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Chorionic Gonadotropin (Systemic)


VA CLASSIFICATION
Primary: HS106
Secondary: DX900; HS900

Note: Controlled substance classification—

Note: Controlled substance classification


U.S.—Schedule IV (controlled substance in some states in the U.S.){17}
Commonly used brand name(s): A.P.L; Pregnyl; Profasi; Profasi HP.

Another commonly used name is
human chorionic gonadotropin (hCG) .
Note: For a listing of dosage forms and brand names by country availability, see Dosage Forms section(s).



Category:


Gonadotropin—

cryptorchidism therapy adjunct—

infertility therapy adjunct—

diagnostic aid (hypogonadism)—

Indications

Note: Bracketed information in the Indications section refers to uses that are not included in U.S. product labeling.

Accepted

[Cryptorchidism (diagnosis)]1or{56}{59}{63}
Cryptorchidism (treatment)—Chorionic gonadotropin is indicated both as a diagnostic trial and for treatment of prepubertal cryptorchidism not due to anatomical obstruction {04} {56} {59} {63}. Treatment with chorionic gonadotropin usually begins at 4 to 9 years of age {04}. If no signs of improvement occur during the initial course, surgery is indicated {18} {56}.

Infertility, male (treatment)—Chorionic gonadotropin is indicated, alone or in combination with menotropins or clomiphene, for treatment of male hypogonadism due to pituitary deficiency {04} {21} {25} {27} {28}. Males who have been hypogonadotropic for prolonged periods may require treatment with testosterone instead {62}.

Infertility, female (treatment)—Chorionic gonadotropin is indicated in conjunction with menotropins, urofollitropin, or in some cases, clomiphene, to stimulate ovulation {04} {25} {26} {29} {40} {42}. In general, use of chorionic gonadotropin with menotropins or urofollitropin is the treatment of choice for induction of ovulation in patients who do not respond to clomiphene. {04} {25} {26} {29} {34} {40} {42} {58} {63}

Reproductive technologies, assisted—Chorionic gonadotropin is indicated, in conjunction with menotropins or urofollitropin, to stimulate the development and maturation of multiple oocytes in ovulatory patients who are attempting to conceive by means of assisted reproductive technologies, such as gamete intrafallopian transfer (GIFT) or in vitro fertilization (IVF) {01} {29} {35} {43} {46} {63}.

[Hypogonadism, male (diagnosis)]1—Chorionic gonadotropin is also used to test the ability of the testes to respond to gonadotropin stimulation in males with delayed puberty.

[Corpus luteum insufficiency (treatment)]1—Chorionic gonadotropin is used to treat corpus luteum dysfunction {19} {22} {23} {24} {25} {26} {32} {33} {36} {40} {41}. Treatment should begin in the cycle of conception and not after the first missed menses. It is continued until hormone production is taken over by the placenta after 7 to 10 weeks of gestation {62} {63}.

Unaccepted
Chorionic gonadotropin has not been found effective and is not indicated for weight reduction. {04}

1 Not included in Canadian product labeling.



Pharmacology/Pharmacokinetics

Physicochemical characteristics:
Source—
    Produced by the placenta {63}; extracted from urine of pregnant women.

Mechanism of action/Effect:

The action of chorionic gonadotropin is almost identical to that of pituitary luteinizing hormone (LH) {04} {36} {43} {65}. It is generally used as a substitute for LH {04} {36} {43} {65}.


Prepubertal cryptorchidism:

Stimulates androgen production by the testes, which may stimulate descent of the testes {04} {67}. The effect is usually permanent but may be temporary. In use as a diagnostic trial, chorionic gonadotropin administration should stimulate increased serum testosterone concentrations {56} {59} {63}.



Hypogonadotropic hypogonadism:

Stimulates androgen production by the testes, which leads to the development of male secondary sexual characteristics {04} {49} {63}.



For induction of ovulation and assisted reproductive technologies (ART):

Clomiphene, menotropins, or urofollitropin prepare the ovarian follicle for ovulation {64}. The combination of follicle-stimulating hormone (FSH) and LH stimulates follicular growth and maturation {64}. Chorionic gonadotropin, whose actions are nearly identical to those of LH, is administered following administration of clomiphene, menotropins, or urofollitropin to mimic the naturally occurring surge of LH that triggers ovulation {64}.



