Fyremadel (Ganirelix)
GnRH antagonist for prevention of premature ovulation during assisted reproduction
Fyremadel contains ganirelix, a gonadotropin-releasing hormone (GnRH) antagonist used in fertility treatment. It is administered by subcutaneous injection to prevent premature ovulation in women undergoing controlled ovarian stimulation for assisted reproductive technology (ART), including in vitro fertilisation (IVF). By blocking the premature LH surge, Fyremadel helps ensure that eggs reach optimal maturity before retrieval, significantly improving the chances of a successful pregnancy.
Quick Facts
Key Takeaways
- Fyremadel (ganirelix) is a GnRH antagonist that prevents premature ovulation during IVF and other assisted reproduction procedures.
- It is administered as a daily subcutaneous injection of 0.25 mg, typically starting on day 5 or 6 of ovarian stimulation with FSH.
- The most common side effect is a local injection site reaction (redness and swelling), which usually resolves within 4 hours.
- The needle shield contains natural rubber latex, which may cause allergic reactions in latex-sensitive individuals.
- Fyremadel must not be used during pregnancy, breastfeeding, or in patients with moderate to severe kidney or liver impairment.
What Is Fyremadel and What Is It Used For?
Fyremadel contains the active substance ganirelix, a synthetic decapeptide that belongs to a class of medicines known as gonadotropin-releasing hormone (GnRH) antagonists. These medicines work by blocking the action of naturally occurring GnRH, a hormone produced in the hypothalamus that plays a central role in regulating the reproductive system.
GnRH normally controls the release of two key reproductive hormones from the anterior pituitary gland: luteinizing hormone (LH) and follicle-stimulating hormone (FSH). These gonadotropins are essential for human fertility and reproduction. In women, FSH stimulates the growth and maturation of ovarian follicles, the small fluid-filled sacs in the ovaries that contain the eggs. LH is responsible for triggering the release of mature eggs from the follicles (ovulation).
By competitively binding to GnRH receptors on the pituitary gland, ganirelix rapidly and reversibly suppresses the secretion of LH and, to a lesser extent, FSH. This blockade is dose-dependent and takes effect within hours of injection. The critical clinical benefit is the prevention of a premature LH surge, which is the primary indication for this medication.
Use in Assisted Reproduction
For women undergoing assisted reproductive technology (ART), including in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI), controlled ovarian stimulation is a fundamental step. During this process, exogenous FSH preparations are used to stimulate the growth of multiple follicles simultaneously, increasing the number of eggs available for retrieval. However, as follicles develop and oestrogen levels rise, there is a risk that the body’s natural feedback mechanisms will trigger a premature LH surge, leading to spontaneous ovulation before the planned egg retrieval procedure.
Premature ovulation is a significant problem in fertility treatment because it results in the loss of developing eggs, which are released into the fallopian tubes rather than being available for retrieval. This substantially reduces the chance of a successful pregnancy. Fyremadel is specifically designed to prevent this premature ovulation by suppressing the LH surge until the treating physician determines that the follicles have reached adequate size and maturity, at which point a trigger injection of human chorionic gonadotropin (hCG) is administered to induce final oocyte maturation in a controlled manner.
In clinical trials, ganirelix has been studied in combination with recombinant FSH preparations and corifollitropin alfa, a long-acting follicle stimulator. The GnRH antagonist protocol, which includes Fyremadel, has become one of the most widely used stimulation protocols in fertility clinics worldwide due to its patient-friendly approach, shorter treatment duration, and reduced risk of ovarian hyperstimulation syndrome (OHSS) compared to traditional GnRH agonist long protocols.
What Should You Know Before Taking Fyremadel?
Contraindications
There are several situations in which Fyremadel must not be used. You should not take this medicine if:
- Allergy to ganirelix – If you are allergic to ganirelix or any of the other ingredients in Fyremadel (listed in the Ingredients section below), you must not use this medicine. Signs of an allergic reaction include skin rash, itching, swelling, or difficulty breathing.
