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Experience with ART indicates that in general the treatment success rate remains stable during the first four attempts and gradually declines thereafter. Females with anovulation resulting from severe LH and FSH deficiency In these women (hypogonadotrophic hypogonadism) the objective of Merional treatment is to develop a single mature Graafian follicle from which the oocyte will be released following the administration of hCG. As these women are amenorrhoeic and have low endogenous oestrogen secretion treatment may commence at any time. The treatment should be adjusted to the individual patient’s response as assessed by measuring follicle size by ultrasound and/or oestrogen secretion. A commonly used regimen commences at 75-150 IU of Merional-and is increased according to the patient’s response. Should an increased dose of Merional-be deemed appropriate, dose adaptation should preferably be made after 7-14 day intervals and preferably by 150 IU increments. It may be acceptable to extend the duration of stimulation in any one cycle up to 5 weeks. When an ideal response is obtained a single injection of 5,000 IU-10,000 IU of hCG should be administered 24-48 hrs after the last Merional injection, mastebolin 100 mg injectable steroids masteron. The patient should be recommended to have coitus on the hCG injection day and the following day. Alternatively intrauterine insemination (IUI) may be performed. Luteal support may be considered since lack of substances with luteotrophic activity (LH/hCG) after ovulation may lead to a premature loss of the corpus luteum. In the event of an excessive response treatment should be suspended and hCG withheld (see section 4. Treatment should recommence in the next cycle at a lower dose than in the previous cycle. There is no relevant use of Merional in the paediatric population in the indications (anovulatory Infertility, females undergoing controlled ovarian stimulation for multiple follicular development prior to assisted reproductive technologies and males with hypogonadotrophic hypogonadism). Merional is intended for intramuscular and subcutaneous administration. The powder should be reconstituted immediately prior to use with the solvent provided. In order to avoid injection of large volumes up to 5 vials of Merional 150 IU may be dissolved in one ml of solvent. Appearance of reconstituted product: The solution must be clear and colourless. Merional should be reconstituted prior to administration according to the instructions provided in section 6. Patients must be suitably trained in how to handle the product by their physician or other healthcare professional prior to self-administration. Merional should not be administered to children or to patients who have: ‘ Hypersensitivity to the active substance menotrophin or to any of the excipients (see section 6. Merional should not be used when an effective response cannot be achieved, such as: In females: ‘ Primary ovarian failure. Special warnings and precautions for use. Merional is a potent gonadotrophin capable of causing mild to severe adverse reactions and should only be used by physicians who are thoroughly experienced with infertility problems and their management. To minimize the risks of Ovarian Hyperstimulation Syndrome (OHSS) or of multiple pregnancies, ultrasound scans as well as oestradiol measurements are recommended.
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