Pergoveris

Pergoveris has a follicle-stimulating effect. It is a complex drug that contains recombinant human FSH and recombinant LH, which are produced by genetic engineering procedures.

The drug is used in cases of female hypogonadism of the hypogonadal type, in which there is a deficiency of FSH with LH. It is prescribed during IVF procedures, as well as ICSI or IVF + ICSI. The advantage of additional administration of r-LH in case of insufficient effect with stimulation of r-FSH only has been confirmed. Due to the addition of lutropin, the sensitivity of the ovaries to r-FSH increases. [ 1 ]

Indications Pergoveris

It is used as part of reproductive programs under the following conditions:

• the presence of a suboptimal response (formation of 4-6 follicles) during previously performed stimulation using pure FSH;
• the patient is over 35 years of age and has previously shown a suboptimal response to stimulation;
• stimulation of follicular growth in case of severe deficiency of FSH with LH without the use of ART.

Release form

The drug is released in the form of powder for the preparation of a medicinal solution; the kit also contains a solvent.

Pharmacodynamics

FSH helps stimulate folliculogenesis, while LH regulates the processes of follicle formation and ovulation. At the same time, it promotes normal activity of the corpus luteum, which is required for conception and pregnancy development. [ 2 ]

LH also stimulates the production of androgens, which are then converted into estrogens, which are necessary to create the conditions required for conception. In addition, without estrogens, there is a disruption of the processes of endometrial growth and the formation of the corpus luteum. [ 3 ]

Pharmacokinetics

After subcutaneous injection, lutropin-α is distributed within the organs; its bioavailability is approximately 60%.

It is observed inside the body for 5 hours. After a single use, the pharmacokinetic properties are similar to the parameters determined with multiple administration; in this case, the substance accumulates only in minimal volumes. Use together with follitropin-α does not lead to the development of interaction.

After a subcutaneous injection, the bioavailability of follitropin-α is 70%. In case of repeated administration, a 3-fold accumulation of the drug is observed. Css values are reached within 3-4 days.

Dosing and administration

Therapy is performed exclusively under medical supervision. The drug is administered only by the subcutaneous method. The powder must be diluted in a solvent, after which the entire portion must be used immediately.

Stimulation of the processes of formation and growth of follicles in case of a pronounced deficiency of FSH with LH.

Therapy can be started on any day of the cycle. First, 1 bottle of the drug is administered per day. The duration of the treatment course is selected individually, taking into account the size and growth of the follicle, determined during ultrasound, and also taking into account blood estrogen levels. Within the boundaries of the 1st stimulation cycle, its period can be prolonged up to 5 weeks.

If an increase in the r-FSH dose is required, it is done after 1-2 weeks, by 37.5-75 ME follitropin-α. After receiving the required reaction, after 1-2 days, 5-10 thousand ME hCG is used. It is necessary to perform intrauterine insemination or have sexual intercourse on the day when hCG was administered, or the day after.

If the response to the stimulation becomes excessive, the therapy is stopped, postponing the use of hCG. The treatment should be resumed during the next cycle, but at a lower dosage of r-FSH.

Stimulation in case of suboptimal response during previous ART programs.

Therapy usually begins with a dose of 300 IU of standard r-FSH, 1 time per day for 5-7 days. Then, from the 7th day, a transition to the introduction of 2 vials of the drug is made.

There are also alternative treatment regimens selected by the doctor taking into account the patient's personal characteristics and data obtained from previous stimulations. A maximum of 450 IU of r-FSHh is allowed per day.

The therapy is performed until the required level of follicular development is achieved, determined by ultrasound and blood estrogen levels. After achieving this level, hCG is used, which is required for complete maturation of the follicles, and then the oocyte is extracted.

In case of significant increase in ovarian size, it is necessary to stop using hCG and suspend therapy. It can be resumed during a new cycle, with the introduction of a reduced dose of the drug.

• Application for children

Pergoveris is not indicated in pediatrics.

Use Pergoveris during pregnancy

It is prohibited to use the medication during pregnancy.

Contraindications

Among the contraindications:

• uterine bleeding of unknown origin;
• carcinoma of the breast, ovary or uterus;
• neoplasms in the pituitary gland or hypothalamus;
• voluminous cysts in the ovarian area;
• neoplasms affecting the uterus, or genital anomalies (congenital) that make pregnancy impossible;
• ovarian insufficiency (primary type);
• breastfeeding period;
• severe intolerance to the drug.

Side effects Pergoveris

Among the frequently developing side symptoms are: drowsiness or headaches, colic or pain in the abdominal area, vomiting, bloating, bowel movements and nausea. In addition, OHSS of varying intensity, cysts in the ovary area and signs in the injection area (swelling, bruising, redness and pain).

Among the manifestations that appear occasionally: exacerbation of bronchial asthma in people with asthma, thromboembolism (in case of severe stage of OHSS) and apoplexy affecting the ovary. In addition, ectopic or multiple pregnancy and general allergy symptoms (rashes, facial swelling, urticaria, breathing problems, anaphylaxis, fever, generalized swelling and arthralgia).

Overdose

Pergoveris intoxication may result in the development of OHSS.

Interactions with other drugs

It is prohibited to mix the medication in one syringe with other medications (except follitropin-α).

Storage conditions

Pergoveris should be stored at temperatures no higher than 25°C.

Shelf life

Pergoveris can be used for a period of 36 months from the date of release of the pharmaceutical product.

Analogues

An analogue of the drug is Menopur.

Reviews

Pergoveris receives quite contradictory reviews. It is usually used in cases of weak response to gonadotropins, diagnosed during previous reproductive programs. There are comments from patients who consider Menopur to be more effective, since it results in the maturation of fewer follicles, but they are of higher quality.