Human Menopausal Gonadotrophin (hMG)
Definition - What does Human Menopausal Gonadotrophin (hMG) mean?
Human menopausal gonadotrophin is a hormonal medication used for the treatment of fertility and ovulation disturbances. It contains gonadotropins, namely follicle stimulating hormone (FSH) and luteinizing hormone (LH). hMG can help a woman ovulate and get pregnant by causing the ovarian follicles to mature. Ovarian follicles are the fluid-filled structures in the ovary that contain and release a mature egg. hMG is derived from the urine of women who have gone through menopause. The hormone is available in the form of injections that are started by the doctor on day two or three of the menstrual period, and continued through days 7 to 14. hMG is also used in males to stimulate sperm production.
Human menopausal gonadotrophin may also be referred to by brand name Menotropin.
FertilitySmarts explains Human Menopausal Gonadotrophin (hMG)
Earlier hMG preparations used to contain equal parts of LH and FSH. But since LH can cause the immature ovarian follicles to degenerate and die (a process called atresia of follicles), new preparations like Fertinex have been introduced that contain higher amounts of FSH than LH. This is because FSH is the actual hormone to help the follicles mature. In contrast, though LH is responsible for the artificial LH burst and ovulation, it favors the selection of only the dominant follicle with the death of other immature follicles.
LH, is, however, also necessary for the process of ovulation because LH acts in conjunction with FSH to accelerate follicle maturation. LH does this by helping more and more androgens convert into estrogens, which then induce a sharp rise in LH and subsequent ovulation.
Who are the candidates for hMG?
- Women with ovulation problems such as those with PCOS, who wish to get pregnant.
- Women who have failed to respond to medications like clomiphene or letrozole for ovulation induction.
- Women undergoing assisted reproduction, such as in vitro fertilization (IVF).
- Men with infertility issues secondary to reduced gonadotropins
After receiving hMG injections for 8 to 14 days daily, the woman undergoes an ultrasound study of the ovaries to determine the maturation of one or more follicles. If one or more follicles are big enough, the woman receives a trigger shot of human chorionic gonadotropin (hCG). hCG mimics LH and signals the follicles to release eggs (i.e. induces ovulation) after approximately 36 hours. At this point, the woman can have a sperm placed inside the uterus (a procedure referred to as intrauterine insemination), or alternatively can perform an intercourse to get pregnant.
The major side effect of hMG with HCG is excessive stimulation of the ovaries, a mechanism termed as ovarian hyperstimulation syndrome (OHSS). This is where too many follicles are formed inside the ovaries, giving rise to abdominal pain, rapid weight gain, vomiting, fluid build-up in the abdomen, and shortness of breath. Hence, doctors closely monitor women receiving hMG injections.
The success rate with hMG injections alone is 15% to 25%. Some women who get pregnant on hMG can even have twins, triplets or multiples. Women can go through three to six cycles of hMG therapy. If these fail, the next option is IVF.