HMG (human menopausal gonadotropin), sold under brand names such as Menopur and known generically as menotropins, is an injectable fertility hormone that supplies both follicle-stimulating hormone (FSH) and luteinizing hormone (LH) activity in a single preparation. It is purified from the urine of postmenopausal women and is used mainly to stimulate the ovaries during in vitro fertilization (IVF) and ovulation induction, with a smaller role in treating male infertility caused by hypogonadotropic hypogonadism.[1] This guide explains what HMG is, exactly how it works, how it is dosed, how it compares to recombinant FSH and to HCG, what it costs, and the safety signals (especially ovarian hyperstimulation) that every patient and researcher should understand.
🔑 Key Takeaways
- HMG (menotropins) is a urine-derived gonadotropin that delivers both FSH and LH activity, unlike recombinant FSH, which provides FSH alone.[1]
- Its FDA-cleared use is to grow multiple follicles for assisted reproduction; the standard Menopur start is 225 IU/day subcutaneously, adjusted no more than 150 IU at a time and capped at 450 IU/day over no more than 20 days.[1][2]
- HMG cannot trigger ovulation by itself, an HCG "trigger shot" is given once follicles are mature to finish egg maturation.[1]
- In men with hypogonadotropic hypogonadism, HMG (FSH source) is combined with HCG (LH source) to restart sperm production, with appearance of sperm in roughly 80 to 86% of treated men in published series.[3][4]
- The main risk is ovarian hyperstimulation syndrome (OHSS); most cases are mild, but injectable gonadotropins carry the highest OHSS risk of any fertility drug class.[5][6]
What Is HMG (Human Menopausal Gonadotropin)?
Human menopausal gonadotropin is a biologic medicine that was first developed in the 1950s and 1960s using a surprising raw material: the urine of postmenopausal women. After menopause, the ovaries stop responding to the pituitary, so the brain pumps out very high levels of FSH and LH, which are excreted in urine. Manufacturers collect and purify this urine to produce a drug that contains both hormones. Modern "highly purified" versions, such as Menopur, remove most of the non-gonadotropin urinary proteins, and each vial is standardized to contain 75 International Units (IU) of FSH activity and 75 IU of LH activity.[1]
The generic name is menotropins, and you will see the terms HMG, hMG, menotropins, and HP-hMG (highly purified human menopausal gonadotropin) used interchangeably. In the FSH part of the molecule, HMG behaves like the FSH your own pituitary makes; the LH activity in modern preparations comes largely from HCG (human chorionic gonadotropin), which binds the same receptor as LH. This dual FSH-plus-LH profile is the single most important thing that distinguishes HMG from recombinant FSH products such as follitropin alfa.[1][4]
HMG is not the same as HCG. HCG (human chorionic gonadotropin) is a single hormone that acts on the LH receptor and is used as the ovulation "trigger" or as an LH substitute in men. HMG supplies FSH plus LH and is used to grow follicles or restart spermatogenesis. The two are often used together but do completely different jobs. For a deeper look at HCG, see our dedicated guide below.
How HMG Works: The FSH and LH Mechanism
Normal reproduction is governed by the hypothalamic-pituitary-gonadal (HPG) axis. The hypothalamus releases gonadotropin-releasing hormone (GnRH) in pulses, the pituitary responds by secreting FSH and LH, and those two hormones act on the ovaries or testes. FSH recruits and grows ovarian follicles (or supports the Sertoli cells that nurse developing sperm), while LH drives the final maturation step and steroid (estrogen and testosterone) production.
HMG bypasses the brain entirely and delivers FSH and LH directly. In women undergoing controlled ovarian stimulation, daily HMG injections push many follicles to grow at once instead of the single follicle a natural cycle would produce. Because the dose suppresses or overrides the body's own feedback loops (often alongside a GnRH agonist or antagonist that blocks a premature LH surge), the patient cannot ovulate on her own, so a separate HCG injection is given to mimic the natural LH surge and trigger final egg maturation roughly 34 to 36 hours before egg retrieval.[1] If you want the broader hormonal context, our overview of kisspeptin, the upstream master switch of the HPG axis, explains how GnRH release is regulated in the first place.
In men, the logic is reversed: HMG provides the FSH needed to support sperm production, while HCG supplies the LH-like signal that tells the Leydig cells to make testosterone. Neither hormone alone reliably restores fertility in men with hypogonadotropic hypogonadism, so they are typically given as a pair.[3][4]
FDA-Approved Uses and Off-Label Roles
The labeled indication for Menopur (menotropins) is the development of multiple follicles and pregnancy in ovulatory women as part of an assisted reproductive technology (ART) cycle, in other words, conventional IVF and ICSI.[1] Beyond that core indication, gonadotropins including HMG are widely used for:
- Ovulation induction in women who do not ovulate, including some women with polycystic ovary syndrome (PCOS) who have not conceived on oral agents. A 2025 Cochrane review found that injectable gonadotropins probably produce more live births than continued clomiphene citrate in clomiphene-resistant women.[7] See our companion guide on PCOS, fertility, and metabolic treatment for how these pieces fit together.
