Use of the drug primobolan enanthate during pregnancy and breast-feeding is contraindicated. Due to the fact that clinical data on the drug during pregnancy is insufficient, in case of unintended reception of pregnancy can not be excluded teratogenic effect of recombinant .
Dosage and administration:
When using pen-injector ( “Puregon Pen”), we must remember that the handle – this is the exact device, releasing the dose set on it. It is shown that by using the pen-injector is introduced 18% more FSH than (using a syringe. It may be significant, particularly when changing pen-injector for a conventional syringe, and vice versa, in one cycle of treatment. Some of the dose correction especially needed when switching from a syringe to the pen, in order to avoid an unacceptable increase in the dose administered.
Starting treatment with P should be under the supervision of a physician experienced in the treatment of infertility.
The dosage should be individualized depending on the ovarian response, under the control of ultrasound and estradiol concentrations. The drug effective at lower total dose and less treatment time required for ripening, compared to FSH obtained from urine, thereby minimizing the risk of ovarian hyperstimulation.
Summary of experience in infertility treatment by in vitro fertilization indicates success most likely during the first 4 courses of therapy and thereafter gradually reduced. Anovulation recommended sequential regimen starting with daily administration of 50 ME formulation primobolan enanthate for at least 7 days. If there is no ovarian response the daily dose is gradually increased until follicle growth and / or increasing the concentration of estradiol in the plasma, indicating the achievement of optimal farmakodinamicheekrgo response. The optimal daily rise in plasma estradiol concentration 40-100%. Thus obtained is then maintained a daily dose to achieve preovuldtsii state. Preovulyatsii condition defined by the presence of the dominant follicle with a diameter of at least 18 mm (USI) and / or the concentration of estradiol in blood plasma . Typically, to achieve this condition It requires 7-14 days of treatment. After this introduction of the drug is stopped and induce ovulation hCG administration. If the amount is too large or follicular estradiol concentration is increased too fast, i.e. more than 2 times per day for 2-3 consecutive days, a daily dose should be reduced. Since each follicle with a diameter of more than 14 mm is preovulatory, the presence of multiple follicles with diameters greater than 14 mm carry the risk of multiple pregnancy. In this case, is not injected, and take measures to protection from possible pregnancy in order to prevent multiple gestations. The induction of superovulation during in vitro fertilization. Apply different stimulation patterns. For at least the first four days it is recommended to inject formulation. Thereafter, the dose can be selected individually, based on the ovarian response. Clinical studies have shown that the application is usually sufficient maintenance dose for 6-12 days, but in some cases may require more prolonged treatment. Preparation primobolan enanthate can be used either alone or in combination with an antagonist or agonist of gonadotropin-releasing hormone for the prevention of premature ovulation peak. When using analogues may require higher total doses . The reaction is controlled by ovarian ultrasound and determination of estradiol concentration in plasma. If there are at least 3 follicles with a diameter of 16-20 mm (, ultrasound), and having a good response of the ovaries (estradiol plasma concentration of 300-400 pg / ml (1000-1300 pmol / l) for each follicle with a diameter more 18 mm) to induce the final phase of follicle maturation through administration . After 34-35 hours, egg aspiration is performed.
The drug, manufactured cartridges, designed to be administered by a pen-injector ( “Pan Puregon”). In this case, the drug is administered subcutaneously. To prevent pain upon injection and to minimize leakage of the drug from the injection site, the solution should be injected slowly. It is necessary to alternate sites subcutaneous injection to avoid the development of lipoatrophy. Unused solution should be destroyed.
Subcutaneous injections may make the woman herself or her partner, receiving detailed instructions from the doctor. Self-administration of the drug is allowed only for patients who have good skills and are always able to consult with a specialist.
Use of the drug primobolan enanthate may be accompanied by the development of local reactions, bruising, pain, redness, swelling, itching, were observed in 3 of 100 patients treated with the drug. The majority of these local reactions are mild and a transient. Generalised hypersensitivity reactions including erythema, urticaria, rash and itching, met at the 1st of the 1,000 patients who received treatment . oxydrolone