Diagnostic aid (hypogonadism):

Should stimulate increased production of testosterone.



Corpus luteum insufficiency:

Promotes maintenance of the corpus luteum; stimulates ovarian production of progesterone {04} {36} {39} {40} {51} {63}.


Half-life:

Biphasic, 11 and 23 hours (serum) {05}.

Time to peak effect:

Females—Ovulation usually occurs within 32 to 36 hours after administration of chorionic gonadotropin {29} {30} {36} {39}.

Elimination:
    Renal, unchanged {05}; 10 to 12% within 24 hours.


Precautions to Consider

Carcinogenicity/Mutagenicity

Studies have not been done in either animals or humans. {05}

Pregnancy/Reproduction
Fertility—
Use of chorionic gonadotropin in conjunction with menotropins or urofollitropin to induce ovulation is associated with a high incidence of multiple gestations and multiple births {01} {02} {04} {29} {63} {64}. As a result, this may increase the risk of neonatal prematurity, as well as other complications associated with multiple gestations {01} {02} {04} {29} {63} {64}.

Pregnancy—
Appropriate studies have not been done in either animals or humans {05} {64} {66} {67}.

Ovarian hyperstimulation syndrome (OHS), which may occur during chorionic gonadotropin therapy, may be more common, more severe, and protracted in patients who conceive {01} {02} {65}.

FDA Pregnancy Category C {05}.

Pediatrics

Precocious puberty has been reported in males treated with chorionic gonadotropin for cryptorchidism {04}. Generally, therapy is withdrawn and the use of chorionic gonadotropin re-evaluated if signs of precocious puberty appear {04}. Also, prolonged or high doses of chorionic gonadotropin may cause abnormally rapid advancement of skeletal maturation and lead to premature epiphyseal fusion {56} {60} {63}. This could result in reduced final adult height {56} {60} {63}.



Laboratory value alterations
The following have been selected on the basis of their potential clinical significance (possible effect in parentheses where appropriate)—not necessarily inclusive (» = major clinical significance):

With diagnostic test results
Immunologic assay for endogenous chorionic gonadotropin {20}    (pregnancy test should be performed at least 10 days or longer after administration of chorionic gonadotropin to avoid false-positive result {20})

With physiology/laboratory test values
17-Hydroxycorticosteroids and
17-Ketosteroids    (urine concentrations may be increased)


Medical considerations/Contraindications
The medical considerations/contraindications included have been selected on the basis of their potential clinical significance (reasons given in parentheses where appropriate)— not necessarily inclusive (» = major clinical significance).


Except under special circumstances, this medication should not be used when the following medical problems exist:

For treatment of cryptorchidism:
» Precocious puberty {04} {52}
For induction of ovulation:
» Abnormal vaginal bleeding, undiagnosed {45}    (may indicate the presence of endometrial hyperplasia or carcinoma, which may be exacerbated by ovulation-induced increases in estrogen serum concentrations {45}; other possible endocrinopathies should also be ruled out {45})


» Fibroid tumors of the uterus or {01}
» Ovarian cyst or enlargement not associated with polycystic ovarian disease {34} {45}    (risk of further enlargement)


» Thrombophlebitis, active    (increased risk of arterial thromboembolism due to elevations in serum estrogen concentrations {45})


For males only:
» Prostatic carcinoma or other androgen-dependent neoplasm {04}    (may be exacerbated by hCG-induced increases in testosterone serum concentrations {45})


Risk-benefit should be considered when the following medical problems exist
Sensitivity to chorionic gonadotropin or other gonadotropins {04}
For induction of ovulation:
» Polycystic ovarian disease {45}    (an exaggerated response to hCG may occur {45}; lower dosage may be required {45})



Patient monitoring
The following may be especially important in patient monitoring (other tests may be warranted in some patients, depending on condition; » = major clinical significance):


