IT IS RECOMMENDED THAT 75 IU RECOMBINANT LH® BE CONCOMITANTLY ADMINISTERED
SUBCUTANEOUSLY WITH 75 IU TO 150 IU GONAL-F® AS TWO SEPARATE INJECTIONS IN THE
INITIAL TREATMENT CYCLE. RECOMBINANT LH® AND GONAL-F® SHOULD BE ADMINISTERED DAILY UNTIL ADEQUATE FOLLICULAR DEVELOPMENT IS INDICATED BY OVARY ULTRASONOGRAPHY AND SERUM ESTRADIOL. TREATMENT DURATION SHOULD NOT NORMALLY EXCEED 14 DAYS UNLESS SIGNS OF IMMINENT FOLLICULAR DEVELOPMENT ARE PRESENT.
TO COMPLETE FOLLICULAR DEVELOPMENT AND EFFECT OVULATION IN THE ABSENCE OF AN
ENDOGENOUS LH SURGE, HUMAN CHORIONIC GONADOTROPIN (HCG) SHOULD BE GIVEN ONE DAY
AFTER THE LAST DOSE OF RECOMBINANT LH® AND GONAL-F®. TREATMENT WITH HCG SHOULD BE
WITHHELD IF THE OVARIES ARE ABNORMALLY ENLARGED OR IF EXCESSIVE ESTRADIOL
PRODUCTION HAS OCCURRED. IF THE OVARIES ARE ABNORMALLY ENLARGED OR ABDOMINAL
PAIN OCCURS, TREATMENT WITH RECOMBINANT LH® AND GONAL-F® SHOULD BE DISCONTINUED AND HCG SHOULD NOT BE ADMINISTERED, AND THE PATIENT SHOULD BE ADVISED NOT TO HAVE
INTERCOURSE; THIS MAY REDUCE THE CHANCES OF DEVELOPING OVARIAN HYPERSTIMULATION
SYNDROME AND, SHOULD SPONTANEOUS OVULATION OCCUR, REDUCE THE CHANCES OF MULTIPLE
GESTATION. A FOLLOW-UP VISIT SHOULD BE CONDUCTED IN THE LUTEAL PHASE.
DOSES ADMINISTERED IN SUBSEQUENT CYCLES SHOULD BE INDIVIDUALIZED FOR EACH
PATIENT BASED ON HER RESPONSE IN THE PRECEDING CYCLE. DOSES OF GONAL-F® GREATER
THAN 225 IU PER DAY ARE NOT ROUTINELY RECOMMENDED. AS IN THE INITIAL CYCLE, HCG
MUST BE GIVEN TO COMPLETE FOLLICULAR DEVELOPMENT AND INDUCE OVULATION. THE
PRECAUTIONS DESCRIBED ABOVE SHOULD BE FOLLOWED TO MINIMIZE THE CHANCE OF
DEVELOPING OVARIAN HYPERSTIMULATION SYNDROME.
THE COUPLE SHOULD BE ENCOURAGED TO HAVE INTERCOURSE DAILY, BEGINNING ON THE DAY
PRIOR TO HCG ADMINISTRATION UNTIL OVULATION BECOMES APPARENT IN THE INDICES USED
FOR THE DETERMINATION OF PROGESTATIONAL ACTIVITY.