hMG (menotropin, Menopur): fertility medicine and side effects
In short
hMG, or menotropin, is a mixture of the hormones FSH and LH purified from the urine of postmenopausal women, authorised in Finland for fertility treatment [1]regulator [3]official. According to a Cochrane review, in IVF it probably led to a live birth slightly more often than recombinant FSH [10]A, and in Finland it is a doping substance under the Criminal Code [6]regulator.
- In Finland, the hMG product Menopur (Ferring) is in EMA's Article 57 data, and menotropin is on Fimea's medicines list [1, 2]regulator.
- The best evidence is from fertility treatment: in a Cochrane review of 59 trials, hMG probably gave more live births and less OHSS than recombinant FSH, on moderate-certainty evidence [10]A.
- In men, hMG is used with hCG to start sperm production when the pituitary hormones are missing [3]official. The data are pooled treatment results and comparative studies, not placebo-controlled trials [16, 18]B.
- In Finland, menotropin is a doping substance under Government Decree 705/2002 [6]regulator. SUEK classifies it under WADA section S2.2.1, which prohibits the substances for male athletes [9]regulator.
What is hMG?
hMG (human menopausal gonadotropin, menotropin) is a medicine with the activity of the pituitary hormones FSH and LH. It is purified from the urine of postmenopausal women [3, 4]official. FSH and LH are glycoproteins, that is, proteins with a sugar part [4]official.
According to the UK summary of product characteristics, Menopur (menotropin) contains FSH, LH and hCG so that FSH and LH activity are equal. The LH activity comes mainly from hCG, and hCG obtained from the urine of pregnant women may be added to reach it [3]official. The product's potency is measured with biological assays [4]official.
In EMA's Article 57 data (as of 9 Oct 2026), menotropin products were listed in 30 countries, and for Finland Menopur (Ferring Lääkkeet Oy) was listed for injection into a muscle and under the skin. There was no EU-wide central marketing authorisation [1]regulator. Menotropin is on annex 1 of Fimea's medicines list [2]regulator. Basics: What are peptides?. All substances: Peptides A-Z.
Evidence at a glance
Each cell gives the kind of study and its source. The letter is the evidence level, not the result.
| Claimed effect | Humans | Animals | Cells |
|---|---|---|---|
| Growing follicles for IVF | Approved use [3, 4]official; Cochrane, 59 trials: probably more live births than recombinant FSH [10]A | - | - |
| Risk of ovarian hyperstimulation syndrome (OHSS) | Cochrane: probably lower than with recombinant FSH [10]A; in high responders 9.7% vs 21.4% [12]A | - | - |
| Inducing ovulation in PCOS | Cochrane: uncertain whether hMG and urinary FSH differ, very low-certainty evidence [15]A | - | - |
| Sperm production in men with a pituitary hormone deficiency | Approved use with hCG in the UK [3]official; meta-analysis: sperm in about 75%, no difference between FSH products [16]B | - | - |
| Safety | OHSS in 7.2% in a US IVF trial [4]official; the most common harms each under 5% [3]official | - | - |
"-" = no such study is known.
What is hMG used for?
hMG is used to treat infertility. The indications in the UK summary of product characteristics are:
- Absent ovulation, including polycystic ovary syndrome (PCOS), when clomiphene treatment has not worked [3]official.
- Controlled ovarian stimulation to grow several follicles for IVF, ICSI and other assisted reproduction [3]official.
- Pituitary-related hypogonadism in men: hMG together with hCG to start sperm production. In primary testicular failure the treatment usually does not work [3]official.
In the United States, Menopur (menotropin) is approved only for women as part of IVF [4]official. Treatment is started by a doctor experienced in treating infertility [3]official.
How does hMG work?
hMG acts directly on the ovaries and testes, and it increases both the development of sex cells and the production of sex hormones [3]official.
- In the ovaries FSH increases the number of growing follicles, and the LH part helps the follicles produce oestradiol [3]official. hMG grows the follicles, but hCG is needed separately to trigger ovulation [4]official.
