Menotropins
Also known as: hMG, Human Menopausal Gonadotropin, Humegon, Menopur, Menotropin, Pergonal, Repronex
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Summary
Menotropins (human menopausal gonadotropin, hMG) are a prescription mixture of follicle‑stimulating hormone (FSH) and luteinising hormone (LH) derived from menopausal urine. They are used to induce ovulation and to stimulate multiple follicle development in controlled ovarian stimulation protocols for intra‑uterine insemination (IUI), in‑vitro fertilisation (IVF) and gamete intrafallopian transfer (GIFT).
Mechanism of Action
The FSH component binds to FSH receptors on granulosa cells, promoting follicular growth and estradiol production. The LH component activates LH receptors on theca cells and later on mature granulosa cells, supporting androgen synthesis and final follicular maturation. Together the hormones mimic the natural gonadotrophin surge, enabling the development of multiple mature oocytes suitable for assisted‑reproduction techniques.
What the Research Shows
Early reviews identified known risks of menotropin therapy, including ovarian hyperstimulation syndrome (OHSS), multiple gestation and adnexal torsion, and emphasized its cost relative to IVF. A 2001 randomised study comparing purified FSH with menotropins in GnRH‑agonist‑suppressed women found menotropin cycles required fewer days (≈16 vs 13) and fewer ampoules, with higher LH, hCG and estradiol exposure and fewer small follicles. The same study noted a non‑significant trend toward lower multiple‑gestation rates. Clinical guidance from the early 1990s recommends menotropins after clomiphene failure or in hypogonadotropic anovulation, often combined with GnRH analogues to prevent premature luteinisation. Overall, evidence supports efficacy in ovulation induction, but comparative superiority over IVF or newer recombinant products remains unsettled.
Reported Benefits
Menotropins effectively induce ovulation in clomiphene‑resistant or hypogonadotropic women, achieving pregnancy rates comparable to those of normally ovulating patients. The combined FSH/LH activity can shorten treatment duration and reduce total ampoule consumption, potentially lowering drug costs. By promoting the growth of fewer small follicles, menotropins may lessen the risk of OHSS and multiple pregnancies compared with high‑dose FSH alone. They also enable the production of multiple oocytes for IVF, increasing the number of embryos available for transfer.
Limitations of the Evidence
Most data derive from small, non‑randomised or early‑phase trials, limiting definitive conclusions about superiority to recombinant gonadotropins or IVF alone. Long‑term follow‑up on congenital malformations is limited, although early reports do not show increased risk. The high cost of the medication, need for intensive monitoring (estradiol levels, ultrasound), and documented adverse events such as OHSS and adnexal torsion constrain its use. Comparative effectiveness studies remain scarce.
Safety Considerations
Menotropin therapy carries a documented risk of ovarian hyperstimulation syndrome, which can be severe and requires careful monitoring of estradiol and follicle size. Multiple gestation and adnexal torsion are also reported complications. A review of early miscarriage and fetal malformation rates found no increase compared with the general population, but longer follow‑up is recommended. Caution is advised in patients with high baseline ovarian response, polycystic ovary syndrome, or previous OHSS.
How It Is Administered
Menotropins are supplied as an injectable powder for reconstitution and are administered either intramuscularly or subcutaneously. Dosing is expressed in international units (IU) of combined FSH and LH, typically given once or twice daily during the stimulation phase of an assisted‑reproduction cycle. The medication is used in conjunction with GnRH agonist or antagonist protocols, and ovulation is usually triggered with hCG or a GnRH agonist.
Routes of Administration
Goals & Uses
- Controlled ovarian hyperstimulationReproductive EndocrinologyHigh
- Ovarian stimulation for ART/IVFReproductive EndocrinologyHigh
- Spermatogenesis induction in hypogonadotropic hypogonadismMale FertilityModerate
- Male hypogonadotropic hypogonadism treatmentEndocrineModerate
- Induction of ovulation in anovulatory womenReproductive EndocrinologyHigh
- Ovulation inductionReproductive EndocrinologyHigh
- Assisted reproductive technology (ART) supportFertilityHigh
Contraindications
- Sex hormone-dependent tumorsOncologyHigh
- PregnancyPopulationHighPotential fetal risk or insufficient safety data
- Primary ovarian failure / hypergonadotropic hypogonadismEndocrineHigh
- Ovarian hyperstimulation syndrome (OHSS) riskReproductive MedicineHigh
- Ovarian cysts or enlargement not due to PCOSGynecologyModerate
- Uncontrolled thyroid or adrenal dysfunctionEndocrinologyHigh
- Abnormal uterine bleeding of undetermined causeGynecologyHigh
- Estrogen‑dependent neoplasmsOncologyModerate
Adverse Effects
- Abdominal discomfortGastrointestinalCommon
- Injection site reactionsLocalCommon
- Multiple gestationReproductiveCommon
- HeadacheNeurologicCommonPain in the head or upper neck
- Ovarian hyperstimulation syndromeReproductive / EndocrineCommon
- Thromboembolic eventsCardiovascularRare
- Abdominal pain and bloatingGastrointestinalCommon
- Multiple pregnancyReproductiveUncommon
- Injection site reactionLocalCommonRedness, swelling, itching, bruising, or pain at the injection site
- Ovarian hyperstimulation syndrome (OHSS)ReproductiveUncommon
Drug Interactions
- Anticoagulants (e.g., warfarin)Low
- Oral contraceptivesModerateDelayed gastric emptying may affect absorption timing
- Human Chorionic Gonadotropin (hCG)Low
- GnRH antagonists (e.g., cetrorelix, ganirelix)Low
- GnRH agonists/antagonistsLow
- Clomiphene citrateLow
- GnRH agonists (e.g., leuprolide)Low
Population Constraints
- Pediatric patientsAgeRelative
- Polycystic ovary syndrome (PCOS)EndocrineRelative
- Lactating womenReproductiveRelative
- Elderly women (>45 y)AgeRelative
- Renal or hepatic impairmentOrgan DysfunctionRelative
- Women over 40 yearsAgeRelative
Regulatory Status
- European UnionApprovedApproved: female infertility, male infertilityEMA approval; marketed under multiple brand names.
