Follistim AQ Uses

Follistim AQ is used to treat female infertility that is not caused by primary ovarian failure and male infertility that is not caused by primary testicular failure.

There may be other uses of Follistim AQ—your doctor or pharmacist can give you further drug information.

Follistim AQ Mechanism of Action

Follistim AQ contains human follicle-stimulating hormone (FSH). This hormone is naturally present in the human body. In women, FSH helps the ovaries get the eggs ready for release. In men, FSH helps sperm to grow and mature. 

Follistim AQ Doses

Follistim AQ Cartridge is an injection solution in a single-patient ready-to-use pen injector device that contains 300 IU (International Units), 600 IU, or 900 IU of premixed recombinant gonadotropin.

Recommended dosing in anovulatory infertile patients for ovulation induction:

The starting dose is 50 IU daily subcutaneously for at least 7 days. Following this, dosage adjustments are made at weekly intervals based on ovarian response (follicular growth and/or serum estradiol levels). If the dose needs to be increased, it is done in increments of 25-50 International Units at weekly intervals. The maximum daily dose of Follistim AQ Cartridge is 250 International Units. 

Treatment is continued until follicular growth is seen on ultrasound imaging and/or serum estradiol levels are approximately similar to pre-ovulatory conditions in healthy women. When pre-ovulatory conditions are achieved, 5,000 to 10,000 International Units of urinary human chorionic gonadotropin (hCG) are used to induce the final egg maturation and ovulation. However, hCG is withheld if ovarian monitoring indicates an increased risk of ovarian hyperstimulation syndrome (OHSS) on the last day of Follistim AQ Cartridge therapy. 

Clinical confirmation of ovulation is made with direct and indirect measures of progesterone production, such as a rise in basal body temperature, an increase in serum progesterone levels, and menstruation following the rise in basal body temperature. Sonographic visualization of the ovaries is used along with these measures of progesterone production to determine if ovulation has occurred.

Both partners are encouraged to have sexual intercourse daily starting on the day prior to hCG administration and until ovulation is apparent. 

During treatment with Follistim AQ Cartridge and for two weeks afterward, healthcare providers assess patients at least every other day for signs of OHSS. 

Follistim AQ must be stopped if abdominal pain develops or ovarian monitoring suggests an increased risk of ovarian hyperstimulation. In most patients, OHSS occurs after treatment stops and the maximum incidence is 7-10 days post-ovulation.

Recommended dosing in ovulatory patients participating in controlled ovarian stimulation as part of assisted reproductive technologies such as IVF (in vitro fertilization) or ICSI (intracytoplasmic sperm injection).

The dose is individualized for each woman and done in a stepwise manner. The starting dose is typically 200 International Units of Follistim AQ injected subcutaneously daily for at least 7 days. Following this, the dose is adjusted up or down based on ovarian response as determined by follicular growth seen on ultrasound evaluation and serum estradiol levels. 

High responders may be recommended to reduce the dose from the sixth day of treatment based on individual response. Women with a high response may also need to temporarily stop the daily dose if they are at risk of ovarian enlargement or OHSS. Normal responders are asked to continue the daily dose until pre-ovulatory conditions are reached (typically 7-12 days). Low responders may be given a higher dose based on ovarian response. The maximum individualized daily dose of Follistim AQ is 500 International Units.

Once a sufficient number of adequately sized follicles are present, Follistim AQ is discontinued. The final maturation of the eggs is induced with 5,000 to 10,000 units of urinary hCG. However, hCG administration may be withheld if ovarian monitoring suggests an increased risk of OHSS on the last day of Follistim AQ therapy.

Egg retrieval is performed 34-36 hours after hCG administration.

Recommended dosing in men to induce spermatogenesis

Men must undergo pretreatment with hCG, followed by concomitant therapy with Follistim AQ and hCG, to induce spermatogenesis. The initial dose is 1,500 International Units of urinary hCG twice weekly. This helps to normalize serum testosterone levels. If serum testosterone levels are not normal after 8 weeks of hCG pre-treatment, the urinary hCG dose may be increased to 3,000 International Units twice weekly. 

Subsequently, once serum testosterone levels are normal, Follistim AQ is administered by subcutaneous injection along with hCG treatment. The dose of Follistim is 450 International Units per week (either 225 International Units twice weekly or 150 International Units thrice weekly), along with the same hCG dose that was used for normalization of testosterone levels. 

Concomitant therapy with Follistim AQ and hCG must be continued for a minimum of 3-4 months to see improvement in spermatogenesis. The combination therapy can be continued in non-responders after this time. Response has been reported with up to 12 months of treatment.