Ovidrel dosing and prescribing for men with hypogonadotrophic hypogonadism

Prepared jointly by the Endocrine Society of Australia and Healthy Male

The recent listing of Ovidrel as a Restricted Benefit Item on the Pharmaceutical Benefits Scheme (PBS), allowing use in males, fills the gap left when Pregnyl was withdrawn from the market in early 2021. However, the off-label use of Ovidrel in men raises some practical issues.

The single-use Ovidrel syringe provides a total 250 µg of recombinant hCG, equivalent to a Pregnyl dose of ~6000 I.U. An appropriate dose of Pregnyl for fertility induction in hypogonadotropic hypogonadism in males (1500 I.U.) is, therefore, one-quarter of an Ovidrel syringe.

The full 250-µg dose of Ovidrel is delivered with 25 ‘clicks’ filling the pen. For men, this is convenient as it allows divided doses of six (6) or eight (8) clicks (~1500-2000 I.U. Pregnyl equivalent) two or three times weekly as the standard dose. Educating patients on correct use will be necessary.

However, many men using Ovidrel will exhaust their prescriptions (with repeats) within six- to eight- (6-8) weeks, if prescribed a standard PBS script (one (1) pen and five (5) repeats). 

To avoid this situation, the PBS does allow a prescriber to phone and ask for an increased quantity of any medication (except for antibiotics and opiates) to allow a patient enough medicine for a four-week period. 

To do this, the prescriber will need to phone to request an “Authority script for increased amounts”, using words to the effect of: "I am requesting an Authority prescription for an increased quantity to allow my patient to have enough supply to last four weeks." The prescriber will then be asked the Ovidrel dose that the patient will be taking and how many Ovidrel pens are needed to last four (4) weeks. The following will help prescribers answer this. 

Pregnyl 1500 I.U. twice a week = 62.5 µg Ovidrel twice a week (i.e. six (6) clicks twice a week)
Therefore one Ovidrel pen would be used every two (2) weeks, so the prescriber would request two (2) pens and five (5) repeats in order for the patient to have enough supply for four (4) weeks

Pregnyl 1500 I.U. three times a week = 62.5 µg Ovidrel three times a week (i.e. six (6) clicks three times a week) 
Therefore one Ovidrel pen would be used every 1.33 weeks, so the prescriber would request three (3) pens and five (5) repeats 

Pregnyl 2000 I.U. twice a week = 83.33 µg Ovidrel twice a week (i.e. eight (8) clicks twice a week) 
Therefore one Ovidrel pen would be used every 1.5 weeks, so the prescriber would request three (3) pens and five (5) repeats (round up 2.67 pens to three (3) pens)

Pregnyl 2000 I.U. three times a week = 83.33 µg Ovidrel three times a week (i.e. eight (8) clicks three times a week) 
Therefore one Ovidrel pen would be used every week, so the prescriber would request four (4) pens and five (5) repeats  

Pregnyl 3000 I.U. twice a week = 125 µg Ovidrel twice a week (i.e. 12 clicks twice a week) 
Therefore one Ovidrel pen would be used every week, so the prescriber would request four (4) pens and five (5) repeats  

Disposable needles

The box containing Ovidrel comes with two screw-on needles per pen. If a patient is using the pen for more than two (2) injections and does not want to re-use the needle, they will need to purchase extra needles from the pharmacy.

Summary

1500 I.U. Pregnyl is approximately equivalent to six (6) clicks of the Ovidrel pen (62.5 µg Ovidrel)

2000 I.U. Pregnyl is approximately equivalent to eight (8) clicks of the Ovidrel pen (83.3 µg Ovidrel)

3000 I.U. Pregnyl is approximately equivalent to 12 clicks of the Ovidrel pen (125 µg Ovidrel)

Phone authority to request increased amounts will almost always be needed to ensure the patient receives a four-week supply.