XP: Gonal F vs. Follistim

katib77

So I had used up all of Jezebells donated Gonal F in the first four days (and last med cycle), and my clinic let me trade the donated Manopur she donated to me for Follistim since they still wanted me on straight FSH (not FSH mixed with LH).

Well I just did the follistim pen after having been used to the Gonal F vial mix and needle.  There was no burning sensation when the meds went in.  And it seemed like less volume of fluid than with Gonal F.  

So now I'm worried - did I do something wrong with the pen? Or is this how the Follistim pen is?  If so - they've really mastered taking the pain out of it!  *But I will say this time I also went in the stomach (since so many of you say that's your preferred injection site) instead of my thigh.  Maybe that made the difference? 

Ugh, I feel like such a newb worrying if I screwed up! Can anyone give me their thoughts on comparing the two meds?

vanessagorc

Well they are the same exact med.  Just manufactured by diff companies.  I always took it in my stomach and only had occasional burning. So maybe that's why. GL!

Faith722

I've always used the follistim pen and never had any issues at all.  It does seem like a smaller amount of fluid than say menopur, but I think that's only b/c you're watching a dial and can't see the fluid. 

Good luck!

adoruhbul

I think it's the fact that the Gonal-F uses a click system and Follistim uses a depress system.  Everytime you push the Gonal -F down it clicks where as Follistim all goes in at once and the injection over all takes less time.

Also I believe Follistim might be tiny bit more concentrated because it you compare the Follistim vial from the gonal-F pen, the gonal-F has significantly more volume, basically double the size.  Gonal-F is definitely mixed with sodium chloride, it gives off an insulin smell--only someone who's used it insulin or in the profession can identify the smell, but I think their intention was to dilute to make it hurt less, but in actuality it burns more because alcohol reacts with sodium chloride and stings.  Many people on insulin use other means of sterilizing the area to avoid that sting that the reaction creates.

Follistim on the other hand doesn't have any kind of diluent in it, which makes less of a stinging sensation and less overall volume.  

This the confusing part I will try to explain.  Follistim is Follitropin beta and Gonal-F is Follitropin alpha, they are actually not the same.  They actually have the potential to work differently on a person.  For example, I don't seem to respond to Gonal-F as well as Follistim because the subunits that are different, are different molecules and bind differently.  Gonal-F is a powder in it's native form, and just like the vial version it needs to be reconstituted and then it can be used, which is what's done for you by the time you get it in pen form.  This process causes the actual hormone to bind to sodium chloride before it reaches your body which causes the different subunit.

Think of hCG and LH.  You can use the LH test to test hCG however you can't use hCG to test LH.  Beta unit's can mimic an Alpha unit, however Alpha cannot mimic beta.  This basically means that Gonal-F is sort a concentrated fake, that works but not necessarily as well.  Follistim on the other hand is naturally derived and was not originally in powder form.

Because of the difference in subunits and actual effectiveness, MOST RE's at this point have discontinued prescribing Gonal-F all together.  It was a concern for awhile and RE's were using it but since it's easy to become tolerant to it, it seems that the consensus of RE's feel it's best to stick with Follistim at this point.  Repronex (generic Menopur) was also discontinued being prescribed by most physicians because the generic counterpart also uses a different binding subunit.

Last cycle I used a total of 2100IU of Follistim and had 9 follies and 12 days of stimming.  This time I used 3800IU of Gonal-F, 4 follies, and 18 days of stimming!  If you are given the choice, I would recommend Follistim.  I am still using both because of my financial situation and a lot has been donated to me or I purchased on Topix and beggars can't be choosers!  

I know I totally got off topic on this one and explained more than necessary but because it really hasn't been mentioned the empirical switch to Follistim, I thought I'd let some people know in case they do have the choice.

brooklynesque

adoruhbul:

This the confusing part I will try to explain.  Follistim is Follitropin beta and Gonal-F is Follitropin alpha, they are actually not the same.  They actually have the potential to work differently on a person.  For example, I don't seem to respond to Gonal-F as well as Follistim because the subunits that are different, are different molecules and bind differently.  Gonal-F is a powder in it's native form, and just like the vial version it needs to be reconstituted and then it can be used, which is what's done for you by the time you get it in pen form.  This process causes the actual hormone to bind to sodium chloride before it reaches your body which causes the different subunit.

Think of hCG and LH.  You can use the LH test to test hCG however you can't use hCG to test LH.  Beta unit's can mimic an Alpha unit, however Alpha cannot mimic beta.  This basically means that Gonal-F is sort a concentrated fake, that works but not necessarily as well.  Follistim on the other hand is naturally derived and was not originally in powder form.

Because of the difference in subunits and actual effectiveness, MOST RE's at this point have discontinued prescribing Gonal-F all together.  It was a concern for awhile and RE's were using it but since it's easy to become tolerant to it, it seems that the consensus of RE's feel it's best to stick with Follistim at this point.  Repronex (generic Menopur) was also discontinued being prescribed by most physicians because the generic counterpart also uses a different binding subunit.

Last cycle I used a total of 2100IU of Follistim and had 9 follies and 12 days of stimming.  This time I used 3800IU of Gonal-F, 4 follies, and 18 days of stimming!  If you are given the choice, I would recommend Follistim.  I am still using both because of my financial situation and a lot has been donated to me or I purchased on Topix and beggars can't be choosers!  

I know I totally got off topic on this one and explained more than necessary but because it really hasn't been mentioned the empirical switch to Follistim, I thought I'd let some people know in case they do have the choice.

Thanks for posting this.  I had no idea they were actually different. 

meganfauer

I have used both and Follistim does seem a bit easier. I never have any pain with it and I took do it in the stomach. Adorabul's explanation does make sense. My RE was admiment this time that I only use Follistim and I could not use the free Gonal F that I had. I was wondering why Since I too thought they were the same and now I know.

 

Good luck

 

mdluv21

I do think pens are less painful but for IVF my RE always has me use vials so that it can be mixed with the menopur and I only have to do a single shot.

He also thinks follistim is slightly more concentrated/powerful than gonal-f but not enough to say you should use one over the other. 

Rachael07.07.07

I love Adoruhbul's explanation, lol. Learn something new every day...

The only thing I will add is that this last cycle I did a hybrid of follistim and then switched to Gonal-F. This was my first time using Gonal-F and it seemed to work much better on my body that Follistim ever did.