For induction of ovulation
» Estradiol {01} {02} {13} {25} {26} {29} {30} {34} {39} {40} {41} {42} {43} {64}    (measurement of serum concentrations is recommended as needed, continuing through the day of chorionic gonadotropin administration {01} {02} {13} {64}; recommended to determine optimal dose and to lessen the risk of ovarian hyperstimulation {46} {64})


» Ultrasound examination {13} {25} {26} {29} {30} {34} {38} {39} {40} {41} {42} {43} {64}    (recommended prior to chorionic gonadotropin therapy to provide information on the number and size of mature follicles, to follow follicular development, and to lessen the risk of ovarian hyperstimulation syndrome and multiple gestation {01} {02} {13} {64})


Daily basal body temperature {13} {25} {42} {62} {64}    (can be used in ovulation induction to determine if ovulation has occurred {13} {25} {42} {62} {64}; if basal body temperature following a treatment cycle is biphasic and is not followed by menses, a pregnancy test is recommended {13} {14} {62} {64})


Progesterone {13} {26} {34} {37} {38} {40} {42} {62} {63} {64}    (measurement of serum concentrations can be performed after therapy to detect luteinized ovarian follicles {62} {63} {64})


For treatment of male infertility (hypogonadism)
Testosterone {28} {31}    (measurement of baseline serum concentrations recommended before and after chorionic gonadotropin administration to rule out other causes and evaluate success of treatment {28} {31}; should increase after chorionic gonadotropin therapy)


Sperm count and determinations of sperm motility {25} {26}    (to evaluate success of treatment {25} {26})


For diagnosis of male hypogonadism (delayed puberty)
Testosterone    (measurement of baseline and post-treatment serum concentrations recommended prior to and 1 day following the course; should double if testes are normal )




Side/Adverse Effects

Note: Use of chorionic gonadotropin in conjunction with other ovulation-inducing agents is associated with an increased risk of thromboembolic events, possibly due to increased serum estrogen concentrations. {04} {46} {53} {63} {69}

The following side/adverse effects have been selected on the basis of their potential clinical significance (possible signs and symptoms in parentheses where appropriate)—not necessarily inclusive:

Those indicating need for medical attention
Incidence more frequent
For induction of ovulation only
    
Ovarian cysts or{01}{02}{04}{06}{34} mild to moderate, uncomplicated ovarian enlargement{01}{02}{04}{39} {34}(mild bloating, stomach or pelvic pain)

Note: Symptoms of ovarian cysts or enlargement are usually mild to moderate and abate within 2 or 3 weeks {34}.



Incidence less frequent or rare
For induction of ovulation only
    
Severe ovarian hyperstimulation syndrome{01}{02}{06}{07}{25}{26}{39}{64} {01}{02}{25}{26}{39}{64}(severe abdominal or stomach pain; feeling of indigestion; moderate to severe bloating; decreased amount of urine; continuing or severe nausea, vomiting, or diarrhea; severe pelvic pain; rapid weight gain; shortness of breath; swelling of lower legs)
    
peripheral edema {04}(swelling of feet or lower legs; rapid weight gain)

Note: Ovarian hyperstimulation syndrome (OHS) may occur in patients treated with hCG for ovulation induction. {01} {02} {26} OHS may often occur 7 to 10 days after ovulation or completion of therapy {01} {02} {06} {07}. OHS is usually avoided or short-lived in patients for whom chorionic gonadotropin is withheld {54} {63}. OHS differs from uncomplicated ovarian enlargement and can rapidly progress to cause serious medical problems {01} {02}. With OHS, a marked increase in vascular permeability results in rapid accumulation of fluid in the peritoneal, pleural, and pericardial cavities (third-spacing of fluids) {01} {02} {26} {39}. Medical complications ultimately arising from this increased vascular permeability may include hypovolemia, hemoconcentration, electrolyte imbalance, ascites, hemoperitoneum, pleural effusions, hydrothorax, acute pulmonary distress, and thromboembolic events {01} {02} {04} {26} {39}. OHS is more common, more severe, and protracted in patients who conceive {01} {02} {26}.



