In IVF treatment for women, the objective for using Merional is to stimulate the ovaries to produce eggs by developing a single mature Graafian follicle, from which the ovum will be released after the administration of hCG. Merional is used to stimulate ovation before treatment cycles, or for polycystic ovary syndrome (PCOS) in the case where Clomid has been tried and failed. The drug Merional can also be used for infertility due to pituitary gland failure and also other forms of male infertility.
How to Use Merional
Merional may be given as a regimen of daily injections. In menstruating patients, treatment should be started within the first seven days of the menstrual cycle. Your doctor will adjust the medication, but typically treatment commences at 75-150 IU and increases accordingly up to a maximum dose 225 IU—but usually not higher. The dosage will be determined by several factors, including the patient’s individual response, as well as the assessment measured by the size of follicle when monitored by ultrasound and/or estrogen secretion. If the patient fails to respond adequately after 4 weeks of treatment, the cycle should be abandoned. A new cycle then should recommence at a higher initial dose than the previous cycle.
After the ideal response has been obtained, the doctor will administer a single injection of 5,000-10,000 IU of HCG 24-48 hours after the last Merional injection. At this phase, it will be recommended that the patient have coitus on the day of the HCG injection and the following day. Intrauterine insemination (IUI) is also a viable option. A lower dose should then be given on the next cycle.
For females undergoing controlled ovarian stimulation for multiple follicular development prior to in-vitro fertilization, a commonly used protocol for superovulation is an administration of 150-225 IU of Merional on a daily basis. This regimen commences on days 2 or 3 of the woman’s menstrual cycle until a satisfactory amount of follicular development has occurred. Again, this process will be monitored by ultrasound and serum estrogen concentration. Adequate follicular development is usually achieved the tenth day of treatment (range 5-20 days). The dosage should not exceeded 450 IU daily.
One possible side effect of taking Merional is the possibility of overstimulation of the ovaries, called ovarian hyperstimulation (OHSS), which risks multiple pregnancies when used for ovulation induction. It is a syndrome that can manifest with increasing degrees of severity, like ovarian enlargement, high serum sex steroids, and an increase in vascular permeability, among other things. Use of Merional may also result in a multiple pregnancy, the majority being twins, especially in high order, which carries the risk of adverse maternal outcomes. To minimize the risk of these conditions, the careful monitoring of the ovaries’ response to the medication is absolutely crucial.
References
Commonly used fertility drugs. (2009, April 14). Retrieved from www.hfea.gov.uk: http://www.hfea.gov.uk/common-fertility-drugs.html
MERIONAL 75IU POWDER AND SOLVENT FOR SOLUTION FOR INJECTION. (2014, August 13). Retrieved from www.drugs.com: http://www.drugs.com/uk/merional-75iu-powder-and-solvent-for-solution-for-injection-leaflet.html