- Hypersensitivity to GnRH or GnRH analogues – If you have a known hypersensitivity to gonadotropin-releasing hormone or any GnRH-like compounds (either agonists or antagonists), you should not receive ganirelix.
- Moderate or severe renal impairment – The safety and efficacy of Fyremadel have not been established in patients with significantly impaired kidney function, and its use is contraindicated in this population.
- Moderate or severe hepatic impairment – Similarly, Fyremadel should not be used in patients with moderate to severe liver dysfunction due to the lack of adequate safety data.
- Pregnancy and breastfeeding – Fyremadel is intended for use only during the ovarian stimulation phase of fertility treatment and must not be administered during pregnancy or while breastfeeding.
Warnings and Precautions
Before you start using Fyremadel, talk to your doctor, pharmacist, or nurse. It is essential to discuss the following precautions to ensure this treatment is safe and appropriate for you:
Allergic reactions, both generalised and local, have been reported with ganirelix, in some cases as early as after the first dose. These reactions include urticaria (hives), angioedema (swelling of face, lips, tongue, and/or throat that may cause difficulty breathing or swallowing), and anaphylaxis. If you experience any signs of a serious allergic reaction, stop using Fyremadel immediately and seek emergency medical attention.
Active allergic conditions: If you have an active allergic condition of any kind, inform your doctor. Your physician will assess the severity and determine whether additional monitoring is necessary during treatment. Patients with a history of allergic reactions may be at increased risk.
Latex allergy: The needle shield of the Fyremadel pre-filled syringe contains dry natural rubber (latex), which comes into contact with the needle. This is important for individuals with a known or suspected latex allergy, as handling or injection may trigger allergic symptoms ranging from mild contact dermatitis to more severe systemic reactions.
Ovarian hyperstimulation syndrome (OHSS): During and after hormonal stimulation of the ovaries, ovarian hyperstimulation syndrome may develop. OHSS is a potentially serious medical condition characterised by enlarged ovaries, abdominal pain and distension, nausea, vomiting, and in severe cases, fluid accumulation in the abdomen and chest. This condition is primarily related to the gonadotropin stimulation treatment rather than Fyremadel itself. Your fertility specialist will monitor your response carefully through ultrasound scans and blood tests to minimise this risk.
Congenital malformations: The incidence of congenital malformations after assisted reproduction may be slightly higher than after spontaneous conception. This modestly increased risk is thought to be related to characteristics of patients undergoing fertility treatment (such as maternal age and sperm characteristics) and the higher prevalence of multiple pregnancies associated with ART. The rate of congenital malformations after use of Fyremadel does not differ from that seen with other GnRH analogues used in assisted reproduction.
Ectopic pregnancy: Women with damaged fallopian tubes have a slightly increased risk of ectopic pregnancy (a pregnancy that develops outside the uterus, typically in a fallopian tube). This is a pre-existing risk factor rather than a direct effect of Fyremadel, but it is important to be aware of this possibility after embryo transfer.
Body weight considerations: The efficacy and safety of Fyremadel have not been established in women weighing less than 50 kg or more than 90 kg. If you fall outside this weight range, discuss this with your doctor, as dose adjustments or additional monitoring may be required.
Children and Adolescents
There is no relevant use of Fyremadel in children or adolescents. This medicine is intended exclusively for adult women undergoing controlled ovarian stimulation as part of assisted reproduction treatment.
Drug Interactions
Tell your doctor or pharmacist if you are taking, have recently taken, or might take any other medicines. Although specific interaction studies with Fyremadel are limited, it is used alongside other fertility medications as part of a coordinated treatment protocol. The most important co-administered medications are FSH preparations and hCG, which are integral to the IVF cycle and are not considered harmful interactions when used as directed by your fertility specialist.
