Gonal-F or Follistim? A Comparison of Two Popular Fertility Treatments
Key takeaways:
Gonal-F (follitropin alfa) and Follistim AQ (follitropin beta) are both medications that treat infertility. They stimulate the ovaries to produce follicles and release mature eggs.
Gonal-F and Follistim work the same way, and they’re similarly effective. But they come in different dosage forms that may affect which one you prefer.
Gonal-F and Follistim are both only available as brand-name medications. But GoodRx discounts and manufacturer coupons can help you save money on your prescription.
Table of contents
If you’re going through fertility treatment, chances are you’ve come across Gonal-F (follitropin alfa) and Follistim AQ (follitropin beta). Both are injectable medications that help stimulate your ovaries to produce eggs. They’re often the first step of assisted reproductive technology like intrauterine insemination (IUI) and in vitro fertilization (IVF).
But what’s the difference between Gonal-F and Follistim? And why would you use one over the other? Here are the basics about these popular fertility medications.
How do Gonal-F and Follistim work for infertility?
Gonal-F and Follistim both contain a lab-made form of follicle stimulating hormone (FSH), or follitropin. FSH is one of the proteins called gonadotropins that regulate fertility. Gonal-F contains follitropin alfa, and Follistim contains follitropin beta. Both forms of follitropin mimic FSH in the body.
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In a typical menstrual cycle, FSH stimulates the ovaries to develop follicles (the sacs that hold developing eggs). Most of the time, one follicle develops fastest and starts to release estradiol (a form of estrogen). This tells the body to release the egg from the ovary to travel down the fallopian tube. Once this happens, FSH levels drop and the cycle restarts.
Follistim and Gonal-F work the same way — they stimulate the ovaries to develop follicles. But there’s a key difference. Normally, FSH is “turned off” once a follicle fully develops. This helps make sure that only one follicle develops at a time. When you use Gonal-F or Follistim, there’s no “off switch.” Instead, your healthcare provider will closely monitor your follicles while you’re using these medications to make sure your ovaries aren’t overstimulated. Once they see that you have several fully developed follicles, you’ll stop using Gonal-F or Follistim and move on to the next step of your treatment.
Which works better: Gonal-F or Follistim?
The truth is, these medications are similarly effective. They were the only ovarian stimulation medications available on the market for over 25 years, so we have a large amount of data on them. Clinical studies, as well as real-life data, show that they’re similarly effective at stimulating follicles and producing mature eggs. They also result in similar successful birth rates when used as part of infertility treatment.
How are Gonal-F and Follistim dosed and given?
Both Gonal-F and Follistim require daily injections. You inject them under the skin of your stomach, thigh, or upper outer arm. Most people choose the stomach area as it’s easy to self-inject there.
You should inject into a new spot each time you use these medications. Alternating between the right and left side of your stomach is a common way to do this. Rotating injection sites helps lower the chance of injection site reactions.
Gonal-F and Follistim have different doses, and they also come in different dosage forms. Both are dosed in international units (IUs). Keep in mind that your dose may be different than described below. Your healthcare provider will adjust your dose based on your medical history and how you respond to treatment. So be sure to follow their directions carefully.
It’s best to use these medications at the same time every day. So choose a time you know you can consistently inject them. If you miss a dose, contact your healthcare provider as soon as possible for instructions on how to proceed.
Gonal-F
Gonal-F is available in several different doses and dosage forms. This may give you more flexible options for your treatment.
The pre-filled pen requires no assembly and is easy to use, but it should be refrigerated before it’s opened. The vials, however, don’t require refrigeration, which may be more convenient for your lifestyle. But they do need to be mixed, which may be more complicated for some people.
The chart below shows the different forms of Gonal-F available:
Products | Doses available | Requires refrigeration | Expiration | How it’s used |
• 300 IU • 450 IU • 900 IU | Recommended* Unused pens are only good for 3 months at room temperature. | After first use: 28 days (regardless of storage) | Pre-filled injection pen; can be used multiple times | |
• 450 IU • 1,050 IU | No | After mixing: 28 days (regardless of storage) | Multi-dose vial of powder; requires mixing | |
• 75 IU | No | Use immediately after mixing. | Single-use vial of powder; requires mixing |
*If you store the Gonal-F Rediject Pen in the refrigerator, remove it from the fridge at least 30 minutes before you inject it. This will help prevent discomfort from a cold injection.
When using Gonal-F to cause ovulation, it’s recommended to start with 75 IU every day for 14 days. After that, the dose may be raised by 37.5 IU every 7 days based on your response. The maximum recommended dose is 300 IU per day. It’s not recommended to use Gonal-F for more than 35 days in a row.
