HMG
FDA ApprovedA urinary-derived glycoprotein hormone preparation containing both FSH and LH in approximately 1:1 ratio, FDA-approved for female infertility (ovulation induction, ART) and male hypogonadotropic hypogonadism. First used clinically in 1961 by Bruno Lunenfeld, HMG enabled the birth of the first American IVF baby in 1981 and remains a cornerstone of fertility medicine with over 60 years of clinical experience. Highly purified preparations (HP-hMG) demonstrate comparable or slightly superior live birth rates compared to recombinant FSH in IVF.
Human Menopausal Gonadotropin · Menotropins · hMG · Menopur · Pergonal · Repronex · HP-hMG
44 human studies
- Preclinical
- 15%
- Human research
- 85%
Based on 52 cited sources
Numeric assessment unreviewed
A historical numeric score is recorded but has not passed a current, compound-specific assessment review. No numeric score is displayed.
This is a limitation of the numeric assessment, not a measured absence of benefit. It does not re-review the separately recorded catalogue classification or establish efficacy or safety.
HMG provides both FSH and LH activity, the two “master hormones” required for reproduction. Its mechanisms are established through decades of clinical use and extensive human trials.
How It Works (Simplified)
HMG delivers both gonadotropins needed for reproductive function:
FSH component binds to granulosa cell receptors, activating cAMP/PKA signaling to stimulate follicle growth and aromatase expression for estrogen synthesis.
LH activity stimulates theca cells to produce androgens, which granulosa cells convert to estrogens - the “two-cell, two-gonadotropin” model.
In men, FSH supports Sertoli cells for spermatogenesis while LH activity stimulates Leydig cells to produce testosterone - restoring reproductive function.
Combined FSH/LH activity may improve oocyte and embryo quality compared to FSH alone, particularly in IVF cycles with standard insemination.
Key Research: A Cochrane Review (van Wely et al. 2011) of 42 RCTs with 9,606 couples found no significant difference in live birth rate between recombinant FSH and urinary gonadotrophins including HMG (OR 0.97, 95% CI 0.87-1.08). PMID:21328276
Important Limitations
- Primary safety concern is Ovarian Hyperstimulation Syndrome (OHSS), occurring in 3-5% of cycles
- Requires careful monitoring with estradiol levels and ultrasound
- Multiple pregnancy risk (20-30% twins in ovulation induction without IVF)
- Urinary-derived product; batch-to-batch variation possible despite purification
- Contraindicated in primary ovarian failure, hormone-dependent tumors, and pregnancy
Initial follicular recruitment phase. HMG administration typically begins cycle day 2-3. FSH component rescues cohort of antral follicles from atresia. Baseline ultrasound confirms no residual cysts.
PMID:21328276Active follicular growth phase. Dominant follicles emerge and grow 1-2mm daily. Estradiol rises progressively. Dose adjustments based on ovarian response. Monitoring with serial ultrasound and estradiol levels.
PMID:16873892Final maturation phase. Lead follicles reach 17-20mm diameter. Estradiol typically 200-300 pg/mL per mature follicle. hCG trigger administered when criteria met. Egg retrieval 34-36 hours after trigger.
PMID:22244781In hypogonadotropic hypogonadism, hCG monotherapy first normalizes testosterone (typically 3 months). HMG then added at 75-150 IU 2-3x weekly. Spermatogenesis initiation takes 3-6 months; optimal sperm counts may require 12-24 months.
PMID:3928676Research-based observations
This timeline reflects observations from published clinical and preclinical studies. Individual responses may vary significantly. This is not a guarantee of effects or a dosing schedule. Consult qualified healthcare providers for personalized guidance.
Hcg
SynergisticStandard clinical combination. HMG provides FSH/LH for follicular development while hCG triggers final oocyte maturation. Well-established protocol in fertility medicine with decades of combined use data.
Gonadorelin
SynergisticGnRH agonists used in long protocols to prevent premature LH surge during HMG stimulation. Established clinical combination for controlled ovarian hyperstimulation.
Kisspeptin
CompatibleKisspeptin acts upstream on GnRH neurons. Emerging research on kisspeptin for oocyte maturation trigger as alternative to hCG. No direct interaction concerns with HMG.
Growth-Hormone
CompatibleGH co-treatment studied as adjuvant in poor responders to gonadotropins. May improve ovarian response to HMG in certain patient populations. Limited interaction data.
Semaglutide
CautionGLP-1 agonists affect reproductive hormones. Weight loss from semaglutide may improve fertility outcomes, but direct interactions with gonadotropins not well characterized.
Testosterone
AvoidExogenous testosterone suppresses gonadotropin axis and impairs spermatogenesis. Contraindicated during HMG therapy for male infertility; must discontinue testosterone before initiating HMG.
Research Note: Interaction data is based on published literature, mechanistic understanding, and theoretical considerations. Most peptide combinations lack direct clinical study. This information is for educational purposes only and does not constitute medical advice. Always consult qualified healthcare providers.
Key Studies Cited
Use the source links in the research discussion above to inspect the referenced records.
This dossier synthesizes available evidence from peer-reviewed literature, regulatory documents, and clinical trial registries. Evidence strength labels summarize the cited material for this entry and should be read alongside its population, model, and study limitations.
For complete methodology details, see our Methodology page.
Important Disclaimer
This dossier is for educational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider before making health decisions.
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Compared With
1 comparisonConditions Studied
3 entries- HMG for Female Infertility HMG is FDA-approved for ovulation induction in anovulatory women and controlled ovarian hyperstimulation for IVF. A Cochrane meta-…
- HMG for Male Hypogonadotropic Hypogonadism FDA-approved indication. Combined hCG/HMG therapy achieves spermatogenesis in 92% of men with hypogonadotropic hypogonadism. Treat…
- HMG for IVF Outcomes Multiple RCTs and meta-analyses show HP-hMG produces comparable or superior outcomes to recombinant FSH in IVF. The MEGASET trial…