Pregnancy and Breastfeeding
Fyremadel is designed for use specifically during the controlled ovarian stimulation phase of assisted reproduction, before embryo transfer occurs. It must not be used during pregnancy or while breastfeeding. If you are pregnant, think you may be pregnant, or are planning to have a baby outside the context of medically supervised fertility treatment, do not use this medicine and consult your healthcare provider.
Driving and Operating Machinery
The effects of Fyremadel on the ability to drive and use machines have not been formally studied. However, based on its pharmacological profile, ganirelix is not expected to significantly affect driving ability or the operation of machinery. If you experience any side effects such as dizziness or malaise that could impair your alertness, exercise caution and refrain from driving or operating heavy machinery until the symptoms resolve.
Fyremadel contains less than 1 mmol (23 mg) of sodium per injection, meaning it is essentially sodium-free. This is relevant for patients on a controlled sodium diet.
How Does Fyremadel Interact with Other Drugs?
Fyremadel (ganirelix) is used as part of a carefully coordinated fertility treatment protocol. Because it is a short-course injectable medication administered under close medical supervision, its interaction profile is relatively well-defined. No formal large-scale drug interaction studies with other non-fertility medications have been conducted, but the available clinical data and pharmacological properties of ganirelix provide useful guidance.
Ganirelix is a synthetic peptide that is metabolised primarily through hepatic peptidase activity and renal clearance. It does not appear to interact significantly with the cytochrome P450 enzyme system, which is the primary pathway for the metabolism of many commonly prescribed medicines. This characteristic reduces the likelihood of pharmacokinetic interactions with other drugs.
Co-administered Fertility Medications
The following medications are routinely used alongside Fyremadel as part of the standard IVF protocol. These are not harmful interactions but rather intended co-prescriptions:
| Medication | Purpose | Timing | Notes |
|---|---|---|---|
| Recombinant FSH (e.g., follitropin alfa/beta) | Stimulates follicle growth | Started on cycle day 2 or 3, continued daily | Administer at roughly the same time as Fyremadel but at a different injection site |
| Corifollitropin alfa | Long-acting follicle stimulator | Single injection on cycle day 2 or 3 | Replaces daily FSH for the first 7 days of stimulation |
| hCG (human chorionic gonadotropin) | Triggers final egg maturation | Given when follicles reach adequate size | Gap between last Fyremadel and hCG should not exceed 30 hours |
| Progesterone | Luteal phase support | Starts after egg retrieval | Not a direct interaction; used after Fyremadel is discontinued |
Potential Interactions to Be Aware Of
While no significant drug interactions have been clinically established, the following general precautions apply based on the pharmacological class and the clinical setting in which Fyremadel is used:
- Other hormonal preparations: Use of other hormonal medications (such as oral contraceptives or hormone replacement therapy) should be discussed with your fertility specialist, as they may affect the outcome of ovarian stimulation.
- Herbal supplements: Certain herbal products, particularly those with oestrogenic or anti-oestrogenic properties (e.g., black cohosh, red clover, soy isoflavones), may theoretically interfere with fertility treatment outcomes. Inform your doctor about any supplements you are taking.
- NSAIDs and aspirin: Non-steroidal anti-inflammatory drugs should be used with caution during IVF cycles, as they may theoretically affect ovulation and implantation. Some clinics advise avoiding NSAIDs during stimulation, though low-dose aspirin is sometimes recommended in certain clinical scenarios.
Fyremadel must not be mixed with FSH in the same syringe. Both medications should be administered at approximately the same time each day, but at different injection sites to avoid local interactions.
What Is the Correct Dosage of Fyremadel?
Fyremadel is used as part of a multi-step fertility treatment protocol. It is essential to follow your fertility specialist’s instructions precisely, as the timing and duration of treatment are critical to the success of the IVF cycle. The medication comes in pre-filled syringes for subcutaneous self-injection, and your clinic will provide thorough training on the correct injection technique before you begin treatment.