Incidence less frequent
In treatment of cryptorchidism only
    
Precocious puberty (acne; enlargement of penis or testes; growth of pubic hair; rapid increase in height)—generally requires discontinuance of chorionic gonadotropin and re-evaluation{04}{56}




Those indicating need for medical attention only if they continue or are bothersome
Incidence less frequent
    
Enlargement of breasts{04}
    
headache{04}
    
irritability{04}
    
mental depression{04}
    
pain at injection site{04}
    
tiredness{04}





Patient Consultation
As an aid to patient consultation, refer to Advice for the Patient, Chorionic Gonadotropin (Systemic).

In providing consultation, consider emphasizing the following selected information (» = major clinical significance):

Before using this medication
»   Conditions affecting use, especially:
Sensitivity to chorionic gonadotropin





Use in children—Use of chorionic gonadotropin for treatment of cryptorchidism has resulted in precocious puberty

Other medical problems, especially:

• For induction of ovulation—Abnormal vaginal bleeding, uterine fibroids, ovarian cyst or enlargement, polycystic ovarian disease, or thrombophlebitis


• For treatment of male hypogonadism—Prostatic carcinoma or other androgen-dependent neoplasm


Proper use of this medication

» Proper dosing

Precautions while using this medication
» Importance of close monitoring by physician

» May take a long time to work; importance of continuing treatment

For induction of ovulation
» Importance of following physician's instructions for recording of basal body temperature and timing of intercourse, when recommended by physician


Side/adverse effects
Signs of potential side effects, especially peripheral edema, ovarian enlargement, cysts, or hyperstimulation syndrome (for ovulation induction), and precocious puberty (for treatment of cryptorchidism)


General Dosing Information
Patients receiving chorionic gonadotropin should be under supervision of a physician experienced in the treatment of gynecologic or endocrine disorders. {04}

For induction of ovulation
Dosage varies considerably and must be adjusted to meet the individual requirements of each patient, on the basis of clinical response {04}.

Conception should be attempted within 48 hours of ovulation {50}. It is recommended that the couple have intercourse or insemination performed daily or every other day beginning the day after chorionic gonadotropin is administered until ovulation is thought to have occurred {26} {46} {63} {64}.

If ovulation does not occur after any cycle of therapy, the therapeutic regimen employed should be re-evaluated. {01} {02} {38} {41} {42} {64} {68} After 3 cycles of non-ovulatory menses, the appropriateness of continuing the use of chorionic gonadotropin for ovulation induction should be reconsidered {01} {02} {25} {38} {41} {64} {68}.

For corpus luteum insufficiency
Treatment must begin in the cycle of conception and not after the first missed menses.

Administration of chorionic gonadotropin should continue until hormone production is taken over by the placenta after 7 to 10 weeks gestation {62} {63}.

For treatment of adverse effects
Ovarian enlargement or ovarian cyst formation

   • Discontinuing therapy until ovarian size has returned to baseline. {01} {02} Chorionic gonadotropin should also be withheld for that cycle {54} {63}.
   • Prohibiting intercourse until ovarian size has returned to baseline to prevent cyst rupture. {01} {02} {26}
   • Reducing dosage in next course of therapy. {01} {02}
Ovarian hyperstimulation syndrome (OHS)



Acute phase

   • Discontinuing therapy. {01} {02} Chorionic gonadotropin should also be withheld for that cycle {54} {63}.
   • Prohibiting intercourse until ovarian size has returned to baseline to prevent cyst rupture. {01} {02}
   • Most cases of OHS will spontaneously resolve when menses begins. {01} {02} {34} In selected cases, hospitalization of the patient with bed rest may be necessary {64}.
   • Utilizing therapy to prevent hemoconcentration and minimize risk of thromboembolism and renal injury. {01} {02} {39}
   • Correcting (cautiously) electrolyte imbalance while maintaining acceptable intravascular volume; in the acute phase, intravascular volume deficit cannot be completely corrected without increasing third space fluid volume. {01} {02}
   • Monitoring fluid intake and output, body weight, hematocrit, serum and urine electrolytes, urine specific gravity, blood urea nitrogen (BUN), creatinine, and abdominal girth daily or as often as required. {01} {02} {26} {39} {64}
   • Monitoring serum potassium concentrations for development of hyperkalemia. {01} {02}
   • Limiting performance of pelvic examinations since they may result in rupture of ovarian cysts and hemoperitoneum. {01} {02} {26} {64}
   • Administering intravenous fluids, electrolytes, and human serum albumin, as needed to maintain adequate urine output and to avoid hemoconcentration. {01} {02} {26} {64}
   • Administering analgesics as needed. {01} {02}
   • Avoiding diuretic use since it reduces intravascular volume further. {01} {02} {26}
   • Removing ascitic, pleural, or pericardial fluid only if it is imperative for relief of symptoms such as respiratory distress or cardiac tamponade; to do so may increase risk of injury to the ovary. {01} {02}
   • In patients who require surgery to control bleeding from ovarian cyst rupture, employing surgical measures that also maximally conserve ovarian tissue. {01} {02}
Intermediate phase

