Indications
Human menopausal gonadotrophin (hMG, also called menotrophin) is a fertility hormone used:
- In women who do not ovulate (release eggs) because the pituitary gland makes too little hormone, to stimulate the growth of follicles (egg sacs)
- In women having assisted reproduction, such as IVF or ICSI, to grow several follicles at once
- In men with low hormone production from the pituitary (hypogonadotropic hypogonadism), together with hCG, to stimulate sperm production
How It Works
hMG is a purified mixture of two natural hormones, follicle-stimulating hormone (FSH) and luteinising hormone (LH), originally obtained from the urine of women after menopause. In women, FSH and LH act on the ovaries to make follicles grow and mature and to produce oestrogen. In men, FSH helps the testes produce sperm.
Dosage and Administration
hMG is given as an injection under the skin or into a muscle, by a doctor, nurse, or by the patient after training. The dose and number of days are set by a fertility specialist for each person, and are adjusted according to ultrasound scans and blood hormone tests. A separate injection of hCG is usually given to trigger final egg maturation. Use only as prescribed.
Interactions
It is commonly used together with other fertility medicines such as hCG, Clomifene or GnRH analogues, which may change the dose needed. No other important drug interactions are known, but tell your specialist about all medicines and supplements you take.
Contraindications
hMG must not be used in:
- Pregnancy
- Enlarged ovaries or ovarian cysts not caused by polycystic ovary syndrome
- Unexplained vaginal bleeding
- Tumours of the ovary, uterus, breast, testes, pituitary gland or hypothalamus
- Primary ovarian or testicular failure (when the ovaries or testes cannot respond)
- Malformations of the reproductive organs or fibroids that make pregnancy impossible
- Uncontrolled thyroid or adrenal disease, or allergy to the medicine
Side Effects
Common side effects include:
- Pain, redness or bruising at the injection site
- Headache, abdominal bloating or discomfort, nausea
- Ovarian hyperstimulation syndrome (OHSS), where the ovaries over-respond
- Multiple pregnancy (twins or more)
Less common risks include ectopic pregnancy, miscarriage, ovarian twisting and blood clots. In men, breast enlargement and acne can occur.
Get urgent medical help if you have severe abdominal pain or swelling, rapid weight gain, much less urine, shortness of breath, vomiting, pain or swelling in the leg, chest pain, or signs of a serious allergic reaction. These may be signs of severe OHSS or a blood clot.
Pregnancy and Lactation
hMG is used to help achieve pregnancy but must not be used once pregnancy has occurred. It is not used during breastfeeding.
Precautions and Warnings
Treatment must be closely monitored with ultrasound scans and blood tests to reduce the risk of OHSS and multiple pregnancy. Before treatment, thyroid, adrenal and pituitary problems should be checked and treated. Tell your specialist if you or your family have had blood clots. Follow advice on intercourse timing and avoid strenuous activity if the ovaries are enlarged.
Overdose
Too much hMG can cause ovarian hyperstimulation syndrome. Contact the fertility clinic or a doctor straight away if a larger dose than prescribed has been injected.
Therapeutic Class
Gonadotrophin; fertility hormone.
Storage
Store as directed on the pack; many products are kept in a refrigerator at 2 to 8°C or below 25°C, protected from light. Do not freeze. Use immediately after mixing, and keep out of the reach of children.
Prepared by the Oshud Alo team from standard drug references. For information only; always follow your doctor's advice.