Treatment Protocol
The standard IVF protocol using Fyremadel consists of three stages:
Stage 1: Ovarian Stimulation
Stimulation of the ovaries with FSH (follicle-stimulating hormone) or corifollitropin alfa typically begins on day 2 or 3 of your menstrual cycle. This phase uses gonadotropin injections to encourage the growth of multiple follicles in the ovaries.
Stage 2: Fyremadel Administration
Fyremadel 0.25 mg is injected subcutaneously once daily, beginning on day 5 or day 6 of stimulation. Your doctor may adjust the starting day based on your individual ovarian response, as assessed by ultrasound monitoring and hormone levels. Daily injections continue until there are a sufficient number of adequately sized follicles.
Stage 3: Ovulation Trigger
When your follicles have reached optimal size (typically 17–18 mm), an injection of hCG (human chorionic gonadotropin) is given to trigger the final maturation of the eggs. The interval between two Fyremadel injections, and between the last Fyremadel injection and the hCG trigger, must not exceed 30 hours to prevent premature ovulation.
| Patient Group | Dose | Route | Frequency | Duration |
|---|---|---|---|---|
| Adult women (50–90 kg) | 0.25 mg | Subcutaneous | Once daily | Day 5/6 of stimulation until hCG trigger |
| Women <50 kg or >90 kg | Consult specialist | Subcutaneous | As directed | Safety not established in this group |
| Children / Adolescents | Not applicable | — | — | No relevant use in this population |
| Renal/hepatic impairment | Contraindicated | — | — | Moderate to severe impairment: do not use |
How to Inject Fyremadel
Fyremadel is supplied in a pre-filled syringe containing a single dose. The injection should be administered slowly directly under the skin, preferably in the upper thigh. Follow these steps carefully:
- Wash your hands thoroughly with soap and water before handling the syringe.
- Clean the injection site with an antiseptic swab (e.g., alcohol wipe), cleaning approximately 5 cm around the injection point. Allow the antiseptic to dry for at least one minute.
- Remove the needle shield and inspect the solution. It should be clear, colourless, and free of particles. Do not use the syringe if the solution is cloudy or contains visible particles, or if the packaging is damaged.
- Pinch the skin between your thumb and index finger to create a fold of skin. Insert the needle at the base of the pinched skin at a 45-degree angle.
- Check the needle position by gently pulling back the plunger. If blood appears in the syringe, do not inject. Remove the syringe, apply pressure to the site with an antiseptic swab, and start again with a new syringe at a different location.
- Inject slowly and steadily by pushing the plunger down until the syringe is empty.
- Remove the needle quickly and press an antiseptic swab against the site. The injection site should stop bleeding within one to two minutes.
- Rotate injection sites each day to minimise local reactions.
Each pre-filled syringe is for single use only. Dispose of used syringes in a sharps container as instructed by your clinic or pharmacist.
Missed Dose
If you forget to take a dose, inject it as soon as you remember. Do not take a double dose to make up for a missed injection. If you are more than 6 hours late (meaning the gap between two injections exceeds 30 hours), take the dose as soon as possible and contact your fertility specialist immediately for further advice. A gap exceeding 30 hours increases the risk of premature ovulation, which could affect the outcome of your treatment cycle.
Overdose
If you accidentally use more than the prescribed amount of Fyremadel, or if someone else accidentally uses the medication, contact your doctor or hospital emergency department immediately for assessment. Based on the pharmacological properties of ganirelix, an overdose would be expected to cause prolonged suppression of LH and FSH secretion, but clinical experience with overdose is limited. Medical monitoring and supportive care would be the appropriate management.
Do not stop using Fyremadel unless your doctor has instructed you to do so. Stopping treatment prematurely may result in premature ovulation, which can significantly reduce the chances of a successful egg retrieval and pregnancy from your IVF cycle.
What Are the Side Effects of Fyremadel?
