HMG dosage protocol

What Human Menopausal Gonadotropin (hMG) Is

Human Menopausal Gonadotropin (hMG), also known as menotropin, is a preparation derived from the urine of postmenopausal women. It contains both follicle-stimulating hormone (FSH) and luteinizing hormone (LH) activity (PMID 12740151, PMID 14607553). These gonadotropins are protein hormones central to regulating reproductive function (PMID 25480425).

How it is Thought to Work

FSH and LH work together to stimulate the growth of follicles and ovulation (PMID 12740151). In assisted reproductive technology (ART) and ovulation induction, LH levels are important for successful conception; high levels can promote follicular atresia (degeneration) and early miscarriage (PMID 12740151). hMG preparations vary in their LH content and are sometimes augmented with human chorionic gonadotropin (hCG), which mimics LH (PMID 12740151).

What Laboratory and Animal Studies Report

In a study on African catfish (Clarias gariepinus), hMG at 0.5 mg/kg body weight failed to induce breeding, oocyte production, or spawning, unlike Ovaprim (PMID 34406590). This indicates that the effectiveness of hMG can vary significantly across different species for inducing reproductive processes (PMID 34406590).

Human Evidence So Far

hMG therapy is considered for women with anovulation (absence of ovulation) who are resistant to clomiphene citrate (PMID 1576983, PMID 10734340). It may also be a first-line treatment for women with hypogonadotropic anovulation (PMID 1576983). A network meta-analysis suggests that hMG therapy results in higher pregnancy rates compared to clomiphene citrate and certain surgical interventions in patients with clomiphene citrate-resistant polycystic ovary syndrome (PCOS) (PMID 28630466).

For controlled ovarian stimulation in high responders undergoing intracytoplasmic sperm injection (ICSI), highly purified hMG (HP-hMG) showed comparable efficacy to recombinant FSH (rFSH) in terms of ongoing pregnancy rates after fresh transfer and cumulative live birth rates (PMID 32416978). Notably, HP-hMG was associated with significantly lower rates of ovarian hyperstimulation syndrome (OHSS) and cumulative early pregnancy loss compared to rFSH in this group of patients (PMID 32416978).

A meta-analysis comparing hMG and rFSH for ovulation stimulation in ART cycles found a higher clinical pregnancy rate for hMG in cycles using a long GnRH agonist protocol (PMID 14607553). However, there was no significant difference in ongoing pregnancy or live birth rates, gonadotropin dose, oocytes retrieved, implantation rate, miscarriage rate, or multiple pregnancy rate (PMID 14607553). Another review found that rFSH treatment resulted in a higher mean number of oocytes retrieved per cycle than hMG in 10 out of 13 studies, at a similar cost per oocyte (PMID 25480425).