Human menopausal gonadotrophin (FSH+LH) Pregnancy: Contraindicated in women who are pregnant and in women who are breast-feeding. There are no or limited data on the use of menotrophins in pregnant women; no animal studies have been carried out to evaluate the effects during pregnancy. Indicated for use in infertility.

Menotrophin (HMG)

Brand names: Menopur, Merional

A human menopausal gonadotrophin preparation containing follicle-stimulating and luteinising hormone activity, used to stimulate follicular development in assisted reproduction and to treat anovulatory infertility.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Anovulatory infertility: recommended initial dose 75–150 IU daily, maintained for at least 7 days, then adjusted according to individual ovarian response

Route: Subcutaneous injection (for subcutaneous use only); first injection under direct medical supervision

Frequency: Once daily; therapy should start within the initial 7 days of the menstrual cycle

Max: 225 IU daily for anovulatory infertility; 450 IU daily for controlled ovarian hyperstimulation in ART (dosing beyond 20 days is not recommended in most cases)

SPC §4.2 (Menopur 1200 IU powder and solvent for solution for injection). Treatment must be initiated under the supervision of a physician experienced in the treatment of fertility problems. There are great inter-individual variations in ovarian response, so dosage must be individualised. ANOVULATORY INFERTILITY: subsequent dosing adjusted on clinical monitoring (ovarian ultrasound alone or with oestradiol measurement); adjustments should not be made more frequently than every 7 days; recommended dose increment is 37.5 IU per adjustment and should not exceed 75 IU; maximum daily dose 225 IU. If a patient fails to respond adequately after 3 weeks, abandon that cycle and recommence at a higher starting dose than in the abandoned cycle. When an optimal response is obtained, stop menotrophin and give a single injection of 5,000 IU to 10,000 IU hCG 1 day after the last menotrophin injection; coitus is recommended on the day of and the day following hCG, or intrauterine insemination may be performed. ART (controlled ovarian hyperstimulation for multiple follicular development): with GnRH agonist down-regulation, start approximately 2 weeks after the start of agonist treatment; with GnRH antagonist down-regulation, start on day 2 or 3 of the menstrual cycle; recommended initial dose 150–225 IU daily for at least the first 5 days; subsequent adjustments should not exceed 150 IU per adjustment; maximum daily dose 450 IU; when a suitable number of follicles have reached an appropriate size, give a single injection of 5,000 IU up to 10,000 IU hCG to induce final follicular maturation before oocyte retrieval; follow patients closely for at least 2 weeks after hCG. MALE INFERTILITY: spermatogenesis is stimulated with chorionic gonadotrophin (1,000–2,000 IU two to three times a week) and then menotrophin is given in a dose of 75 or 150 IU units of FSH with 75 to 150 IU units of LH two or three times weekly; treatment should be continued for at least 3 or 4 months. EXCESSIVE RESPONSE: stop treatment and withhold hCG; the patient should use a barrier method or refrain from coitus until the next menstrual bleeding starts; recommence in the next cycle at a lower dose. PAEDIATRIC and ELDERLY: no relevant use — no dose given. Reconstituted solution can be used for up to 28 days; avoid shaking; do not use if particles are present or the solution is not clear.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Women and men: tumours of the pituitary gland or hypothalamus; hypersensitivity to the active substance or to any of the excipients
Women: ovarian, uterine or mammary carcinoma
Women: pregnancy and lactation
Women: gynaecological haemorrhage of unknown aetiology
Women: ovarian cysts or enlarged ovaries not due to polycystic ovarian disease
Men: tumours in the testes; prostate carcinoma
Should not be administered where outcome is unlikely to be favourable: primary ovarian failure; malformation of sexual organs incompatible with pregnancy; fibroid tumours of the uterus incompatible with pregnancy; structural abnormalities such as tubal occlusion (unless superovulation is induced for IVF), ovarian dysgenesis, absent uterus or premature menopause

Side effects

Ovarian hyperstimulation syndrome (OHSS) — common; severe cases may involve ascites, pelvic fluid collection, pleural effusion, dyspnoea, oliguria, thromboembolic events and ovarian torsion (rare)
Common: abdominal pain, abdominal distension, nausea
Common: headache
Common: injection site reactions (most frequently injection site pain)
Common: pelvic pain (including ovarian and adnexa uteri pain)
Uncommon: ovarian cyst, breast complaints, dizziness, vomiting, diarrhoea, acne, rash, hot flush; rare hypersensitivity reactions including anaphylactic reaction

Clinical monograph

How it works

Its FSH and LH activity stimulates ovarian follicular growth, maturation and oestrogen production, mimicking endogenous gonadotrophin action.

Prescribing in practice

Use only under specialist supervision with cycle monitoring, because ovarian stimulation risks ovarian hyperstimulation syndrome and multiple pregnancy.
Tailor stimulation to the individual ovarian response using ultrasound and hormone results.
Exclude hormone-dependent tumours, uncontrolled thyroid or adrenal disorders, and other contraindications to ovulation induction before treatment.

Monitoring

Monitor follicular development with serial ultrasound and oestradiol levels to titrate dosing and reduce the risk of hyperstimulation and multiple pregnancy.

Counselling the patient

Report bloating, abdominal pain, nausea or reduced urine output, which may indicate ovarian hyperstimulation.
Be aware of the increased likelihood of multiple pregnancy with fertility treatment.
Keep to the planned schedule of injections and monitoring appointments.

Evidence & guidelines

Menotrophin is a long-established gonadotrophin used for ovulation induction and controlled ovarian stimulation, as described in assisted-reproduction practice and the SPC.

Reference: NICE CG156; Confirm identity and dosing against the manufacturer SPC (eMC) and NICE. Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Pathways