- In the testes FSH matures the Sertoli cells and sperm production. This requires a high level of male hormone in the testis, which is achieved with prior hCG treatment [3]official.
- Difference from pure FSH: in a randomised trial of 731 women, blood androgen and oestradiol levels were higher and progesterone lower with hMG than with recombinant FSH [14]A.
Has hMG been studied in humans?
Yes. In fertility treatment there are large randomised trials and Cochrane reviews [10, 11, 12, 13, 15]A. For men, the data are pooled treatment results and comparative studies, not placebo-controlled trials [16, 18]B.
Fertility treatment in women
- Cochrane 2026: recombinant FSH or hMG. 59 trials, 18,119 women. With recombinant FSH there were probably fewer live births than with hMG (15 trials, 4,793 women) and probably more OHSS (37 trials, 9,813 women). The certainty of the evidence was moderate. According to the authors, many trials were sponsored by the pharmaceutical industry [10]A.
- Cochrane 2025: network meta-analysis. In women whose ovaries respond strongly, hMG may have reduced OHSS compared with recombinant FSH, but on the basis of one trial, with low certainty. In other groups, differences between protocols could not be shown with confidence [11]A.
- MEGASET 2012. 749 women at 25 clinics in seven countries. The ongoing pregnancy rate after a fresh transfer was 29-30% with hMG and 27% with recombinant FSH, and hMG was found to be at least as effective [13]A.
- MEGASET-HR 2020. 620 women whose ovaries produce many eggs. Ongoing pregnancies were 35.5% and 30.7%, OHSS 9.7% with hMG and 21.4% with FSH, and the cumulative live birth rate was nearly the same (50.6% and 51.5%). Some of the authors were employees of the manufacturer [12]A.
- Cochrane 2025: PCOS and inducing ovulation. Three small trials compared hMG with urinary FSH. It is uncertain whether either has an advantage, and the certainty of the evidence was very low [15]A.
Men
- Meta-analysis 2014. 44 studies of gonadotropin treatment in men without sperm because of pituitary-related deficiency. Sperm production was achieved in about 75%. There was no difference between FSH products, and the combination of hCG and FSH succeeded more often. Results were poorer if the deficiency had begun before puberty [16]B.
- Chinese comparison 2019 (Peking Union Medical College Hospital). 220 men received either GnRH pump treatment under the skin or hCG and hMG injections. In the pump group sperm appeared more often and sooner, on average in about 6 months, compared with about 11 months in the hCG and hMG group. The group sizes in the abstract are inconsistent, and randomisation is not described [18]B.
Who researches hMG?
hMG is studied mainly by fertility researchers. Researchers from Amsterdam University Medical Centre (Amsterdam UMC) are among the authors of the Cochrane reviews comparing hMG and FSH [10, 15]A. The large MEGASET trials were run in several countries, and the authors of MEGASET-HR included employees of the manufacturer Ferring [12, 13]A. The meta-analysis of treatment in men is by a group in Florence [16]B.
Who wrote this page: the editorial team
This page was written by the Molecular Recovery editorial team. The draft was made with the help of AI, and the claims were checked against the sources (AI policy). The page has not been medically reviewed. How we work: About us.
How long does hMG stay in the body?
According to the product texts, the half-life of the FSH in hMG ranges from about half a day to just over a day. According to the UK summary of product characteristics, the half-life of FSH with repeated dosing was about 30 hours under the skin and about 27 hours into a muscle, and peak levels were reached within 7 hours [3]official. The US text gives a half-life of 11-13 hours [4]official.
Levels vary a lot from person to person. Menotropin is excreted mainly through the kidneys, and its handling in kidney or liver impairment has not been studied [3]official.
What are the side effects of hMG?
The main harm of hMG is ovarian hyperstimulation syndrome (OHSS), which in its severe form can be life-threatening [3]official. More: Side effects and safety.
