HMG

Human menopausal gonadotropin (hMG, menotropins) is a hormone mixture derived from the urine of postmenopausal women. It provides follicle-stimulating hormone (FSH) and luteinizing hormone (LH) activity, essential for ovarian follicle growth and ovulation Human menopausal gonadotrophin in a pre-filled injection pen is non-inferior to the US-approved powder formulation+1. Highly purified preparations (HP-hMG) are standardized at 75 IU of FSH per vial and also contain hCG, which contributes LH-like effects Reverse-Phase High-Performance Liquid Chromatography/Mass Spectrometry (RP-LC-MS/MS, Label-Free Method) for Component Analysis of Gonadotropin Drugs.

In fertility research, hMG is primarily used for ovarian stimulation in IVF, where it supports the development of multiple follicles to retrieve eggs Luteinizing hormone activity in ovarian stimulation: comparative efficacy and safety of gonadotropins versus recombinant follicle-stimulating hormone-a systematic review and meta-analysis. It is also studied for ovulation induction in women with polycystic ovary syndrome (PCOS) or low pituitary hormone levels (hypogonadotropic hypogonadism) Efficacy of sequential letrozole and gonadotropin therapy for ovulation induction in women with polycystic ovary syndrome: a systematic review and meta-analysis+1. In men, combined with hCG, hMG can restart sperm production when the pituitary fails to send enough signals Fertility Outcomes in Men with Nonobstructive Azoospermia Due to Hypogonadotropic Hypogonadism After Gonadotropin Therapy+1.

Large meta-analyses show that hMG achieves similar live birth rates to recombinant FSH while possibly offering a lower risk of ovarian hyperstimulation syndrome (OHSS) Luteinizing hormone activity in ovarian stimulation: comparative efficacy and safety of gonadotropins versus recombinant follicle-stimulating hormone-a systematic review and meta-analysis+1. Modern formulations can be injected under the skin and are available as ready-to-use pre-filled pens that are as effective as traditional powders Human menopausal gonadotrophin in a pre-filled injection pen is non-inferior to the US-approved powder formulation+1.

hMG works by directly activating the receptors for FSH and LH on ovarian cells. FSH binds to granulosa cells, stimulating follicle growth and the conversion of androgens to estrogens Human menopausal gonadotrophin in a pre-filled injection pen is non-inferior to the US-approved powder formulation+1. LH and hCG both attach to a shared receptor on theca and granulosa cells, which boosts androgen production and supports the later stages of follicle maturation and ovulation Human menopausal gonadotrophin in a pre-filled injection pen is non-inferior to the US-approved powder formulation+2.

The hCG component in hMG has a longer half-life than pituitary LH, providing sustained LH-like activity. This may help fine-tune ovarian response and contribute to the lower OHSS risk seen with hMG in some studies Comparative Effectiveness of Follitropin Delta, Follitropin Alpha, and <scp>hMG</scp> in <scp>ART</scp> Cycles: A Single‐Center Retrospective Cohort Study With Propensity Score Matching+1.

In simple terms, hMG replaces the natural FSH and LH signals that the pituitary would send, allowing researchers to control the number and timing of follicle development.

The primary effect of hMG in women is the growth of multiple ovarian follicles containing mature eggs, essential for IVF egg retrieval Luteinizing hormone activity in ovarian stimulation: comparative efficacy and safety of gonadotropins versus recombinant follicle-stimulating hormone-a systematic review and meta-analysis. In ovulation induction, it can produce a single mature follicle for timed intercourse or insemination Gonadotropins for ovulation induction in women with polycystic ovary syndrome. In men, long-term hMG combined with hCG can restore sperm production in hypogonadotropic hypogonadism, with sperm appearing in the ejaculate in about three-quarters of cases after 6–24 months of treatment Fertility Outcomes in Men with Nonobstructive Azoospermia Due to Hypogonadotropic Hypogonadism After Gonadotropin Therapy+1.