Like all medicines, Fyremadel can cause side effects, although not everybody gets them. The side effects associated with ganirelix are generally mild and related to the injection process. However, some serious but rare reactions have been reported and it is important to be aware of them.
The following side effects have been categorised according to their frequency based on clinical trial data and post-marketing surveillance reports. Understanding these frequencies helps put the risks into perspective and enables you to make an informed decision about your treatment together with your fertility specialist.
Very Common
- Injection site reactions – Redness (erythema) with or without swelling at the injection site. This is the most frequently reported side effect and is typically mild, resolving spontaneously within 4 hours of injection. Rotating injection sites each day helps minimise this reaction.
Uncommon
- Headache – Mild to moderate headaches that typically resolve without treatment
- Nausea – Feelings of sickness that may occur during treatment
- Malaise – A general feeling of being unwell or discomfort
Very Rare
- Allergic reactions – Have been observed as early as after the first dose
- Skin rash – Generalised rash or localised skin eruption
- Facial swelling – Oedema of the face
- Dyspnoea – Difficulty breathing or shortness of breath
- Angioedema – Swelling of the face, lips, tongue, and/or throat that may cause difficulty breathing or swallowing
- Anaphylaxis – Severe, life-threatening allergic reaction requiring immediate emergency treatment
- Urticaria – Hives or wheals on the skin
Side Effects Related to Fertility Treatment
In addition to the direct side effects of Fyremadel, certain adverse events are known to occur in the context of controlled ovarian hyperstimulation treatment as a whole. These include:
- Abdominal pain and bloating – Common during ovarian stimulation due to enlarged ovaries and may range from mild discomfort to more pronounced pain.
- Ovarian hyperstimulation syndrome (OHSS) – A potentially serious condition that occurs when the ovaries over-respond to stimulation medications. Symptoms range from mild abdominal discomfort and bloating to severe manifestations including significant fluid retention, blood clots, and kidney dysfunction. Your clinic will monitor you closely to minimise this risk. The incidence of OHSS may be lower with GnRH antagonist protocols (including Fyremadel) compared with GnRH agonist protocols.
- Ectopic pregnancy – A pregnancy developing outside the uterus, most commonly in the fallopian tube. This risk is slightly elevated in women with pre-existing tubal damage.
- Miscarriage – The risk of miscarriage in IVF pregnancies is comparable to that in naturally conceived pregnancies, particularly when adjusted for maternal age. For more information, refer to the patient information leaflet of the FSH preparation used in your stimulation cycle.
One patient in clinical studies experienced worsening of a pre-existing eczema condition after the first dose of ganirelix. If you have a history of skin conditions, monitor your skin during treatment and report any changes to your doctor.
If you experience any of the following symptoms after injecting Fyremadel, stop using the medication and seek emergency medical attention immediately: difficulty breathing, swelling of the face, lips, tongue or throat, widespread hives, rapid heartbeat, dizziness, or feeling faint. These may be signs of a serious allergic reaction (anaphylaxis).
How Should You Store Fyremadel?
Proper storage of Fyremadel is important to ensure the medication remains effective and safe to use throughout your treatment cycle. The following guidelines should be observed:
- Keep out of sight and reach of children – Store the pre-filled syringes in a secure location where children cannot access them.
- Check the expiry date – Do not use Fyremadel after the expiry date printed on the label and carton. The expiry date refers to the last day of the stated month.
- No special storage conditions – This medicine does not require any special temperature or humidity conditions for storage. However, it is advisable to store it in its original packaging to protect it from light and physical damage.
- Inspect before use – Before each injection, visually inspect the syringe. Only use syringes containing a clear, particle-free solution in undamaged packaging. If the solution appears cloudy, discoloured, or contains visible particles, do not use it and contact your pharmacist for a replacement.
- Single use only – Each pre-filled syringe is intended for a single injection. Do not re-use syringes, even if some solution appears to remain.
