Posology : מינונים

4.2      Posology and method of administration

Posology
Sterility in females:
The dosage of HMG for the induction of follicle growth in normo- or hypogonadotropic women varies according to the individual. The amount depends on ovarian response and should be checked by ultrasound examinations of the ovaries and measuring estradiol levels. If the HMG dosage is too high for the treated individual, multiple uni- and bilateral follicle growth can occur.
HMG is administered intramuscularly or subcutaneously and in general, the therapy is begun with a daily dosage corresponding to 75–150 IU FSH. If the ovaries do not respond, the dosage can slowly be increased until a rise in estradiol secretion and follicle growth is evident.
Treatment with the same dosage of HMG continues until the desired pre-ovulatory estradiol serum level is attained. If the level rises too quickly, the dosage should be reduced. To induce ovulation, 5000 or 10000 IU HCG are injected i.m. 1 to 2 days after the last HMG administration.
Note: After a HMG dosage too high for the corresponding individual has been administered the following HCG administration can cause an unintentional hyperstimulation of the ovaries.

Sterility in males:
Initially, 3 X 1000 to 3000 IU HCG a week are administered until a normal testosterone serum level is reached. Then, an additional dose of HMG (3 X 75–150 IU FSH + 75–150 IU LH) per week is administered IM for a few months.

Method of administration
Menogon is administered by intramuscular or subcutaneous injection after reconstitution with the solvent provided and should be administered immediately. Shaking should be avoided.
The solution should not be used if it contains particles or if it is not clear.

Selection of patients
Women:
1. Before treatment with Menogon is instituted, a thorough gynecologic and endocrinologic evaluation must be performed. This should include a hystero-salpingogram (to rule out uterine and tubal pathology) and documentation of anovulation by means of basal body temperature, serial vaginal smears, examination of cervical mucus, determination of serum (or urine) progesterone, urinary pregnanediol and endometrial biopsy.
2.    Primary ovarian failure should be excluded by the determination of gonadotropin levels.
3.    Careful examination should be made to rule out the presence of an early pregnancy.
4.    Patients in late reproductive life have a greater predilection to endometrial carcinoma as well as a higher incidence of anovulatory disorders. Cervical dilation and curettage should always be done for abnormal uterine bleeding or other signs of endometrial abnormalities.
5.    Evaluation of the husband’s fertility potential should be included in the workup.

Men:
Patient selection should be made based on a documented lack of pituitary function. Prior to hormonal therapy, these patients will have low testosterone levels and low or absent gonadotropin levels. Patients with primary hypogonadotropic hypogonadism will have a subnormal development of masculinization, and those with secondary hypogonadotropic hypogonadism will have decreased masculinization.