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Infertility and PCOS: Antagon: A New Infertility Drug

Author: Angie Boss
Published on: February 12, 2000

This July, Organon (the Dutch pharmaceutical company responsible for Pergonal) announced that U.S. Food and Drug Administration approved Antagon Injection (ganirelix acetate) as another weapon in the battle against infertility. Antagon is indicated for inhibiting premature LH (luteinizing hormone) surges in women undergoing controlled ovarian hyperstimulation (COH). This might be done for in-vitro fertilization (IVF), oocyte retrieval, or intracytoplasmatic sperm injection.

The main advantage of Antagon is that it reduces the treatment period for COH. In an IVF cycle, for example, a cycle is initiated by administering leuprolide acetate (Lupron, for example). It’s job is to supress the premature LH surge that triggers ovulation.

In a normal ovulatory cycle, FSH (follicle stimulating hormone) is secreted by the pituitary gland and acts on the ovarian follicle to stimulate the maturation of the egg. At ovulation, there is an LH surge (which is what you measure with an ovulation predictor kit). The LH’s responsibility is to rupture the follice and release the egg. In women with PCOS, hormone levels tend to be abnormal and are classically characterized by inappropriate pituitary gonadotropin secretion, causing an elevated LH to FSH ratio. LH levels in women with PCOS are sometimes two or three times higher than normal.

By using a medication to inhibit ovulation, the eggs remain available and ready for retrieval by a fertility specialist. When using leuprolide, it has to be injected daily for as many as 26 days. By contrast, according to the Organon’s press release, in clinical trials patients only needed to take Antagon for an average of five days.

One physician explained that “Antagon has the advantage of directly cutting off LH production, while leuprolide tricks the pituitary gland into turning off. Like a light switched off, Antagon works immediately. Leuprolide requires that the lights be turned on and left on until the bulb is burned out.”

The manufacturer recommends that women begin FSH therapy (such as Metrodin) or Gonal-F) on day two or three of the cycle. Antagon Injection (250 mg) is administered by the patient subcutaneously once a day during the early to mid-follicular phase, usually beginning on day 8. It is continued daily until hCG is given when a sufficient number of follicles of adequate size are present. The hCG is withheld if the ovaries are abnormally enlarged to prevent ovarian hyperstimulation.

The reported side effects seem to be minimal, with only about 2% reporting gastrointestinal and gynecological abdominal pain, headache, vaginal bleeding, nausea, and injection site pain. However, fetal death was also reported when a pregnant women took the drug, so it should obviously be discontinued when pregnant.

While the cost for Lupron can be as high as $250- to $350 per cycle, Antagon is estimated to be about the same price (according to Resolve). While it isn’t cheap, having a shortened cycle and fewer injections will be music to some women’s ears. Unfortunately, it is available in other countries, but women in the U.S. must wait a little longer until the medication can be found on their pharmacist’s shelves.

Organon won’t say exactly when it can be expected to hit, their only answer is “later this year.” Neither online pharmacies or local pharmacies I checked with in Central Indiana say that they expect it soon. But when it does, there are some women who will be glad it’s here.

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