   • Once patient is stabilized, minimizing third spacing of fluids by cautiously replacing potassium, sodium, and fluids as required, based on monitoring of serum electrolyte concentrations. {01} {02} {64}
   • Avoiding diuretic use. {01} {02} {26}
Resolution phase

   • The third space fluid shifts to intravascular compartment, resulting in decreased hematocrit value and increased urinary output. {01} {02}
   • Peripheral and/or pulmonary edema may result if third space fluid volume mobilized exceeds renal output. {01} {02}
   • Administering diuretics when required, to manage pulmonary edema. {01} {02}



Parenteral Dosage Forms

Note: Bracketed uses in the Dosage Forms section refer to categories of use and/or indications that are not included in U.S. product labeling.

CHORIONIC GONADOTROPIN FOR INJECTION USP

Usual adult dose
Hypogonadotropic hypogonadism in males
Intramuscular, 1000 to 4000 Units two to three times a week for several weeks to months {04} {05} {06} {07}; may be continued indefinitely as long as a response occurs.

For induction of spermatogenesis in infertility, treatment is usually continued for 6 months or longer {61} {63}. If sperm counts are still not adequate (>5 million per mL), menotropins or urofollitropin may be added to the regimen {61} {63}. It may be necessary to continue a combined regimen for up to 12 additional months {61} {63}.

[Corpus luteum insufficiency]1
Intramuscular, 1500 Units (average; dosage will vary depending upon patient) every other day from the day of ovulation until the time of expected menses or confirmed pregnancy {55} {63}. After pregnancy is confirmed, this dose may be continued for up to 10 weeks gestation {55} {63}.

Induction of ovulation or
Assisted reproductive technologies
Intramuscular, 5000 to 10,000 Units one day following the last dose of menotropins or urofollitropin or five to nine days following the last dose of clomiphene. {04} {05} {06} {07} {13} {26} {36} {38} {41} {46} {63}

Note: If the ovaries are abnormally enlarged or the serum estradiol concentration is excessively elevated on the last day of menotropins or urofollitropin therapy, chorionic gonadotropin should not be given for that cycle {26} {29} {34} {38} {40} {41} {63}.
Dosage varies considerably and must be adjusted to meet the individual requirements of each patient, on the basis of clinical response {04}.



Usual pediatric dose
Prepubertal cryptorchidism
Intramuscular, 1000 to 5000 Units two to three times a week for a maximum of 10 doses, discontinuing when the desired response is achieved. {04} {05} {06} {07} {59}

Note: Treatment with more than 10 doses is not recommended if progressive descent does not occur {59}.
Several dosage schedules have been used; dosage will vary depending on the degree of sexual development already present. {04}


[Diagnostic aid (hypogonadism) in males]1
Intramuscular, 2000 Units once a day for three days.


Size(s) usually available:
U.S.—


5000 Units (Rx) [A.P.L{04}] [Profasi{07}][Generic]{08}{09}


10,000 Units (Rx) [A.P.L{04}] [Pregnyl{06}] [Profasi{07}][Generic]{08}{09}


20,000 Units (Rx) [A.P.L{04}][Generic]{08}{09}

Canada—


5000 Units (Rx)[Generic]{10}


10,000 Units (Rx) [A.P.L{11}] [Profasi HP{12}][Generic]{10}


20,000 Units (Rx)[Generic]{10}

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer.

