choriogonadotropin alfa: clinical use

Prescribing considerations

• Treatment should be supervised by a clinician experienced in fertility management.
• Assess the cause of infertility and contraindications to pregnancy; evaluate relevant thyroid, adrenal, prolactin, pituitary and hypothalamic disorders.
• Assess individual OHSS and thromboembolic risk before administration.
• Record the product name and batch number for biological-medicine traceability.
• Warn that serum or urine hCG testing may be falsely positive for up to ten days.

Contraindications and cautions

• Hypersensitivity to choriogonadotropin alfa or an excipient
• Hypothalamic or pituitary tumour
• Ovarian enlargement or cyst unrelated to polycystic ovary syndrome
• Unexplained gynaecological bleeding
• Ovarian, uterine or breast carcinoma
• Active thromboembolic disease
• Primary ovarian failure or another condition in which an effective response cannot be obtained
• Reproductive-organ malformation or uterine fibroid incompatible with pregnancy
• Postmenopausal status

Monitoring

• Monitor ovarian response within the specialist fertility pathway before administration.
• Continue surveillance for OHSS, which may progress after administration and can be prolonged by pregnancy.
• Consider ectopic-pregnancy assessment where symptoms or tubal risk factors are present.
• Safety, efficacy and pharmacokinetics have not been established in renal or hepatic impairment.

Clinical pharmacology

Recombinant hCG has the same amino-acid sequence as urinary hCG and is an LH/CG-receptor agonist. It produces resumption of oocyte meiosis, ovulation, corpus-luteum formation and luteal steroid production.

Formulation and product differences

• Ready-to-use, clear, colourless to slightly yellow solution in a single-use prefilled syringe for subcutaneous injection.
• Store refrigerated in the original package and do not freeze. It may be kept at or below 25°C for up to 30 days within its shelf life without returning it to refrigeration, then discarded if unused.