Common side effects
According to the UK summary of product characteristics, the most frequently reported adverse reactions in clinical trials were OHSS, abdominal pain, headache, abdominal swelling and injection-site pain, and none occurred in more than 5%. The table of adverse reactions covers women [3]official.
In a US IVF trial, OHSS occurred in 7.2% of 373 women, and 35.3% of pregnancies were multiple [4]official.
Serious side effects
Severe OHSS can cause fluid to collect in the abdomen and chest and can cause blood clots [3]official. In women treated with gonadotropins, serious lung complications and blood clots, rarely fatal, and ovarian torsion have been reported [4]official. Multiple pregnancies, miscarriages and ectopic pregnancies are more common during treatment than in natural pregnancy [3]official.
The treatment is not used during pregnancy or breastfeeding. In men, testicular tumours and prostate cancer are contraindications [3]official.
Interactions and who has no data
According to the UK summary of product characteristics, menotropin interactions have not been studied in humans. Clomiphene may enhance the follicle response, and more hMG may be needed together with a GnRH agonist [3]official.
According to the summary of product characteristics, the effect of menotropin on pregnancy has not been studied in animals, and cancer risk has not been studied because treatment is short-term [3]official. There are no data on people with kidney or liver impairment [3]official.
What speaks against it and what is unknown
In the Cochrane review the advantage of hMG over recombinant FSH has moderate certainty, but the difference is small, and many of the trials were funded by the pharmaceutical industry [10]A.
Counter-evidence
- In the network meta-analysis, the advantage of hMG in preventing OHSS rested on one trial with low certainty, and 169 trials were left out of the analysis because of risk of bias or missing data [11]A.
- In MEGASET-HR, the cumulative live birth rate was nearly the same with hMG and FSH [12]A.
- For inducing ovulation in women with PCOS, it is uncertain whether hMG has an advantage over urinary FSH [15]A.
- In men, GnRH pump treatment produced sperm faster than the combination of hCG and hMG in one study [18]B.
What the evidence does not support
- "A product purified from urine is weaker": in IVF, hMG was not worse than recombinant FSH; live births were probably more frequent [10]A.
- "hMG is better for everyone": a benefit has been shown in IVF, but for inducing ovulation in PCOS the evidence is very weak [10, 15]A.
What is not known
- Whether gonadotropin treatment raises the risk of ovarian tumours. According to the summary of product characteristics, this has not been established [3]official.
- Long-term harms of treatment in men: the UK table of adverse reactions covers women [3]official.
- How hMG affects cumulative live births when frozen embryo transfers are counted. An ongoing US trial is measuring this [19]E, not peer-reviewed.
- Whether hMG is used for doping and with what consequences: we know of no published study on the subject.
hMG dosing in studies
Menopur (menotropin) is a prescription medicine in the UK and the United States [3, 4]official, so this site has no dose page or calculator for hMG. The dose is decided by the treating doctor according to the product's approved information [3]official.
According to the UK summary of product characteristics, the ovarian response varies so much that a uniform dosage cannot be given; the dose is adjusted individually according to the ovarian response, which is monitored with ultrasound and blood tests [3]official. In the studies, hMG was given as daily injections under the skin or into a muscle while the follicles were being grown [3, 4]official. Dose amounts are not given on this page.
hMG vs FSH products: what is the difference?
In studies, hMG is compared with products that contain FSH only:
- hMG vs recombinant FSH (IVF): probably more live births and less OHSS with hMG [10]A.
- hMG vs urinary FSH (PCOS): uncertain whether they differ [15]A.
- Hormonal effect: more androgens and oestradiol and less progesterone with hMG [14]A.
- hCG and hMG vs a GnRH pump in men: the pump produced sperm faster in one study [18]B.
Combinations and blends
hMG is usually used as part of a combined treatment. In fertility treatment, after the follicles have been grown, hCG is given to trigger ovulation or egg maturation [4, 5]official, and the pituitary's own activity is often regulated with a GnRH agonist or antagonist [11, 13]A.
