Can't Find Gonal-F? Here Are Your Options

When you're in the middle of a fertility treatment cycle, being told your pharmacy can't fill your Gonal-F prescription is more than an inconvenience — it can feel like your entire timeline is at risk. Time-sensitive protocols mean you can't always wait for a backorder to resolve.

The good news is that there are legitimate alternatives to Gonal-F that your fertility doctor may recommend. Let's look at what Gonal-F is, how it works, and which medications can serve a similar role.

What Is Gonal-F?

Gonal-F is a brand-name injectable fertility medication containing follitropin alfa, a recombinant (lab-produced) form of human follicle-stimulating hormone (FSH). It's manufactured by EMD Serono and is one of the most widely prescribed gonadotropin medications in the United States.

Gonal-F is FDA-approved for:

• Ovulation induction in women who aren't ovulating
• Controlled ovarian stimulation during IVF cycles
• Inducing sperm production in men with hypogonadotropic hypogonadism

It's available as the Gonal-F RFF Redi-ject prefilled pen (in 300 IU, 450 IU, and 900 IU strengths) and as multi-dose vials for reconstitution. For a detailed overview, see our post on what is Gonal-F.

How Does Gonal-F Work?

Gonal-F works by mimicking the action of your body's natural FSH. When injected, follitropin alfa binds to FSH receptors on granulosa cells in the ovaries, stimulating the growth and maturation of ovarian follicles. Each follicle contains an egg, so stimulating multiple follicles (as in IVF) increases the number of eggs available for retrieval.

The dose is carefully adjusted based on ultrasound monitoring and blood estradiol levels, with the goal of producing an adequate number of mature follicles without overstimulating the ovaries. Learn more in our detailed explanation of how Gonal-F works.

Alternatives to Gonal-F

If Gonal-F isn't available, your doctor has several alternatives to consider. Always talk to your fertility specialist before switching medications — they'll choose the best option based on your specific treatment protocol, diagnosis, and response history.

1. Follistim AQ (Follitropin Beta)

Follistim AQ is the closest alternative to Gonal-F. It contains follitropin beta, another recombinant FSH product that works through the same mechanism. Manufactured by Organon (formerly Merck), Follistim is delivered using the Follistim Pen with replaceable cartridges.

Key details:

• Same drug class (recombinant FSH)
• FDA-approved for the same indications as Gonal-F
• Available in 300 IU, 600 IU, and 900 IU cartridges
• Cash price is similar: approximately $800-$1,400 per cartridge depending on strength
• Many fertility doctors consider Follistim and Gonal-F to be clinically interchangeable, though individual response may vary slightly

If your doctor is comfortable with a switch, Follistim is usually the first alternative they'll reach for.

2. Menopur (Menotropins)

Menopur is a different type of gonadotropin that contains both FSH and LH (luteinizing hormone) activity. It's derived from the urine of postmenopausal women and is highly purified. Manufactured by Ferring Pharmaceuticals, Menopur is often used alongside Gonal-F or Follistim in IVF protocols, but it can also be used as the primary gonadotropin.

Key details:

• Contains both FSH and LH activity (75 IU each per vial)
• Available as a powder for reconstitution, mixed and injected subcutaneously
• May be preferred for patients who benefit from LH supplementation
• Cash price: approximately $100-$150 per vial (multiple vials needed per day)
• Different preparation method — requires mixing with diluent before injection

Menopur isn't a direct 1-for-1 swap for Gonal-F, but many successful IVF protocols use Menopur as the primary or sole gonadotropin.

3. Clomid (Clomiphene Citrate)

Clomid is an oral medication that's been used for decades to induce ovulation. It's a selective estrogen receptor modulator (SERM) that works by blocking estrogen feedback to the brain, causing the pituitary gland to release more FSH and LH naturally.

Key details:

• Oral tablet — no injections required
• Much less expensive: approximately $10-$50 per cycle with a coupon
• FDA-approved for ovulation induction
• Not appropriate for IVF stimulation (doesn't produce enough follicles)
• Typically a first-line treatment before moving to injectables
• Common side effects include hot flashes, mood changes, and visual disturbances

Clomid is not a replacement for Gonal-F in IVF, but if you're using Gonal-F for ovulation induction or IUI cycles, Clomid may be a viable alternative to discuss with your doctor.

4. Letrozole (Femara)

Letrozole is an aromatase inhibitor used off-label for ovulation induction, particularly in women with polycystic ovary syndrome (PCOS). It works by temporarily lowering estrogen levels, which signals the brain to increase FSH production.

Key details:

• Oral tablet — no injections
• Very affordable: approximately $10-$30 per cycle with a coupon
• Often considered first-line for PCOS-related anovulation
• Not sufficient for IVF stimulation protocols
• Generally well-tolerated with fewer side effects than Clomid

Like Clomid, Letrozole is not a substitute for Gonal-F in IVF, but may be appropriate for less intensive fertility treatments.

How to Decide Which Alternative Is Right for You

The best alternative depends on your specific situation:

• If you're in an IVF cycle: Follistim AQ is the most direct substitute. Menopur is also a strong option, sometimes used alone or in combination.
• If you're doing IUI or ovulation induction: Follistim, Menopur, Clomid, or Letrozole may all be options depending on your history and response.
• If cost is the primary concern: Clomid and Letrozole are dramatically cheaper but only appropriate for certain protocols. See our guide on saving money on Gonal-F.

Never switch medications on your own. Always consult your reproductive endocrinologist or fertility specialist before making any changes to your protocol.

Final Thoughts

Not being able to find Gonal-F is stressful, but it doesn't mean your treatment has to stop. Medications like Follistim AQ and Menopur can serve similar roles in your fertility protocol, and oral options like Clomid and Letrozole may be appropriate depending on your treatment plan.

Before switching, check if Gonal-F is available using Medfinder — it may be in stock at a pharmacy you haven't tried yet. And read our guide on how to find Gonal-F in stock near you for more practical tips.