HMG
HMG (Human Menopausal Gonadotropin, Menotropins)
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| Risk Tier | ORANGE |
| Category | Sexual Health / Fertility |
| Subcategory | Combined Gonadotropin Stimulation |
| Pharmacological Class | Glycoprotein Hormone Combination |
| Subclass | FSH + LH Combined Gonadotropin |
| Molecular Type | Purified or recombinant mixture of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) in approximately 1:1 ratio |
| Origin | Historically purified from post-menopausal urine (menopausal women have elevated FSH and LH due to loss of ovarian feedback); modern preparations may be highly purified or recombinant |
| Regulatory Status | FDA-approved for fertility treatment. Brand names include Menopur (menotropins), Pergonal (discontinued), Repronex (discontinued). Approved for ovulation induction and controlled ovarian hyperstimulation in ART. |
| Route of Administration | Intramuscular injection, subcutaneous injection |
| Reconstitution | Lyophilized powder; reconstitute with supplied diluent or bacteriostatic water |
| Storage | Refrigerate (2-8°C) |
Description
Human Menopausal Gonadotropin (HMG, menotropins) is a preparation containing both follicle-stimulating hormone (FSH) and luteinizing hormone (LH) activity, historically derived from the urine of post-menopausal women. After menopause, the loss of ovarian estrogen and inhibin feedback results in dramatically elevated pituitary secretion of both FSH and LH, which are excreted in the urine and can be purified for pharmaceutical use. Modern HMG preparations (such as Menopur) are highly purified and standardized to provide a defined ratio of FSH and LH activity (typically 75 IU FSH : 75 IU LH per vial).
FSH and LH have complementary roles in reproductive physiology. In females, FSH stimulates ovarian follicle growth and maturation (recruitment, selection, and development of dominant follicles), granulosa cell proliferation, estradiol synthesis, and expression of LH receptors on granulosa cells. LH drives theca cell androgen production (which granulosa cells aromatize to estradiol), triggers ovulation (the LH surge), and supports corpus luteum formation and progesterone production. In males, FSH acts on Sertoli cells to support spermatogenesis, while LH acts on Leydig cells for testosterone production (similar to HCG). The combined FSH+LH preparation in HMG provides both signals simultaneously, which is particularly important in patients with hypogonadotropic hypogonadism (where both pituitary gonadotropins are deficient) and in controlled ovarian stimulation protocols where both follicle development (FSH-driven) and steroidogenesis (LH-dependent) need to be supported.
Clinical Context
HMG has been a cornerstone of fertility medicine since the 1960s and remains widely used in IVF and IUI protocols. The debate between pure FSH preparations (follitropin alfa/Gonal-F, follitropin beta/Follistim) and FSH+LH combinations (HMG/Menopur) has been ongoing for decades. Current evidence suggests that the LH component in HMG may improve outcomes in certain patient populations — particularly older women, poor responders, and patients with hypogonadotropic hypogonadism — by supporting theca cell steroidogenesis and follicular maturation. The 75 IU vial at $28.06 is cost-effective for research and clinical protocols.
- FDA-approved for fertility treatment — decades of clinical safety data
- Contains both FSH and LH activity — provides both gonadotropin signals simultaneously
- OHSS risk: ovarian hyperstimulation syndrome is the most serious potential complication in female patients — requires careful monitoring (ultrasound + estradiol levels)
- In males: typically combined with HCG for spermatogenesis induction; HMG provides FSH (Sertoli cell stimulation) while HCG provides LH activity (Leydig cell testosterone production)
- Multiple pregnancy risk in fertility treatment — careful dose titration and monitoring required
- Each vial contains 75 IU — typical female stimulation protocols use 75-300 IU daily for 7-12 days
- Contraindicated in patients with ovarian cysts, unexplained vaginal bleeding, sex hormone-dependent tumors, and primary gonadal failure
- The purified urinary origin is well-established; highly purified preparations have minimal non-gonadotropin protein contamination
Published Research
Published Research & Clinical Data
Peer-reviewed studies and clinical trial data related to HMG
All research below is conducted by independent institutions. MedTech Research Group provides these references for informational purposes only.
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