Human Menopausal Gonadotrophin

Introduction: Human Menopausal Gonadotrophin (HMG) possesses both follicle-stimulating hormone (FSH) and luteinizing hormone (LH) activities. It is used for ovulation induction in women, in vitro fertilisation (IVF) procedures and spermatogenesis stimulation in men.

How it works: The FSH component of HMG induces an increase in the number of growing follicles and stimulates their development in the ovaries. The LH component helps produce androgens in theca cells which are aromatized to estradiol in granulosa cells. In the testes, FSH induces maturation of Sertoli cells and development of spermatozoa.

Important Information: Female ovulation induction: 75-150 IU FSH/day IM/SC, followed by HCG 5,000-10,000 IU. Male: First normalize testosterone with HCG, then HMG 75-150 IU FSH 2-3 times weekly.

• Female infertility: hypo- or normogonadotropic ovarian insufficiency - stimulation of follicle growth
• Male infertility: hypo- or normogonadotropic hypogonadism - in combination with HCG to stimulate spermatogenesis
• In vitro fertilisation (IVF) procedures and other assisted conception techniques

Female Sex hormones

Gonadotrophin

Human Menopausal Gonadotrophin directly affects the ovaries and the testes. It has gametotropic and steroidogenic effect. In the ovaries, the FSH-component induces an increase in the number of growing follicles and stimulates their development. FSH increases the production of estradiol in the granulose cells by aromatizing androgens that originate in the Theca cells under the influence of the LH-component. In the testes, FSH induces the transformation of premature to mature Sertoli cells and causes the maturation of the seminal canals and development of the spermatozoa.

FSH stimulates follicle growth and estradiol production while LH helps androgen production. In men, FSH stimulates spermatogenesis.

Female Dose (IM/SC):

• Ovulation induction: 75-150 IU FSH daily, adjust gradually until adequate response
• After pre-ovulatory estradiol level achieved, HCG 5,000-10,000 IU (1-2 days after last HMG dose)
• Start within first 7 days of menstrual cycle

Male Dose (IM/SC):

• First treat with HCG 2 X 5,000 IU/week (until testosterone normalizes)
• Then HMG 75-150 IU FSH 2-3 times weekly (for several months)

IVF/Assisted Conception:

• 75-300 IU FSH daily (start on day 2 or 3 of cycle)

* Use as directed by the registered physician

Intramuscular (IM) or subcutaneous (SC) injection. First injection should be performed under direct medical supervision.

If you miss a dose, consult your doctor.

Common Side Effects:

• Ovarian hyperstimulation
• Risk of multiple pregnancy and miscarriage
• Hypersensitivity and local reactions at injection site
• Nausea
• Vomiting
• Joint pain
• Fever
• In men: gynecomastia, acne, weight gain

Serious (Potentially Fatal): Rupture of ovarian cysts and intraperitoneal haemorrhage

Precautions:

• Hyperprolactinemia or tumors of the pituitary or hypothalamus
• Ovarian enlargement at risk of rupture
• Risk of multiple births
• Regular ultrasound and estradiol monitoring required during treatment
• If unintentional hyperstimulation occurs, discontinue treatment

Contraindications (Female):

• Pregnancy
• Ovarian cysts or enlargement not caused by polycystic ovarian syndrome
• Vaginal bleeding of unknown cause
• Tumors of breast, uterus, ovaries
• High FSH levels indicating primary ovarian failure

Male:

• Prostate carcinoma
• Tumors in the testes
• Normal gonadotrophin levels

Drug Interactions:

• Drugs with luteinising hormone activity may increase risk of ovarian hyperstimulation syndrome
• Can be injected together with HCG when treating infertile males

Food Interactions: No interaction found/established.

Use in Pregnancy: No indication for use during pregnancy.

Use in Lactation: No indication for use during lactation.

Pediatric Use: Safety and efficacy in children have not been established.

Geriatric Use: Not applicable (infertility treatment).

Renal & Hepatic Impairment: No known restrictions. However, consult your doctor.

Overdose: May lead to ovarian hyperstimulation. Mild hyperstimulation: observation. Severe cases: hospitalization and supportive treatment required.

Storage: Store at 2°C-8°C. Do not freeze. Can be stored below 25°C for maximum 3 months. Protect from light.

Human Menopausal Gonadotrophin