In men, hMG is given together with hCG [3]official. In a meta-analysis, the combination of hCG and FSH produced more sperm than hCG alone [17]B.
Is hMG legal in Finland?
In Finland, hMG is both a medicine and a doping substance under the Criminal Code [2, 6]regulator.
- Medicine. Menotropin is on annex 1 of Fimea's medicines list [2]regulator. In EMA's Article 57 data, Menopur was listed for Finland (as of 9 Oct 2026) [1]regulator.
- Doping substance. Government Decree 705/2002 lists as doping substances under chapter 44 of the Criminal Code, among others, substances that increase testosterone production in the human body, such as "gonadotropiini" (gonadotropin) and "menotropiini" (menotropin) [6]regulator.
- Criminal Code. Under chapter 44, section 6 of the Criminal Code, a person who unlawfully "manufactures or attempts to manufacture a doping substance", "imports or attempts to import a doping substance" or "sells, brokers, hands over to another or otherwise distributes or attempts to distribute a doping substance" is sentenced "to a fine or to imprisonment for at most two years". Under the same section, a person "who possesses a doping substance, probably with the intention of distributing it unlawfully" is also sentenced for a doping offence (our translation of the Finnish text) [7]regulator.
- In general. On importing medicines: Peptides and the law in Finland. Other EU countries: Peptides and the law in Europe. On bringing them back from travel: Travelling with peptides.
This is not legal or medical advice. Disclaimer.
Is hMG doping?
According to SUEK's interpretation, hMG is prohibited for male athletes. Section S2.2.1 of the WADA 2026 Prohibited List prohibits testosterone-stimulating peptides in males, "including, but not limited to" chorionic gonadotrophin (CG) and luteinizing hormone (LH). Class S2 also prohibits substances with a similar chemical structure or similar biological effect, and the prohibitions apply at all times [8]regulator. Menotropin is not named on the WADA list [8]regulator.
On SUEK's Finnish list, "Menotropiini (Gonadotropiini)" appears in section S2.2.1 in italics. According to SUEK, substances in italics are not named as such on the WADA list but, in SUEK's interpretation, are covered by the listed substances. A footnote says these substances are prohibited at all times and only for male athletes [9]regulator. Menopur's LH activity comes mainly from hCG [3]official.
In the same section S2.2.1, WADA also names kisspeptin, and class S2.2 includes growth hormone and its fragments, such as AOD-9604 (section S2.2.3), and growth hormone releasing factors (section S2.2.4), such as tesamorelin, sermorelin, CJC-1295, ibutamoren (MK-677), ipamorelin, hexarelin, GHRP-2 and GHRP-6 [8]regulator. In the Finnish doping decree, the same list as menotropin includes insulin-like growth factor (IGF-1) [6]regulator; compare IGF-1 LR3.
How is the quality of an hMG product assessed?
hMG is a biological product whose FSH and LH potency is measured with biological assays and standardised against World Health Organization standards [4]official. The product's name and batch number are recorded during treatment for traceability [3]official.
A certificate of analysis (COA) does not show that a product is safe. More: How to read a COA and check a test result.
Animal and laboratory tests
According to the US label, the FSH potency of Menopur (menotropin) is measured as ovarian weight gain in female rats and its LH potency as seminal vesicle weight gain in male rats [4]official. According to the UK summary of product characteristics, non-clinical data show no special hazard for humans, but reproductive toxicity animal studies and carcinogenicity studies have not been carried out [3]official.
The future: what comes next?
hMG is still being studied in fertility treatment. A US phase 3 trial (659 women planned) is assessing the efficacy and safety of an hMG product in a placebo-controlled design, and primary results are expected around 2028 [19]E, not peer-reviewed.
