ADULTS - WOMEN WITH HYPOTHALMIC-PITUITARY DYSFUNCTION WHO PPRESENT WITH EITHER OLIGOMENORRHOEA OR AMENORRHOEA (WHO GROUP II):-MAY BE GIVEN AS A COURSE OF DAILY INJS. IN MENSTRUATING PT.TT SHOULD COMMENCE WITH IN THE FIRST 7 DAYS OF M.CYCLE. TT.SHOULD BE TAILORED FOR EACH PT. USUAL DOSE - 75-150 IU DAILY ADMN. MAY BE INCREASED OR DECREASED BY UPTO 75 IU/DAY AT 7 OR 14 DAY INTERVALS.THE DOSE SHOULD NOT BE INCREASED MORE THAN TWICE IN ANY CYCLE OR MORE THAN 75 IU PER ADJUSTMENT,IF NECESSARY TO OBTAIN AN ADEQUATE BUT NOT EXCESSIVE RESPONSE.IF PT.FAILS TO RESPOND ADEQUATELY AFTER 4 WEEKS. THAT CYCLE SHOULD BE ABANDONED. WHEN AN ADEQUATE RESPONSE IS OBTAINED A SINGLE IM INJ. OF UPTO 10,000 IU PROFASI SHOULD BE GIVEN 24-48 HOURS AFTER THE LAST METRODIN HP INJ.THE PT IS ADVISED TO HAVE COITUS ON THE DAY OF AND THAT FOLLOWING PROFASI INJ. IF AN EXCESSIVE RESPONSE IS OBTAINED THEN TT. SHOULD BE STOPPED AND PROFASI WITHHELD.TT SHOULD COMMENCE IN NEXT CYCLE AT A LOWER DOSES. WOMEN UNDER GOING SUPEROVULATION FOR INVITRO FERTILIZATION AND OTHER ASSISTED CONCEPTION TECHNIQUES:- A REGIMEN FOR SUPEROVULATION INVOLVES ADMINISTRATION OF 150-225 IU OF METRODIN DAILY,COMMENCING ON DAYS 2 OR 3 OF CYCLE.TT IS CONTINUED WITH THE DOSE ADJUSTED TO A MAXIMUM OF 450 IU DAILY ACCORDING TO THE PT. RESPONSE,UNTIL ADEQUATE FOLLICULAR DEVELOPMENT IS ACHIEVED.
A SINGLE INJ OF UPTO 10,000 IU OF PROFASI IS GIVEN 24-48 HRS AFTER THE LAST INJ OF METRODIN TO INDUCE FINAL FOLLICULAR MATURATION. DOWN REGULATION WITH A GNRH AGONIST IS NOW COMMONLY USED IN ORDER TO SUPPRESS ENDOGENOUS LH SURGE AND TO CONTROL TONIC LEVELS OF LH. METRODIN HP IS STARTED APPROXIMATELY 2 WKS AFTER THE START OF AGONIST TT, BOTH BEING CONTINUED UNTIL ADEQUATE FOLLICULAR DEVELOPMENT IS ACHEEIVED.