Posts Tagged ‘follistim response’
10 Things About Follistim
Written by Arpee on August 18, 2008 – 5:34 pm -I noticed that almost half of my blog visitors are looking for information regarding Follistim. So I figured it may be helpful to some that I put this together based on what I learned about it, what to expect, what Follistim dosages are, etc. So here goes…
Follistim’s generic name is follitropin beta.
1. Follistim is a recombinant follicle stimulating hormone (rFSH) versus the human menopausal gonadotropin (hMG) such as Humegon, Pergonal, Repronex and Menopur which are extracted from the urine of menopausal women.
I think the FSH term is self-explanatory, but as for the term “recombinant”? I am not a scientist but what I picked up is that it is a genetic engineering process that uses Chinese hamster ovary (CHO) cells in the manufacturing process. I am sure it is a controlled manufacturing process, but just the thought of injecting myself with something “mixed” with non-human feels creepy.
I guess we do choose our own poison - non-human derivative or human menopausal urine? And no, I am not making these up … see these sources. (a) (b) (c).
Of course, Organon’s website indirectly states “mammalian” host cells vs directly stating Chinese hamster ovary cells! I suppose they don’t want to freak us out!
2. Follistim is prescribed to women with ovulation problems. Typically, women who are clomid-resistant or have PCOS use Follistim. (I have read about other women having protocols that includes clomid and Follistim, though.)
Follistim is also used for ovarian stimulation in preparation for fertilization - usually using assisted reproductive technologies (ART) such as intra-uterine insemination (IUI) or in-vitro fertilization (IVF).
3. Follistim is what it is called in the US. The rest of the world calls it Puregon. They are made by Organon, a Schering Plough company.
Other fertility drugs that are used for similar results are:
- Gonal F (follitropin alfa, rFSH) from Serono
- Bravelle from Ferring (urofollitropin, highly-purified human-derived FSH or hFSH)
4. Follistim is usually used together with human chorionic gonadotropin (hCG such as Ovidrel or Pregnyl) to trigger ovulation.
Follistim is also usually used with an gonadotropin releasing hormone (GnRH) agonist and/or antagonist for IVF protocols. GnRH agonist such as Lupron blocks the production of FSH and LH, and is administered 10-20 days in the previous cycle. GnRH antagonist such as Ganirilex/Antagon or Cetrotide blocks the effect of GnRH, and is administered on the later part of the stimulation cycle. (a)
5. Follistim dosages that you will be prescribed is an ESTIMATE and will latter be dependent on the individual response.
Your Reproductive Endocrinologist or Fertililty Specialist has some baseline dosages in mind based on your individual case and thus will estimate how much you will be asked to order from the pharmacy. The protocol is started on between cycle day 3 (CD3) to CD5.
6. Follistim requires close response monitoring by sonogram and Estradiol blood test every 2-3 days.
Sonogram will show the endometrium lining thickness and the the follicle count and size. A gradual increase is desired from CD3 to CD14. (In my case, my RE wanted to see endometrium lining thickness greater than 9.5mm and mature follicle (size>18mm) count of 3 to 5 follicles before we trigger on the CD13-14.)
Blood work is needed to read the Estradiol (E2) levels as well. As a rule of thumb, it is said that for every mature follicle, expect 200pc/ml. (In my case, the desired level was 1500 pc/ml.) Levels greater than 3000 pc/ml are usually associated with Ovarian Hyper Stimulation Syndrome (OHSS).
See a sample of Follistim response data vs dosages here.
Throughout the protocol, the dosage may be adjusted or “titrated” based on your response to the Follistim. For some, a cycle’s dosage may be too low or was increased too late that the right size and number of follicles is not produced. For some, a cycle’s dosage may be too much or was decreased too late that results to Ovarian Hyper Stimulation Syndrome (OHSS). If the baseline or adjusted dosage works, well and good. Do not be surprised though if it does not work and you will need another Follistim cycle.