The most serious adverse effect is ovarian hyperstimulation syndrome (OHSS), where the ovaries rapidly enlarge, fluid leaks from blood vessels, and in severe cases, blood clots or kidney failure can occur Highly purified human menotropin (HP-hMG) is associated with a low incidence of ovarian hyperstimulation syndrome (OHSS) in patients undergoing in vitro fertilization: menopur in gnrh antagonist single embryo transfer - high responder (MEGASET-HR) trial outcomes+2. Research suggests hMG is associated with a lower OHSS risk than recombinant FSH alone, especially in high-risk patients Luteinizing hormone activity in ovarian stimulation: comparative efficacy and safety of gonadotropins versus recombinant follicle-stimulating hormone-a systematic review and meta-analysis+1. Common side effects include injection site reactions (less with highly purified preparations) Subcutaneously administered Menopur(R), a new highly purified human menopausal gonadotropin, causes significantly fewer injection site reactions than Repronex(R) in subjects undergoing in vitro fertilization, headache, and abdominal bloating Impact of fertility treatments on headache disorders: a systematic review with an overview of treatment modalities.

In fertility research, hMG administration is carefully tailored using ultrasound and blood tests. Typical IVF stimulation protocols begin with 150–225 IU injected subcutaneously daily for 10–14 days, with dose adjustments based on follicle growth and estrogen levels Luteinizing hormone activity in ovarian stimulation: comparative efficacy and safety of gonadotropins versus recombinant follicle-stimulating hormone-a systematic review and meta-analysis+1. For ovulation induction in PCOS, a low-dose step-up approach starts at 75 IU and increases by 37.5 IU every 5–7 days until a dominant follicle develops Efficacy of sequential letrozole and gonadotropin therapy for ovulation induction in women with polycystic ovary syndrome: a systematic review and meta-analysis+1.

Monitoring is critical: transvaginal ultrasound measures follicle size and number, while blood estradiol tracks ovarian response Luteinizing hormone activity in ovarian stimulation: comparative efficacy and safety of gonadotropins versus recombinant follicle-stimulating hormone-a systematic review and meta-analysis+1. The goal is to balance the chance of pregnancy against the risk of OHSS; if many follicles develop, a freeze-all strategy or a lower trigger dose may be used ESHRE guideline: ovarian stimulation for IVF/ICSI: an update in 2025†. The interactive protocol timeline below illustrates a common ovulation induction regimen.

hMG is supplied as a sterile lyophilized powder requiring reconstitution. Typically, a 75 IU vial is mixed with 1 mL of 0.9% sodium chloride diluent provided by the manufacturer Human menopausal gonadotrophin in a pre-filled injection pen is non-inferior to the US-approved powder formulation+1. The diluent is added gently, and the vial is swirled (not shaken) until the powder dissolves completely, forming a clear solution.

Once reconstituted, the solution must be used immediately; any unused portion is discarded because it contains no preservatives Human menopausal gonadotrophin in a pre-filled injection pen is non-inferior to the US-approved powder formulation. Unmixed vials are stored at room temperature (15–30°C) away from light. A pre-filled liquid pen formulation is also available, which eliminates the mixing step Human menopausal gonadotrophin in a pre-filled injection pen is non-inferior to the US-approved powder formulation+1. Use the calculator below to explore how vial size, diluent volume, and desired dose relate.

In ovarian stimulation research, hMG is almost always combined with other medications. GnRH antagonists or agonists are used to block premature ovulation, allowing controlled follicle growth Luteinizing hormone activity in ovarian stimulation: comparative efficacy and safety of gonadotropins versus recombinant follicle-stimulating hormone-a systematic review and meta-analysis+1. A final triggering injection of hCG is often used to induce egg maturation, but this raises OHSS risk when many follicles are present Luteinizing hormone activity in ovarian stimulation: comparative efficacy and safety of gonadotropins versus recombinant follicle-stimulating hormone-a systematic review and meta-analysis+1.