Preparation of dosage form:
Using standard aseptic technique, add 1 to 10 mL of diluent provided to each vial, depending upon manufacturer labeling. {04} {05} {06} {07} {08} {09} {10} {46} {55} {56} {63}

Stability:
Reconstituted solution is stable in the refrigerator for 60 or 90 days, depending on manufacturer {04} {05} {06} {07} {10}.



Revised: 05/16/2001



References

Note: All references used in the development and earlier revisions of this monograph have not yet been incorporated into the computer database and, therefore, are not listed below. Citations for information not yet referenced in the monograph will be provided upon request.


  1. Panel comment, 8/24/89.
  1. Not used.
  1. A.P.L. package insert (Ayerst—US), Rev 4/75.
  1. Follutein package insert (Squibb—US), Rec 3/14/89, Rev 7/83.
  1. Pregnyl package insert (Organon—US), Rec Oct 31 1988, Rev 4/88.
  1. Profasi HP package insert (Serono—US), Rec 10/31/88, Rev 1/84.
  1. Chorionic gonadotropin for injection USP (LyphoMed—US), Rec 3/23/89, Rev 8/85.
  1. Chorionic gonadotropin for injection USP (Quad—US), Rec 11/4/88, Rev 6/86.
  1. Chorionic gonadoptropin (Human) p.m. (Taro), Rev 1983. In: CPS 1988: 168.
  1. A.P.L. product monograph (Ayerst), Rev 1987. In: CPS 1988: 58-9.
  1. Profasi HP product monograph (Pharmascience), Rev 1985. In: CPS 1988: 748.
  1. Panel comments. Panel meeting 3/12/90 and subsequent ballot 4/16/90.
  1. Panel comment. Panel ballot 4/16/90.
  1. Overstreet, Price K, Rosenberg JM. Sports pharmacy: amateur athletes, ergogenic substances, and the role of the pharmacist. Wellcome Trends in Hospital Pharmacy 1990; Feb: 2, 3, 7, 8.
  1. USOC. Guide to banned medications 1989; May 15.
  1. Florida Dept. of Professional Regulation. Board of pharmacy newsletter 1988 Feb; 6(1): 1, 5.
  1. Elder JS. The undescended testis: hormonal and surgical management. Surg Clin N Am 1988; 68(5): 983-1005.
  1. Belarsch-Allart J, De Mouzon J, Lapousterle C, Mayer M. The effect of hCG supplementation after combined GnRH agonist/HMG treatment in an IVF programme. Hum Reprod 1990; 5(2): 163-6.
  1. Damewood MD, Shen W, Zacur HA, Schlaff WD, Rock JA, Wallach EE. Disappearance of exogenously administered human chorionic gonadotropin. Fertil Steril 1989; 52(3): 398-400.
  1. Finkel DM, Phillips JL, Snyder PJ. Stimulation of spermatogenesis by gonadotropins in men with hypogonadotropic hypogonadism. N Engl J Med 1985; 313(11): 651-5.
  1. Hutchinson-Williams KA, DeCherney AH, Lavy G, Diamond MP, Naftolin F, Lunenfeld B. Luteal rescue in in vitro fertilization-embryo transfer. Fertil Steril 1990; 53(3): 495.
  1. Smith EM, Anthony FW, Gadd SC, Masson GM. Trial of support treatment with human chorionic gonadotropin in the luteal phase after treatment with buserelin and human menopausal gonadotropin in women taking part in an in vitro fertilization programme. Br Med J 1989; 298: 1483-6.
  1. Blumenfeld Z, Nahhas F. Luteal dysfunction in ovulation induction: the role of repetitive human chorionic gonadotropin supplementation during the luteal phase. Fertil Steril 1988; 50(3): 403-7.
  1. American College of Obstetricians and Gynecologists. Technical bulletin no. 125: Infertility.
  1. American College of Obstetricians and Gynecologists. Technical bulletin no. 120: Medical induction of ovulation. Washington, D.C.: Author, Sep 1988.
  1. American College of Obstetricians and Gynecologists. Technical bulletin no. 142: Male infertility. Washington, D.C.: Author, Jun 1990.
