follicle-stimulating agent.
• It should be used only after adequate follicular development occurs.
• Patients with excessive ovarian response should withhold the treatment.

Gonadotropin Dose in Childrens

Not applicable.

Pregnancy Risk Factor: D

• It has been shown to have adverse effects on fetal health.
• Reports of ectopic pregnancy, preterm labor, spontaneous abortion, and postpartum fever have been made.

Gonadotropin use during breastfeeding:

• It is unknown if the drug can be found in breastmilk.
• It is recommended that lactating mothers be cautious when using it.

Gonadotropin Dose in Kidney Disease:

• Data is limited regarding its use in patients ith renal disease.

Gonadotropin Dose in Liver Disease:

• Data is limited regarding its use in patients ith liver disease.

Common Side Effects of Gonadotropin Include:

• Endocrine & metabolic:
  • Ovarian cyst
  • Ovarian hyperstimulation
• Gastrointestinal:
  • Abdominal pain
  • Nausea
  • Vomiting
• Local:
  • Pain at injection site
  • Bruising at injection site
  • Injection site reaction
  • Inflammation at injection site

• Miscellaneous:
  • Postoperative pain

Contraindication to Gonadotropin Include:

• Allergy reactions to hCG preparations and any component of the formulation
• Primary ovarian failure
• Thyroid dysfunction or adrenal dysfunction uncontrolled
• Uncontrolled intracranial lesion organic like a pituitary tumour
• Abnormal uterine bleeding
• Ovarian cysts or ovarian enlargement of unknown cause
• Tumors that are hormone-dependent
• Pregnancy

Warnings and Precautions

• Ovarian enlargement:
  • You may experience abdominal pain or distension as a side effect of the treatment. These symptoms usually resolve within 2 to 3 weeks.
  • If abnormally large ovaries are found to lower the risk of developing ovarian hyperstimulation syndrome, treatment must be stopped.
• Ovarian hyperstimulation syndrome:
  • This is an uncommon exaggerated response for ovulation-induction therapy.
  • Although the clinical symptoms of this syndrome can appear within 24 hours of treatment initiation and last for 7 to 10 days, severe symptoms may develop after that time.
  • Mild OHSS may manifest as abdominal distension, or discomfort, diarrhea, nausea, and vomiting.
  • Symptoms of severe OHSS include severe abdominal pain, oliguria and anuria as well as severe dyspnea and hypotension.
  • Patients can also experience hemoconcentration, kidney dysfunction, elevated liver enzymes and hypoproteinemia.
  • The treatment focuses on fluid and electrolyte management and prevention of thromboembolic complications.
  • Patients with ovarian hyperstimulation syndrome must stop taking gonadotropins.
• Thromboembolism
  • It has been linked to arterial thromboembolism.

Monitor:

• Ultrasound and estradiol levels to assess follicle development and assess the number and size of follicles
• Monitor basal body temperature, serum progestin level, menstruation, and sonography for clinical evidence of ovulation.

Ovarian Hyperstimulation syndrome:

• Monitor hospitalized patients daily for:
  • abdominal circumference
  • albumin
  • cardiac & respiratory status
  • electrolytes
  • hematocrit
  • hemoglobin
  • fluid status
  • creatinine
  • urine output
  • urine specific gravity
  • vital signs
  • weight
• Monitor Liver functions weekly.

How to administer Gonadotropin?

• It should be administered subcutaneously only around the umbilicus.

Mechanism of action of Recombinant human chorionic Gonadotropin:

• It is an analog of the Luteinizing hormone Luteinizinghormone, and it is made using recombinant genetic technology.
• It stimulates late follicular maturation, and it initiates the rupture.

It has been abioavailabilityAvail a Discount of up to 40%half-life eliminationInitial time is 4 hours, with a terminal half-life 29 hours.

Time to get therepeak plasma concentration

It takes between 12 and 24 hours. It isexcretedIn the urine.

International Brands of Recombinant human chorionic Gonadotropin:

• Ovidrel
• Ovitrelle

Gonadotropin Brands in Pakistan: