HMG

Human Menopausal Gonadotropin (hMG) is a purified mixture of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) extracted from the urine of postmenopausal women. It's primarily used in assisted reproductive technology (ART) to stimulate ovarian follicle development. [1][2]

hMG contains both FSH and LH activity, which work synergistically to promote folliculogenesis and steroidogenesis in the ovaries. The FSH component stimulates follicle growth, while the LH component supports androgen production necessary for estrogen synthesis. This dual action makes hMG particularly valuable in controlled ovarian stimulation protocols. [3]

The medication is administered via subcutaneous or intramuscular injection and requires careful monitoring through ultrasound and hormone level assessment. Modern formulations have improved purity compared to earlier preparations, reducing adverse reactions while maintaining therapeutic efficacy. [4]

Fertility Enhancement

• Stimulates multiple follicle development for IVF/ART procedures [1]
• Provides both FSH and LH activity in a single medication [2]
• Particularly beneficial for patients with LH deficiency [3]
• Supports folliculogenesis and oocyte maturation [4]

Clinical Applications

• FDA-approved for ovulation induction [1]
• Used in controlled ovarian hyperstimulation [5]
• Treatment for anovulation in women [6]
• Male infertility treatment (less common) [7]

Therapeutic Advantages

• Natural source of gonadotropins with LH activity [2]
• May improve pregnancy rates in certain patient populations [3]
• Suitable for hypogonadotropic hypogonadism [8]
• Effective alternative when recombinant FSH alone is insufficient [4]

Common Side Effects:

• Injection site reactions
• Abdominal bloating and discomfort
• Headache
• Nausea
• Breast tenderness
• Mood swings [1][2]

Serious Risks:

• Ovarian hyperstimulation syndrome (OHSS) - potentially life-threatening [3]
• Multiple pregnancy (twins, triplets, or higher-order multiples) [4]
• Ectopic pregnancy
• Ovarian torsion
• Thromboembolic events
• Ovarian enlargement and cysts [5]

Contraindications:

• Primary ovarian failure
• Uncontrolled thyroid or adrenal dysfunction
• Hormone-dependent tumors
• Abnormal uterine bleeding of unknown origin
• Ovarian cysts or enlargement
• Pregnancy [6]

Monitoring Requirements:

• Regular ultrasound monitoring of follicle development
• Serum estradiol level monitoring
• Risk assessment for OHSS
• Careful dose titration based on response [7]

Important Warnings:

• Increased risk of arterial thromboembolism
• Potential for severe OHSS requiring hospitalization
• Multiple pregnancy carries higher maternal and fetal risks
• Should only be used under specialist supervision [3][5]