Just a note though that there is anecdotal information that one patient’s response could vary from cycle to cycle as well.
7. Follistim is expensive … but DesignRx can give you a big discount.
8. Follistim has an expiration - 28 days from piercing or 3 months at room temp or until expiration date when refrigerated.
How to maximize the use of your precious follistim? Can you use expired follistim? See tomorrow’s post.
9. Follistim has been in use for more than a decade now.
It was first introduced in 1995 in Europe.
It was introduced in 1996 in the US but the Follistim® AQ Cartridge was FDA approved only in 2004.
It was introduced in 2005 only in Japan.
10. Follistim is expected to become cheaper by 2015.
This is when Organon’s Follistim comes off patent. Expect the influx of generic manufacturers to lower the price by then!
Anything of key significance I missed, fellow Follistim-users?
Posted in In Between Cycles, Infertility Learnings | 3 Comments »
CD13: Follistim Day 9 Response (Cycle #2)
Written by Arpee on July 20, 2008 – 11:59 pm -The leading follicle last Thursday really grew and it is ripe for the picking!
I don’t have ultrasound image to show today though because in my excitement, I forgot to remind Dr H to print it for me.
Endometrial Lining = 7.1 -> 10.2 -> 10.5
Right Ovary = 10: 7, 6/3, 5/5, 4 -> 6: 11, 10/3, 8, 7 -> 5: 16, 15, 14/2, 10
Left Ovary = 9: 8, 7, 6/4, 5, 4/2 -> 5: 14, 10, 9, 8/2 -> 5: 20, 15, 13, 11/2
Estradiol = 91 -> 380 -> ?
(For those who are new here - You can go to Follistim response in the top tabs to see the tabulation of all my stats summary from both cycles.)
Dr H said she’ll print an ultrasound image tomorrow. Maybe, it will not show up as big anymore though since I injected Ovidrel this afternoon. She also mentioned that the other 3 next biggest would be candidates too. So potentially I will ovulate 1-4 eggs. Yaiikkks -potentially, quadrups?
So… we will be going in for our very first IUI tomorrow !!!
When I asked Dr H about the probability of conception for IUI, I initially got the “it depends on the quality of the egg”. I eventually got some quantity: 20-25%. This is about the same as the IVF success rates (live birth) they have for my age range.
We then asked about what the effect of SA low morphology to this probability and she said that post-count wash count was more important that morphology. The desired level is 10million count. I better go take care of the boys now. 
Meanwhile, say a prayer for us!
Posted in Follistim Cycle, IUI | 7 Comments »
CD10: Follistim Day 6 Response (Cycle #2)
Written by Arpee on July 17, 2008 – 1:38 pm -Murphy threw a couple of curveballs today - I woke up late because of tossing and turning last night thinking of the “expired” Follistim (will post about this separately) and then I had to get some gas because DH did not replenish the car’s gas. So there I was late for a 7:30am ultrasound appointment, so I detoured for the blood draw because I didn’t want to be late for both. It was already 8:45 when I came in for my ultrasound appointment. Dr Hansard graciously squeezed me into her schedule - but not without asking me why I was late.
I have 1 “leading” follicle - yehey!!!
Read more »
Posted in Follistim Cycle, Ovary Follicle Egg | 4 Comments »
CD7: Follistim Day 3 Response (Cycle #2)
Written by Arpee on July 14, 2008 – 9:49 pm -The effect of the lower Follistim dosage on my left ovary is shown in the ultrasound image below: (It was Cindy the sonologist who did the ultrasound.)
Other stats are as follows:
Endometrial Lining = 7.1
Right Ovary = 10: 7, 6/3, 5/5, 4
Left Ovary = 9: 8, 7, 6/4, 5, 4/2
Estradiol = 91
Read more »
Posted in Follistim Cycle, Ovary Follicle Egg | No Comments »