A Japanese phase 3 trial compares a combination of follitropin alfa and lutropin alfa with hMG in women lacking LH and FSH. Results are expected around 2028 [20]E, not peer-reviewed. Registry entries are not peer-reviewed results.
FAQ
What does hMG contain?
FSH, LH and hCG purified from the urine of postmenopausal women. FSH and LH activity are equal, and the LH activity comes mainly from hCG [3]official.
What is hMG used for?
To treat infertility: to grow follicles in women, and together with hCG to start sperm production in men whose pituitary hormones are missing [3]official.
Is hMG better than recombinant FSH?
In IVF, probably slightly. In a Cochrane review, hMG probably gave more live births and less OHSS, on moderate-certainty evidence [10]A.
What are the side effects of hMG?
The main harm is ovarian hyperstimulation syndrome. Other common harms are abdominal pain, headache, abdominal swelling and injection-site pain [3]official.
What happens after hMG treatment is stopped?
According to the summary of product characteristics, OHSS usually appears only after hormone treatment has ended and is at its worst about 7-10 days later. This is why patients are followed for at least two weeks after the hCG injection [3]official.
Is hMG legal in Finland?
In Finland hMG is a medicine and a doping substance under the Criminal Code [2, 6]regulator. Chapter 44, section 6 of the Criminal Code makes punishable, among others, a person who unlawfully "imports or attempts to import a doping substance" (our translation) [7]regulator. This is not legal advice.
Is hMG doping?
According to SUEK's interpretation, yes, for men. SUEK classifies menotropin under WADA section S2.2.1, which prohibits testosterone-stimulating peptides for men at all times [8, 9]regulator.
What experiences are there with hMG?
User accounts of hMG have not been compiled on this site. Individual accounts are not research results.
Read the research yourself: sources
Every source opens the original publication or the regulator's page. The level shows what the source itself reports.
- European Medicines Agency. Article 57 product data (EMA/518502/2018 Rev.90, data as of 9 Oct 2026): human menopausal gonadotropin entries, 73 rows in 30 countries; Finland: Menopur (Ferring Lääkkeet Oy), intramuscular and subcutaneous use; no row for the European Union (no central authorisation). EMA regulator
- Finland. Lääkeluettelo (Fimea medicines list), 230/2025, annex 1: "Menotropiini". Finlex regulator
- Electronic medicines compendium (UK). MENOPUR 150 IU powder and solvent for solution for injection: summary of product characteristics, Ferring Pharmaceuticals Ltd (text revised 3 Jun 2026; prescription only medicine). eMC official
- U.S. National Library of Medicine, DailyMed. MENOPUR (menotropins for injection) label, Ferring Pharmaceuticals Inc. (label version of May 2026). DailyMed (NIH) official
- European Medicines Agency. Ovitrelle (choriogonadotropin alfa): EPAR product information, Annex I summary of product characteristics (last updated 23 May 2025). EMA (PDF) official
- Finland. Government Decree on doping substances referred to in chapter 44, section 16(1) of the Criminal Code, 705/2002 (consolidated): "menotropiini" and "gonadotropiini". Finlex regulator
- Finland. Criminal Code 39/1889, chapter 44, sections 6-8 (doping offence, aggravated and petty doping offence). Finlex regulator
- World Anti-Doping Agency. 2026 Prohibited List, class S2 and section S2.2.1: testosterone-stimulating peptides in males, including, but not limited to, chorionic gonadotrophin (CG) and luteinizing hormone (LH). WADA (PDF) regulator
- Finnish Center for Integrity in Sports (SUEK). Dopingaineryhmät ja -aineet 2026 (prohibited substances 2026, based on the WADA list), section S2.2.1, "Menotropiini (Gonadotropiini)" in italics, and footnote 2. SUEK regulator
