What is HMG?

What sources report

HMG has been part of US fertility care since the first menotropins product, Pergonal, was approved on August 22, 1975, and Menopur followed on October 29, 2004.¹⁷³ It is well studied in women having IVF, while the evidence in men comes from small studies, and none of the trials below used a research-labeled vial.¹⁵¹⁸

How it works

FSH activity is the main driver of recruiting and growing ovarian follicles, and LH activity, from both LH and hCG, supports steroid hormone production and the development of a follicle ready to ovulate.² Menotropins do not trigger ovulation themselves: hCG is given once ultrasound and estradiol monitoring show enough development.¹ Without any LH activity, FSH alone can still grow follicles, but they develop abnormally, with low estradiol, and fail to luteinize after a normal trigger.²

Each Menopur vial carries 75 IU of FSH activity and 75 IU of LH activity, units of biological activity rather than weight.³¹ Every hormone in the mix pairs a shared 92-amino-acid alpha chain with its own beta chain, 111 amino acids for FSH and 121 for LH, and the natural hormones carry sugar chains.²⁰²¹²² In 33 healthy women with pituitary suppression, a single 225 IU dose under the skin brought FSH to a peak at about 18 hours, and with repeated doses its elimination half-life was 11 to 13 hours by either route.¹

What the trials found

The 2011 version of the same Cochrane review pooled all urinary gonadotropins against recombinant FSH and found no significant difference in live birth or OHSS; the 2026 update separates HMG and supersedes it.²³¹⁵

Use in men

In the UK, Menopur is licensed for men with hypogonadotrophic hypogonadism, given with hCG to stimulate sperm production; the US label covers only women.¹⁶¹ In a 1985 study of 21 such men given hCG, sperm counts became normal in all 6 whose condition began after puberty but in only 1 of 15 with prepubertal onset.¹⁸ When 14 of the prepubertal-onset men also received hMG, counts normalized in 5 of 7 without a history of undescended testes versus 1 of 7 with it.¹⁸ A 2014 meta-analysis of 44 gonadotropin studies found 75% overall success, higher with hCG plus FSH and lower with prepubertal onset; its abstract reports no result for hMG on its own.²⁴ Goal pages: Peptides and men's health, Peptides and testosterone and Peptides and women's health.

How it compares

Recombinant FSH (follitropin alfa) provides FSH activity only, so estradiol runs higher with menotropins in down-regulated IVF cycles.² Urofollitropin (Bravelle), an FSH product, may share a syringe with Menopur under the US label.¹ In the UK, HMG is licensed for anovulatory women who did not respond to clomiphene citrate, a use the US label does not include.¹⁶¹ Related profiles: HCG, Kisspeptin-10 and Gonadorelin. The HMG research vial is listed at HMG for sale; it is not Menopur.

Side effects

In two US label trials of 434 women having IVF or ICSI, the most common reactions were:

Uncomplicated ovarian enlargement occurs in about 5 to 10% of women given menotropins plus an hCG trigger and usually settles within 2 to 3 weeks without treatment.² Thrombophlebitis affected less than 1% of trial subjects.¹ Reports after marketing add nausea, vomiting, abdominal discomfort, fatigue, dizziness, pelvic pain, ovarian cysts, breast pain or swelling, acne, rash and hot flushes, plus two anaphylaxis events.¹²

Warnings on the labels:

• OHSS: fluid can leak from blood vessels into the abdomen, chest and possibly around the heart, and the condition can turn serious quickly. Early signs are severe pelvic pain, nausea, vomiting and weight gain; it peaks about 7 to 10 days after treatment, is worse if pregnancy occurs, and women are watched for at least two weeks after the hCG trigger.¹⁴ It affected 7.2% of 373 women in the pivotal IVF trial.⁴
• Enlarged ovaries: if the ovaries are abnormally enlarged on the last treatment day, hCG is withheld, and intercourse and pelvic exams are avoided because a ruptured cyst can bleed internally.¹
• Lungs and blood clots: lung problems and clots in veins or arteries, including stroke, pulmonary embolism, limb loss and rarely heart attack, have been reported, in rare cases fatally; a history of clots, severe obesity and thrombophilia raise the risk.¹²
• Ovarian torsion: reported, and linked to OHSS, pregnancy, past abdominal surgery or torsion, ovarian cysts and polycystic ovaries.¹
• Multiple pregnancy: 30 of 85 pregnancies (35.3%) in the IVF trial were multiple on ultrasound.⁴
• Pregnancy outcomes and tumors: miscarriage risk is increased with gonadotropins, ectopic pregnancy and birth defects may be more common after assisted reproduction, and ovarian tumors have been reported after multiple stimulation drugs; the label says a causal link to the drug has not been established.¹
• Who should not use it: prior allergy to menotropins, high FSH showing primary ovarian failure, pregnancy, uncontrolled thyroid, adrenal or pituitary disorders, sex hormone dependent reproductive tumors, pituitary or hypothalamic tumors, unexplained uterine bleeding, and ovarian cysts or enlargement not due to polycystic ovary syndrome.¹
• Other groups: Pregnancy Category X; passage into breast milk is unknown, and safety is not established in children or with kidney or liver impairment.¹⁴

Dosage information

Menopur is prescribed and dosed by physicians experienced in infertility treatment, with monitoring facilities and the lowest effective dose.¹ Label and trial schedules:

No dose is established outside monitored fertility treatment, and none of these schedules applies to a research-labeled vial or is guidance for any person.¹² Units and dosing terms are explained in Peptide dosage basics.

Reconstitution and storage

From Menopur's labels:

• Diluent and route: sterile 0.9% Sodium Chloride Injection (saline); the US product is for subcutaneous use only.¹⁴
• Mixing: usually 1 mL of saline; the vial is swirled gently until the powder dissolves and not shaken, because shaking causes bubbles.¹
• Several vials: one to six vials can be dissolved in turn in the same 1 mL, giving about 75 IU per mL for one vial up to 450 IU per mL for six.² The Reconstitution calculator handles other volumes.
• After mixing: used immediately, with leftover material discarded; Canada's monograph allows no storage period after mixing.¹²
• Before mixing: the US label allows the refrigerator or room temperature, 3 to 25 °C (37 to 77 °F), protected from light; Canada's monograph says 15 to 25 °C.¹⁴²
• Injection site and sharps: the Instructions for Use place the injection in the lower abdomen, about 1 to 2 inches below the navel, alternating sides day to day, and used needles go straight into an FDA-cleared sharps container.¹² Clinical background: How subcutaneous injections are given.

No stability study of research-labeled HMG vials was found. For lab steps, see How to reconstitute a peptide vial; for storage, see How to store peptides.

Regulatory status

United States

Menopur (Ferring, BLA 021663) was approved on October 29, 2004, carries marketing status "Prescription", and holds 75 IU of FSH activity and 75 IU of LH activity per vial for injection under the skin.³ Its former new drug application was deemed a biologics license on March 23, 2020.³ The label's only indication is the development of multiple follicles and pregnancy in ovulatory women during an assisted reproduction cycle, and the package is marked "Rx only".¹⁴ FDA lists the earlier brands Pergonal (approved August 22, 1975), Humegon (September 1, 1994) and Repronex (August 27, 1999) as discontinued.⁷⁸⁹

FDA says biological products are not eligible for the 503A and 503B compounding exemptions and that federal law provides no pathway for marketing biologics made outside an approved license; it named menotropins among four bulk substances affected by the 2020 transition.¹⁰²⁵

Other countries and sport

Canada's Menopur monograph, authorized March 23, 2026, lists one indication: multiple follicle development and pregnancy in an assisted reproduction program.² In the UK, Menopur is prescription only and licensed more broadly: anovulation, including polycystic ovarian disease, after clomiphene fails; controlled ovarian stimulation; and men with hypogonadotrophic hypogonadism.¹⁶ For sport, a 2008 review stated that gonadotropins are prohibited only in males.¹⁷ WADA's 2026 list bans chorionic gonadotrophin and LH in males at all times (S2.2.1), but that entry does not name menotropins, so HMG's status is not confirmed here.¹¹