Human Menopausal Gonadotropin (HMG) is a hormonally active medication containing follicle-stimulating hormone (FSH) and luteinizing hormone (LH) in a 1:1 ratio, extracted from the urine of postmenopausal women. FDA-approved for fertility treatment, HMG stimulates ovarian follicle development in women and spermatogenesis in men. While largely replaced by recombinant gonadotropins in some settings, HMG remains an effective and cost-efficient option for ovulation induction and assisted reproduction.
Mechanism of Action
HMG acts on gonadal tissue through two mechanisms: FSH stimulates growth and maturation of ovarian follicles containing eggs in women, and promotes spermatogenesis in men. LH stimulates ovulation and corpus luteum formation in women, and Leydig cells in men to produce testosterone. Highly purified HMG (HP-hMG) has enhanced FSH receptor activity with reduced inactive proteins. The LH component modifies follicular development and decreases intermediate-sized follicles, potentially resulting in safer, more controlled stimulation.
01 FDA-approved for fertility treatment
02 Stimulates ovarian follicle development
03 Contains both FSH and LH naturally
04 Promotes spermatogenesis in men
05 Cost-effective alternative to recombinant FSH
06 LH activity may improve fertilization rates
07 Long clinical track record
08 Lower OHSS incidence with HP-hMG
Molecular Data
Type
Gonadotropin mixture
Peak 0.0 mcg
Trough 0.0 mcg
SS Peak 0.0 mcg
SS Trough 0.0 mcg
Research Indications
Female Fertility (FDA-Approved)
Stimulates follicular development in anovulatory women.
Used in IVF protocols to stimulate multiple follicle development.
Effective for inducing ovulation in polycystic ovary syndrome patients.
Male Fertility
FSH promotes sperm production; LH stimulates testosterone for sperm development.
Treats male infertility due to insufficient gonadotropin production.
Testosterone Support
LH component stimulates testicular testosterone production.
Dosing Protocols
HMG is administered via intramuscular or subcutaneous injection. Treatment typically starts on day 2-3 of the menstrual cycle and continues for 7-12 days with monitoring. Dosing is individualized based on follicular response monitored by ultrasound and estradiol levels.
Goal Dose Frequency Route Ovulation induction 75-150 IU Daily IM or SubQ IVF stimulation 150-300 IU Daily for 7-12 days IM or SubQ Male fertility 75-150 IU 2-3x weekly IM or SubQ
Reconstitution Instructions
Materials Needed:
Lyophilized powder vial Sterile diluent (provided) Syringes Alcohol swabs
1 Add provided diluent to powder vial 2 Gently swirl until dissolved 3 Draw prescribed dose into syringe 4 Inject intramuscularly or subcutaneously 5 Use immediately after reconstitution
Interactions
++
hCG
hCG is typically used to trigger ovulation after HMG-induced follicular development.
synergistic
%
GnRH agonists
Often used in combination protocols for IVF to prevent premature LH surge.
requires timing
%
Clomiphene
May be used in sequential protocols for ovulation induction.
requires timing
+
Gonadorelin
Different mechanisms; may be used in different fertility protocols.
compatible
What to Expect
Days 1-3
Follicular recruitment begins
Days 4-7
Follicular growth continues; monitoring required
Days 8-12
Follicles reach mature size; trigger ovulation
Post-trigger
Ovulation occurs ~36 hours after hCG trigger
Side Effects & Safety
Common Side Effects
Injection site reactions Abdominal discomfort Ovarian enlargement Mood changes Headache
Stop Signs - Discontinue if:
Severe abdominal pain or bloating Rapid weight gain Difficulty breathing Nausea and vomiting Decreased urination
Contraindications
Primary ovarian failure Uncontrolled thyroid or adrenal dysfunction Sex hormone-dependent tumors Abnormal uterine bleeding of unknown cause Ovarian cysts (not due to PCOS) Pregnancy
Quality Checklist
Good Signs
White lyophilized powder Pharmaceutical grade product Proper cold chain maintained Clear solution after reconstitution
Warning Signs
Research-grade products lack quality assurance
Bad Signs
Discolored powder or solution Particulates visible Exposed to temperature extremes
Frequently Asked Questions
Is HMG derived from human urine really safe?
Yes. HMG is extracted from postmenopausal women's urine and has been used clinically for decades with excellent safety data. Modern purification processes make it equivalent to recombinant versions in terms of safety and efficacy.
Does HMG cause fewer side effects than recombinant gonadotropins?
HMG's LH component may actually reduce OHSS risk and improve fertilization rates compared to FSH-only protocols. The 1:1 ratio of FSH and LH more closely mimics natural physiology, potentially resulting in safer, more physiologic stimulation.
How much does HMG cost compared to recombinant FSH?
HMG is typically 40-60% less expensive than recombinant FSH or LH products. Generic HMG products are cost-effective alternatives without sacrificing efficacy, making it attractive for patients with multiple IVF cycles ahead.
Can men use HMG for infertility?
Yes. HMG is effective for male hypogonadotropic hypogonadism, with the FSH component promoting spermatogenesis and LH stimulating testosterone production. Treatment typically requires months but can restore both sperm production and natural testosterone levels.
References
Human Menopausal Gonadotropin
ScienceDirect (2024)
HMG contains FSH and LH in 1:1 ratio extracted from postmenopausal urine.
HMG vs Recombinant FSH in PCOS Patients Undergoing IVF
PMC/NCBI (2013)
No significant differences in pregnancy rates between FSH alone, rFSH+HMG, and rFSH+rLH groups.
Effect of HMG and HP-FSH on IVF Outcomes
Human Reproduction (1996)
Beneficial effects of HMG on fertilization rates and pre-embryo development compared to HP-FSH.
Generic hMG vs Costly FSH for Ovulation Induction
PubMed (2001)
Generic hMG products do not adversely affect pregnancy rates and are appropriate cost-effective alternatives.
Disclaimer
This information is for educational and research purposes only. Consult a healthcare professional before use.