- Berkhout RP, Kostova EB, van Wely M. Recombinant follicle-stimulating hormone (rFSH) versus other recombinant or urinary gonadotropins for ovarian stimulation in assisted reproductive technology cycles. Cochrane Database Syst Rev. 2026;7(7):CD005354. PMID 42445958 A
- Melo P, Eapen A, Chung Y, et al. Controlled ovarian stimulation protocols for assisted reproduction: a network meta-analysis. Cochrane Database Syst Rev. 2025;7(7):CD012586. PMID 40590303 A
- Witz CA, Daftary GS, Doody KJ, et al. Randomized, assessor-blinded trial comparing highly purified human menotropin and recombinant follicle-stimulating hormone in high responders undergoing intracytoplasmic sperm injection. Fertil Steril. 2020;114(2):321-330. PMID 32416978 A
- Devroey P, Pellicer A, Nyboe Andersen A, Arce JC. A randomized assessor-blind trial comparing highly purified hMG and recombinant FSH in a GnRH antagonist cycle with compulsory single-blastocyst transfer. Fertil Steril. 2012;97(3):561-571. PMID 22244781 A
- Smitz J, Andersen AN, Devroey P, Arce JC. Endocrine profile in serum and follicular fluid differs after ovarian stimulation with HP-hMG or recombinant FSH in IVF patients. Hum Reprod. 2007;22(3):676-687. PMID 17110397 A
- Weiss NS, Kostova EB, Mol BWJ, van Wely M. Gonadotropins for ovulation induction in women with polycystic ovary syndrome. Cochrane Database Syst Rev. 2025;4(4):CD010290. PMID 40193219 A
- Rastrelli G, Corona G, Mannucci E, Maggi M. Factors affecting spermatogenesis upon gonadotropin-replacement therapy: a meta-analytic study. Andrology. 2014;2(6):794-808. PMID 25271205 B
- Muir CA, Zhang T, Jayadev V, Conway AJ, Handelsman DJ. Efficacy of Gonadotropin Treatment for Induction of Spermatogenesis in Men With Pathologic Gonadotropin Deficiency: A Meta-Analysis. Clin Endocrinol (Oxf). 2025;102(2):167-177. PMID 39445789 B
- Lin J, Mao J, Wang X, Ma W, Hao M, Wu X. Optimal treatment for spermatogenesis in male patients with hypogonadotropic hypogonadism. Medicine (Baltimore). 2019;98(31):e16616. PMID 31374027 B
- ClinicalTrials.gov. NCT07216742: A Multicenter, Randomized, Placebo-controlled, Double-blind Study to Evaluate the Efficacy and Safety of a Human Menopausal Gonadotropin in the Development of Multiple Follicles, Pregnancy, and Cumulative Live Birth as Part of an ART Cycle (Granata Bio Corporation; phase 3, 659 participants planned, United States; recruiting, primary completion estimated Nov 2028). Registry record, read 15 Oct 2026. ClinicalTrials.gov E, not peer-reviewed
- ClinicalTrials.gov. NCT07340827: A Parallel-group Treatment, 2-arm Study to Compare the Efficacy and Safety of Follitropin Alfa and Lutropin Alfa Fixed Dose Combination Versus hMG for Inducing Follicular Development in Japanese Participants With LH and FSH Deficiency Undergoing ART (Merck Healthcare KGaA; phase 3, randomised, 266 participants planned, Japan; recruiting, primary completion estimated Jul 2028). Registry record, read 15 Oct 2026. ClinicalTrials.gov E, not peer-reviewed
Research sources checked on 15 Oct 2026. Regulatory and registry sources checked on 15 Oct 2026.
Evidence levels: A = randomised human trial or meta-analysis · B = observational human study or case series · C = animal study · D = cell or laboratory study · E = not peer-reviewed · regulator = a regulator's assessment or decision, not research evidence. The marker official means official product information (summary of product characteristics or label); it is not research evidence. For a review, the level shows what kind of research the statement rests on. No level: statements that something has not been studied, reviews' interpretations, named hypotheses and the general rules in our certificate-of-analysis guide.
Content is general information about research, not medical advice. If you have symptoms, contact a healthcare professional.