- Disposal – Do not dispose of used syringes in household waste or drain them into sewage systems. Return used syringes and needles to your pharmacy or fertility clinic for safe disposal in a sharps container. This protects the environment and prevents accidental needle-stick injuries.
What Does Fyremadel Contain?
Active Ingredient
The active substance is ganirelix. Each pre-filled syringe contains 0.25 mg of ganirelix (as the acetate salt) dissolved in 0.5 mL of aqueous solution. Ganirelix is a synthetic decapeptide that acts as a competitive antagonist at GnRH receptors, blocking the release of luteinizing hormone and follicle-stimulating hormone from the pituitary gland.
Inactive Ingredients (Excipients)
The other ingredients in Fyremadel are:
- Acetic acid (E260) – Used as a buffering agent to maintain the correct pH of the solution
- Mannitol (E421) – Acts as a tonicity agent (osmotic stabiliser) to ensure the solution is isotonic with body fluids, improving comfort at the injection site
- Water for injections – The solvent in which the active ingredient and excipients are dissolved
- Sodium hydroxide and acetic acid – Used to adjust the pH (acidity) of the solution to the appropriate level for subcutaneous injection
Appearance and Packaging
Fyremadel is a clear, colourless aqueous solution for injection. It is supplied as a ready-to-use solution in pre-filled glass syringes fitted with injection needles (27 gauge). The pre-filled syringes are designed for subcutaneous administration and require no reconstitution or preparation before use.
Fyremadel is available in pack sizes of 1 or 5 pre-filled syringes with injection needles. Not all pack sizes may be marketed in your country.
The needle shield of the pre-filled syringe contains dry natural rubber (latex) that comes into contact with the needle. If you have a known latex allergy, inform your doctor or nurse before using this product, as an alternative administration method may need to be considered.
Frequently Asked Questions About Fyremadel
GnRH antagonists such as Fyremadel (ganirelix) block GnRH receptors immediately upon administration, providing rapid suppression of LH secretion within hours. In contrast, GnRH agonists initially stimulate the pituitary gland (known as the “flare effect”), and suppression only occurs after 1–2 weeks of continuous use through receptor desensitisation. Antagonist protocols offer several practical advantages: they require fewer injections overall, involve a shorter treatment duration, and have been associated with a lower risk of ovarian hyperstimulation syndrome (OHSS). These benefits have made GnRH antagonist protocols the preferred approach in many fertility centres worldwide, particularly for patients at higher risk of OHSS.
Yes, Fyremadel is designed for self-administration at home. The pre-filled syringe makes the injection process straightforward. Your fertility clinic will provide thorough training on the correct injection technique before you start treatment, including how to prepare the injection site, insert the needle at the correct angle, and dispose of used syringes safely. Many patients find it helpful to have a partner assist with the injections, particularly in the beginning. If you feel unsure about self-injecting, your clinic nurse can perform the first injection while you observe, giving you confidence to continue at home.
The time of day for your Fyremadel injection should be consistent each day and will depend on your individual treatment schedule as determined by your fertility specialist. The critical consideration is the 30-hour rule: the interval between two consecutive Fyremadel injections, and between the last Fyremadel injection and the hCG trigger, must not exceed 30 hours. If you inject in the morning, continue injecting in the morning throughout the treatment period, including on the day the hCG trigger is given. If you inject in the afternoon, the last Fyremadel injection should be on the afternoon before the day of ovulation induction. Your clinic will provide specific timing instructions tailored to your protocol.
GnRH antagonist protocols using ganirelix have been extensively studied and show comparable pregnancy and live birth rates to GnRH agonist long protocols in most patient populations. A Cochrane systematic review concluded that while there may be a slight difference in pregnancy rates per cycle, the overall cumulative pregnancy rates (including frozen embryo transfers) are similar between the two approaches. The antagonist protocol offers additional benefits, including a lower risk of OHSS, fewer injections, shorter treatment duration, and better patient comfort – all of which contribute to it being the preferred protocol in many fertility clinics globally. Your fertility specialist will select the most appropriate protocol based on your individual clinical profile.