When using Gonal-F as part of assisted reproductive technology, it’s recommended to start with 150 IU to 225 IU every day for 5 days. After that, the dose may be raised by 75 IU to 150 IU every 3 to 5 days. It’s not recommended to inject more than 450 IU per day or use any dose for more than 10 days in a row.
Follistim
Follistim is only available in one dosage form, known as Follistim AQ. Unlike Gonal-F, the Follistim pen doesn’t come prefilled — you have to insert the cartridge and assemble it yourself. It’s also best to refrigerate it before it’s opened.
Product | Doses available | Requires refrigeration | Expiration | How it’s used |
• 150 IU • 300 IU • 600 IU • 900 IU | Recommended* Unused cartridges are only good for 3 months at room temperature. | After first use: 28 days (regardless of storage) | Pre-filled cartridge; can only be used in a Follistim injector pen |
*If you store Follistim AQ in the refrigerator, remove it from the fridge at least 30 minutes before you inject it. This will help prevent discomfort from a cold injection.
To cause ovulation, the recommended starting Follistim dosage is 50 IU daily for 7 days. After that, the dose can go up by 25 IU to 50 IU every 7 days based on your response. It’s not recommended to use more than 250 IU per day.
When using Follistim as part of assisted reproductive technology, it’s recommended to start with 200 IU daily for 7 days. After that, your healthcare provider will adjust your dose based on your response. The maximum recommended dose is 500 IU per day.
Can you take Follistim and Gonal-F together for infertility?
No. Gonal-F and Follistim shouldn’t be used at the same time. But in some cases you may switch from one to the other mid-treatment. This doesn’t happen often, and should only be done with your healthcare provider’s approval. But in certain cases, such as a medication shortage or change in price, it may be necessary.
What are the known side effects of Follistim and Gonal-F?
Headache and abdominal pain are common side effects of both Gonal-F and Follistim. They can both also cause injection site reactions, which can include pain, bruising, or swelling in the area where the medication is injected. Changing the injection site with every dose can help prevent this side effect.
The biggest concern with either medication is ovarian hyperstimulation syndrome (OHSS). OHSS happens when the ovaries have been overstimulated. It causes a large amount of fluid to collect in the abdomen, which could be fatal if left untreated. Symptoms of OHSS include severe pelvic pain, nausea and vomiting, and rapid weight gain. You may also notice your stomach become large and bloated.
Your healthcare provider will monitor you for signs of overstimulation throughout your treatment. You’ll have frequent appointments, so be sure to stay on top of them. Call your healthcare provider or seek medical care right away if you develop signs of OHSS. Keep in mind that OHSS can happen even 7 to 10 days after you’ve stopped using stimulation medication.
Other rare side effects of Gonal-F and Follistim include blood clots, lung issues, and allergic reactions. Let your healthcare provider know if you have pain or swelling in one leg, difficulty breathing, or an itchy rash on your body.
How to save on Follistim and Gonal-F
Gonal-F and Follistim are both only available as brand-name medications. But GoodRx can help you save on your prescription.
If you’re uninsured or underinsured, or your insurance doesn’t cover fertility medications, you may be eligible for Gonal-F’s compassionate care program, which offers up to 50% off the cost of your medication. Follistim AQ’s patient assistance program offers up to 75% off for those eligible.
Keep in mind that both Gonal-F and Follistim are typically dispensed through specialized fertility pharmacies. And often, the pharmacy will offer better pricing on one medication over the other. This is how some healthcare providers choose which form of follitropin they prescribe. So be sure to talk to your provider and your fertility pharmacy about the different prices and discounts available. And don’t be afraid to shop around, since prices aren’t the same at every pharmacy.
The bottom line
Gonal-F and Follistim are injectable medications that treat infertility. They contain lab-made forms of FSH that stimulate the ovaries to produce follicles. Gonal-F and Follistim are similarly effective, but they come in different doses and dosage forms that may affect which one you prefer.
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References
A-S Medication Solutions. (2020). Gonal-F RFF [package insert].
American Society for Reproductive Medicine. (2014). Ovarian hyperstimulation syndrome (OHSS).
Bergandi, L., et al. (2020). Human recombinant FSH and its biosimilars: Clinical efficacy, safety, and cost-effectiveness in controlled ovarian stimulation for in vitro fertilization. Pharmaceuticals.
EMD Serono, Inc. (2020). Gonal-F [package insert].
EMD Serono, Inc. (2020). Gonal-F RFF Redi-ject [package insert].
LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. (2018). Gonadotropins.
Merck Sharp & Dohme LLC. (2020). Follistim AQ [package insert].