- United StatesApprovedApproved: female infertility – ovulation induction, male hypogonadotropic hypogonadismApproved by FDA; prescription only.
- United KingdomApprovedApproved: female infertility, male infertilityMHRA approved; prescription required.
Derived from pooled human urine; marketed under several brand names (e.g., Menopur, Repronex). Approved for infertility treatment in many jurisdictions.
Evidence & Sources
- Journal ArticleModerateShoham Z, Zosmer A, Insler V1991-01-01T00:00:00.000000Z
- Journal ArticleModerateFilicori M, et al.2001-01-01T00:00:00.000000Z
- Journal ArticleModerateCorsan GH, Kemmann E1991-01-01T00:00:00.000000Z
- Journal ArticleModerateJennings JC, Moreland K, Peterson CM1996-01-01T00:00:00.000000Z
- Journal ArticleModerateBlacker CM1992-01-01T00:00:00.000000Z
Frequently Asked Questions
What clinical situations warrant the use of menotropins?
Menotropins are indicated when ovulation induction is needed after clomiphene failure, in women with hypogonadotropic anovulation, or when multiple follicle development is desired for IUI, IVF or GIFT cycles. They are also employed when a combined FSH‑LH stimulus is preferred over FSH alone.
How do menotropins differ from recombinant FSH products?
Menotropins contain both FSH and LH activity derived from human urine, whereas recombinant FSH provides only FSH with higher purity and batch consistency. The LH component in menotropins may shorten treatment duration and reduce small follicle development, but recombinant products avoid exposure to human urinary contaminants.
What are the main risks associated with menotropin therapy?
The principal risks are ovarian hyperstimulation syndrome, multiple pregnancy, and adnexal torsion. Early data do not show a higher rate of congenital malformations, but careful monitoring of hormone levels and follicle size is essential to mitigate these complications.
Can menotropins be given subcutaneously, or is intramuscular injection required?
Both routes are approved. Menotropins can be administered intramuscularly or subcutaneously, allowing flexibility based on patient preference and clinical protocol.
Why might a physician choose menotropins over clomiphene citrate?
Clomiphene is first‑line for normo‑estrogenic anovulation, but in cases of clomiphene resistance, hypogonadotropic infertility, or when multiple oocytes are needed for assisted reproduction, menotropins provide a more potent gonadotrophin stimulus that can improve ovulation and pregnancy outcomes.
What is Menotropins?
Menotropins (human menopausal gonadotropin, hMG) are a prescription mixture of follicle‑stimulating hormone (FSH) and luteinising hormone (LH) derived from menopausal urine. They are used to induce ovulation and to stimulate multiple follicle development in controlled ovarian stimulation protocols for intra‑uterine insemination (IUI), in‑vitro fertilisation (IVF) and gamete intrafallopian transfer (GIFT).
What is Menotropins used for?
Menotropins is educationally associated with: Controlled ovarian hyperstimulation, Ovarian stimulation for ART/IVF, Spermatogenesis induction in hypogonadotropic hypogonadism, Male hypogonadotropic hypogonadism treatment, Induction of ovulation in anovulatory women, Ovulation induction, Assisted reproductive technology (ART) support. Educational only — not medical advice.
How is Menotropins administered?
Recorded routes of administration: Intramuscular, Subcutaneous.
What are the potential side effects of Menotropins?
Reported adverse effects include: Abdominal discomfort, Injection site reactions, Multiple gestation, Headache, Ovarian hyperstimulation syndrome, Thromboembolic events, Abdominal pain and bloating, Multiple pregnancy, Injection site reaction, Ovarian hyperstimulation syndrome (OHSS). This list is not exhaustive — consult a qualified clinician.
Who should avoid Menotropins?
Recorded contraindications: Sex hormone-dependent tumors, Pregnancy, Primary ovarian failure / hypergonadotropic hypogonadism, Ovarian hyperstimulation syndrome (OHSS) risk, Ovarian cysts or enlargement not due to PCOS, Uncontrolled thyroid or adrenal dysfunction, Abnormal uterine bleeding of undetermined cause, Estrogen‑dependent neoplasms. Consult a qualified clinician before use.