  1. Lipshultz LI (editor). Male infertility. Norwell, MA: Serono Symposia, USA.
  1. American Fertility Society. Ovulation drugs: a guide for patients. Birmingham, AL: Author, 1990.
  1. American Fertility Society. IVF & GIFT: a patient's guide to assisted reproductive technology. Birmingham, AL: Author, 1989.
  1. American Fertility Society. Investigation of the infertile couple. Birmingham, AL: Author, 1986.
  1. Yovich JL, Edirisinghe WR, Cummins JA. Evaluation of luteal support therapy in a randomized controlled study within a gamete intrafallopian transfer program. Fertil Steril 1991; 55(1): 131-9.
  1. Reshef E, Segars JH, Hill GA, Pridham, DD, Yussman MA, Wentz AC. Endometrial inadequacy after treatment with human menopausal gonadotropin/human chorionic gonadotropin. Fertil Steril 1990; 54(6): 1012.
  1. Tummon IS, Henig I, Radwanska E, Binor Z, Rawlins R, Dmowski WP. Persistent ovarian cysts following administration of human menopausal and chorionic gonadotropins: an attenuated form of ovarian hyperstimulation syndrome. Fertil Steril 1988; 49(2): 244-8.
  1. Sauer MV, Paulson RJ, Lobo RA. A preliminary report on oocyte donation extending reproductive potential to women over 40. N Engl J Med 1990; 323(17): 1157-60.
  1. Hodgen GD. Neuroendocrinology of the normal menstrual cycle. J Reprod Med 1989; 34(1 Supp): 68-75.
  1. Blackwell RE. The infertility workup and diagnosis. J Reprod Med 1989; 34(1 Supp): 81-5.
  1. Bonaventura LM. Practice management for ovulation induction. J Reprod Med 1989; 34(1 Supp): 86-9.
  1. Goldfarb AF (moderator). Panel discussion. J Reprod Med 1989; 34(1 Supp): 90-4.
  1. Caldwell BV. Monitoring gonadotropin therapy. J Reprod Med 1989; 34(1 Supp): 95-9.
  1. March CM. Experience with ultrasound. J Reprod Med 1989; 34(1 Supp): 100-3.
  1. Marut EL. The polycystic ovary syndrome. J Reprod Med 1989; 34(1 Supp): 104-7.
  1. Scott RT, Rosenwaks Z. Ovulation induction for assisted reproduction. J Reprod Med 1989; 34(1 Supp): 108-14.
  1. A.P.L. package insert (Ayerst—US), Rec 12/12/89, Rev 8/24/89.
  1. Panel comments. Panel survey date 4/25/91.
  1. Panel comment. Panel survey date 4/25/91.
  1. Panel comment. Panel survey date 4/25/91.
  1. Panel comment. Panel survey date 4/25/91.
  1. Panel comment. Panel survey date, 4/25/91.
  1. Panel comment. Panel survey date 4/25/91.
  1. Panel comment. Panel survey date 4/25/91.
  1. Panel comment. Panel survey date 4/25/91.
  1. Panel comment. Panel survey date 4/25/91.
  1. Panel comment. Panel survey date 4/25/91.
  1. Manufacturer comment, Panel survey date 4/25/91.
  1. Becker KL (editor). Principles and practices of endocrinology. Philadelphia: J.B. Lippincott Co., 1990.
  1. Panel comment. Panel survey date 4/25/91.
  1. Panel comment. Panel survey date 4/25/91.
  1. Panel comment. Panel survey date 4/25/91.
  1. Panel comment. Panel survey date 4/25/91.
  1. Panel comment, Panel survey date 4/25/91.
  1. Panel consensus. Endocrinology panel meeting 11/26/91.
  1. Panel consensus, panel ballot date 3/18/92.
  1. Panel consensus, 2/20/92.
  1. Panel comment, panel date 3/18/92.
  1. Panel comment, panel date 3/18/92.
  1. Panel comment, panel date 3/18/92.
  1. Panel consensus, Obstetrics and Gynecology panel meeting 11/18/91.
  1. Panel comment, panel date 3/18/92.
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