If you pull back the plunger and see blood enter the syringe before injecting, this indicates the needle tip has entered a blood vessel. In this case, do not inject the solution. Withdraw the needle, apply firm pressure to the injection site with a clean antiseptic swab until any bleeding stops (usually within one to two minutes), and discard the used syringe properly. Take a new pre-filled syringe and start the injection process again at a different site on your thigh. This is a standard precaution for any subcutaneous injection and does not indicate a problem with the medication itself.
Fyremadel, Orgalutran, and various ganirelix acetate injection products all contain the same active substance – ganirelix acetate 0.25 mg/0.5 mL – and are therapeutically equivalent. They differ only in brand name and manufacturer. Fyremadel is marketed by Sun Pharmaceutical Industries Europe B.V. Your fertility clinic may prescribe any of these products interchangeably, and the clinical efficacy and safety profile are the same regardless of which brand you receive. Other available brands include Ganirelix Orifarm. Always follow the specific instructions provided with whichever brand you are dispensed.
References
This article is based on peer-reviewed medical literature, international clinical guidelines, and approved product information. All medical claims are supported by evidence rated Level 1A (systematic reviews and meta-analyses of randomised controlled trials) or Level 1B (individual RCTs) according to the GRADE evidence framework.
- European Society of Human Reproduction and Embryology (ESHRE). ESHRE Guideline on Ovarian Stimulation for IVF/ICSI. Human Reproduction Update. 2020;26(Suppl 1):i1–i45. doi:10.1093/humrep/deaa009
- Al-Inany HG, Youssef MA, Ayeleke RO, et al. Gonadotrophin-releasing hormone antagonists for assisted reproductive technology. Cochrane Database of Systematic Reviews. 2016;(4):CD001750. doi:10.1002/14651858.CD001750.pub4
- National Institute for Health and Care Excellence (NICE). Fertility problems: assessment and treatment. Clinical guideline CG156. 2013 (updated 2017). www.nice.org.uk/guidance/cg156
- Practice Committee of the American Society for Reproductive Medicine (ASRM). Gonadotropin-releasing hormone agonists and antagonists in assisted reproductive technology. Fertility and Sterility. 2023;119(1):16–25.
- World Health Organization. WHO Model List of Essential Medicines – 23rd List. Geneva: WHO; 2023.
- European Medicines Agency (EMA). Fyremadel – Summary of Product Characteristics. Amsterdam: EMA; 2020.
- Lambalk CB, Banga FR, Huirne JAF, et al. GnRH antagonist versus long agonist protocols in IVF: a systematic review and meta-analysis accounting for patient type. Human Reproduction Update. 2017;23(5):560–579. doi:10.1093/humupd/dmx017
- Humaidan P, Quartarolo J, Papanikolaou EG. Preventing ovarian hyperstimulation syndrome: guidance for the clinician. Fertility and Sterility. 2010;94(2):389–400.
Editorial Team
This article was written and reviewed by the iMedic Medical Editorial Team, comprising licensed physicians specialising in reproductive medicine, endocrinology, and clinical pharmacology. Our editorial process follows the GRADE evidence framework and adheres to international medical guidelines from ESHRE, ASRM, NICE, and WHO.
Content developed by specialist physicians with clinical experience in reproductive medicine and fertility pharmacology. All information is derived from peer-reviewed sources and approved product labelling.
Independently reviewed by the iMedic Medical Review Board for accuracy, completeness, and adherence to current evidence-based guidelines. Reviewed according to WHO, ESHRE, and ASRM standards.
All medical claims are graded using the GRADE framework. This article is based on Level 1A evidence (systematic reviews and meta-analyses of randomised controlled trials) and current international guidelines.
iMedic receives no commercial funding from pharmaceutical companies. All content is produced independently and is free from industry influence or advertising.