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The maximum daily dose is usually not higher than 225 IU. If a patient fails to adequately respond after 4 weeks of treatment, the cycle should be abandoned and the patient should recommence at a higher initial dose than in the previous cycle. When an ideal response is obtained a single injection of 5,000-10,000 IU of hCG should be administered 24-48 hrs after the last Merional injection. The patient should be recommended to have coitus on the hCG injection day and the following day. Alternatively intrauterine insemination (IUI) may be performed. 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. Females undergoing controlled ovarian stimulation for multiple follicular development prior to in-vitro fertilization or other assisted reproductive technologies. A commonly used protocol for superovulation involves the administration of 150-225 IU of Merional daily commencing on days 2 or 3 of the cycle and continued until sufficient follicular development has been achieved as assessed by monitoring serum oestrogen concentrations and/or ultrasound examination with the dose adjusted according to the patient’s response but usually not higher than 450 IU daily. Adequate follicular development is usually achieved by the tenth day of treatment (range 5-20 days). A single injection of 5,000 IU-10,000 IU of hCG should be administered 24-48 hours after the last injection to induce follicular maturation. Pituitary down-regulation in order to suppress the endogenous LH surge and to control tonic levels of LH is now commonly achieved by administration of a gonadotrophin releasing hormone (GnRH) agonist. In a commonly used protocol the administration of Merional-is started approximately two weeks after the start of agonist treatment, both being continued until adequate follicular development has been achieved, steroid pills muscle growth. For example, following two weeks of pituitary down-regulation with an agonist, 150-225 IU Merional are administered for seven days; the dose is then adjusted according to the patient’s ovarian response. 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. 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.
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