hMG (human menopausal gonadotropin)

HMG is an injectable medication prescribed during controlled ovarian stimulation in artificial insemination (AI) and in vitro fertilization (IVF) treatments.

Its active ingredient, hMG, is a human gonadotropin obtained from the purification of urine from women in menopause. Its acronym stands for human menopausal gonadotropin.

hMG contains two gonadotrophins: follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Its pharmacological action is equivalent to the action of FSH released by the pituitary gland.

What is hMG for?

HMG is a medicine mainly indicated for the treatment of female infertility:

• Primary or secondary amenorrhea
• Oligomenorrhea
• Anovulation (absence of ovulation)
• Stimulation of follicular development in cases of severe FSH and LH deficiency
• Stimulation of multiple follicular development in IVF.

It is also used for the treatment of male infertility caused by impaired pituitary hormone secretion or lack of response from the testicle. Possible applications include oligospermia, asthenozoospermia, oligoasthenozoospermia, azoospermia due to pituitary cause, functional hypogonadism, functional eunuchoidism, and cryptorchidism.

Presentation and price

hMG is composed of 75 IU (international units) of follicle-stimulating hormone (FSH) and 75 IU of luteinizing hormone (LH), so it is commonly referred to as HMG lepori 75. As an excipient it contains 10 mg lactose.

It also contains 1 ml of a sterile physiological solution as a solvent, so it is a lyophilized compound that must be dissolved for administration.

hMG is available in two injectable forms:

• 1 vial: one ampoule of HMG powder and one ampoule of solvent.
• 10 vials: 10 ampoules of HMG-lepori powder and 10 ampoules of solvent

Ovarian stimulation

The cost of hMG depends on the type of format required. The pack of one vial costs about 20€ and the pack of 10 vials costs about 149€.

Due to its characteristics, this medicine cannot be obtained without a prescription.

Conservation

Both ampoules should be kept in the original packaging to protect them from light and moisture. Store at a temperature above 25°C.

After mixing the medicine with the solvent, immediate use is recommended. The solution should be clear and colorless, otherwise, it is recommended to discard it. It must never be used after the expiration date indicated on the container.

Administration of HMG-lepori

Treatment should always be started under the supervision of a doctor and in accordance with the prescribed dosage. It can be administered both subcutaneously and intramuscularly by injections in the abdominal area.

The solution to be injected is not prepared, it is necessary to mix the contents of the solvent ampoule with the lyophilized contents (powder):

• Both blisters are opened.
• The needle is placed in the syringe
• The solvent liquid is aspirated into the syringe
• The solvent is poured into the powder ampoule so that they mix
• The mixture is aspirated so that the medication can be applied

Administration hMG

If a dose of two ampoules of hMG 75, i.e. 150 IU, is required, an additional step should be taken: pour the mixture into another ampoule of powder and aspirate the mixture to apply the medication. The same would be done if a larger dose is required, as the medication must be administered in a single injection.

Side effects and contraindications

This hormone medication may have the following side effects:

• Abdominal pain
• Pain and redness at the injection site
• Headache
• Pelvic pain
• Ovarian hyperstimulation syndrome (OHSS): in case of symptoms indicating a possible hyperstimulation, consult your doctor to discontinue the medication.
• Multiple pregnancies: in artificial insemination, it occurs between 12 and 30% of the cases, being more frequent in young women with more than 5 ovarian follicles larger than 16 mm and inseminated with more than 30 million spermatozoa. In IVF, in cycles where two embryos are transferred, the probability of having a twin pregnancy is 6%. In cycles where three embryos are transferred, the probability of having a twin pregnancy is 12% and of having a triple pregnancy is 3%.

Allergic reactions and thrombophlebitis are rare.

hMG is contraindicated in pregnancy and breast-feeding. Its use is also not recommended in the presence of evident thyroid or adrenal dysfunction, pituitary tumor, infertility due to non-functional causes, uterine bleeding of unknown origin, history of thromboembolic diseases, or ovarian cysts.