Oral agents like clomiphene citrate or letrozole are sometimes added to lower the hMG dose needed, especially in poor responders Effectiveness of minimal stimulation versus conventional GnRH antagonist protocols in controlled ovarian hyperstimulation: a retrospective analysis of 10769 IVF/ICSI cycles+1. Non-steroidal anti-inflammatory drugs (NSAIDs) have been studied to prevent premature ovulation, but their routine use is not standard Association Between Diclofenac Sodium Use and Reduced Cycle Cancellation from Premature Ovulation in Women with Diminished Ovarian Reserve Undergoing IVF: A Retrospective Cohort Study. Animal studies suggest that high-dose green tea extract (EGCG) may impair uterine blood vessel development, so caution with concentrated supplements is advised during hMG protocols Evaluation of Endometrial Angiogenesis in Mice Uterus Before Implantation in Natural Cycles Followed by Use of Human Menopausal Gonadotropin - Human Chorionic Gonadotropin Drugs and Epigallocatechin Gallate.

hMG is frequently stacked with other hormones to enhance fertility outcomes. In IVF, it is commonly paired with hCG to trigger ovulation or provide luteal phase support Luteinizing hormone supplementation with human menopausal gonadotropin versus low dose human chorionic gonadotropin during ovarian stimulation does not affect live birth rates after fresh and frozen embryo transfer. Adding growth hormone in poor responders has shown increased egg numbers and more embryos for transfer Effect of growth hormone adjuvant treatment on oocyte retrieval in patients with poor ovarian response and no viable embryos in previous <i>in vitro</i> fertilization (IVF) cycles. In men, hMG is combined with hCG to stimulate both testosterone and sperm production, a proven strategy for restoring fertility in hypogonadotropic hypogonadism Fertility Outcomes in Men with Nonobstructive Azoospermia Due to Hypogonadotropic Hypogonadism After Gonadotropin Therapy+1.

Some protocols stack oral medications like clomiphene or letrozole with low-dose hMG to improve ovarian response while minimizing total gonadotropin exposure Addition of Clomiphene Citrate to a Low-Dose Gonadotropin-Releasing Hormone (GnRH)-Antagonist Protocol in Poor Responders: A Prospective Cohort Study+1. These combinations are tailored to individual ovarian reserve and response patterns.

Highly purified human menopausal gonadotropin (Menopur®) is FDA-approved for ovarian stimulation and ovulation induction, available as both powder and pre-filled pen Human menopausal gonadotrophin in a pre-filled injection pen is non-inferior to the US-approved powder formulation+1. It requires a prescription and is not a controlled substance. Internationally, it is approved in Europe, the UK, Australia, and many other countries.

The World Anti-Doping Agency (WADA) prohibits hMG in all athletes at all times under category S2.2 (Gonadotrophins), as it can indirectly increase testosterone production.

The most critical risk is ovarian hyperstimulation syndrome, which can vary from mild bloating to life-threatening blood clots and kidney failure Highly purified human menotropin (HP-hMG) is associated with a low incidence of ovarian hyperstimulation syndrome (OHSS) in patients undergoing in vitro fertilization: menopur in gnrh antagonist single embryo transfer - high responder (MEGASET-HR) trial outcomes+2. Some studies suggest hMG carries a lower OHSS risk than recombinant FSH alone Luteinizing hormone activity in ovarian stimulation: comparative efficacy and safety of gonadotropins versus recombinant follicle-stimulating hormone-a systematic review and meta-analysis. Common side effects include injection site discomfort (reduced with highly purified formulations) Subcutaneously administered Menopur(R), a new highly purified human menopausal gonadotropin, causes significantly fewer injection site reactions than Repronex(R) in subjects undergoing in vitro fertilization, headache, and abdominal bloating Impact of fertility treatments on headache disorders: a systematic review with an overview of treatment modalities. Rarer complications include ovarian torsion and thromboembolism.

hMG should only be used under specialist supervision with regular ultrasound and blood monitoring. It is contraindicated in pregnancy, hormone-sensitive cancers, and unexplained vaginal bleeding. Long-term cancer risk after multiple cycles is not fully established.