- Intrauterine insemination (IUI) cycles, where HMG grows one or a few follicles before insemination.
- Male hypogonadotropic hypogonadism, where HMG plus HCG is used off-label to induce or restore spermatogenesis.[3][4]
HMG Dosage and Protocol
Dosing is individualized and must be supervised by a fertility specialist with ultrasound and bloodwork monitoring. The figures below reflect the Menopur prescribing information and are for education, not self-treatment.
Women (IVF / Controlled Ovarian Stimulation)
- Starting dose: 225 IU per day, given subcutaneously into the abdomen.[1][2]
- First adjustment: not before day 5 of dosing, based on ovarian response measured by ultrasound and estradiol.[1]
- Adjustment size: no more than 150 IU at any single change, with at least 2 days between adjustments.[2]
- Maximum dose: 450 IU per day.[1][2]
- Duration: typically 7 to 20 days; treatment should not exceed 20 days.[1][2]
- Trigger: an HCG injection is given once follicles are mature; HCG is withheld if monitoring suggests excessive response and OHSS risk.[1]
Men (Hypogonadotropic Hypogonadism, Off-Label)
Protocols vary by clinic, but a common approach starts with HCG (often 1,000 to 2,500 IU two or three times weekly) to normalize testosterone, then adds HMG (commonly 75 to 150 IU two or three times weekly) to provide FSH once testosterone is restored. Because spermatogenesis is slow, therapy usually continues for 6 to 24 months. In published series, sperm appeared in the ejaculate of roughly 80 to 86% of treated men, with a mean time to first sperm of about 8 to 9 months for HMG-based regimens.[3][4] Notably, prior testosterone (androgen) therapy did not reduce the eventual response in one classic study, although multiple pituitary deficits and a history of undescended testicles (cryptorchidism) were negative predictors.[8] Men exploring fertility while on or after testosterone may also want to read about enclomiphene, an oral alternative that raises endogenous FSH and LH.
HMG vs Recombinant FSH vs HCG: What Is the Difference?
One of the most common points of confusion is how HMG relates to the other gonadotropins. The table below summarizes the practical differences.
| Feature | HMG (menotropins) | Recombinant FSH | HCG |
|---|---|---|---|
| Hormones supplied | FSH + LH activity | FSH only | LH-like activity only |
| Source | Purified urine of postmenopausal women | Lab-made (recombinant DNA) | Recombinant or urinary (pregnancy/postmenopausal) |
| Main job in women | Grow multiple follicles | Grow multiple follicles | Trigger final egg maturation / ovulation |
| Main job in men | Provide FSH for sperm production | Provide FSH for sperm production | Provide LH signal for testosterone |
| Live-birth difference (IVF) | Little to no difference vs recombinant FSH in head-to-head data[7] | Not used for follicle growth | |
| Typical relative cost | Lower (urinary product)[4] | Higher | Low per trigger dose |
The headline finding from comparative trials is reassuring: when researchers compared HMG with recombinant FSH for ovulation induction and IVF, there was little or no difference in birth rate, clinical pregnancy, or multiple pregnancy in the best available evidence, though the certainty of that evidence is low.[7] In men with congenital hypogonadotropic hypogonadism, follitropin alfa and HMG produced essentially identical sperm-appearance rates (about 86% each) and similar time to first sperm, with the urinary product offering a cost advantage.[4]
HMG Cost: What a Cycle Actually Runs
HMG is a specialty injectable, and price varies widely between specialty fertility pharmacies and standard retail chains. The breakdown below is a synthesized 2026 estimate to help with planning; ask your clinic and pharmacy for an exact quote, and check the manufacturer's HEART patient-assistance program, which can discount Menopur by 25 to 75% for qualifying patients.[9]
| Scenario | Vials needed | Per-vial range | Estimated total |
|---|---|---|---|
| Light IUI / low-dose ovulation cycle | ~7-14 (75 IU each) | $90-$130 (specialty pharmacy) | ~$630-$1,800 |
| Standard IVF stimulation | ~20-40 | $90-$130 | ~$1,800-$5,200 |
| Same IVF cycle at retail pricing | ~20-40 | $250-$300+ | $5,000-$12,000+ |
| With HEART assistance (qualifying) | Varies | From ~$72.75/vial | Reduced 25-75% |
These figures are for the HMG component only; a full IVF cycle also includes monitoring, retrieval, lab fees, and other medications. For broader context on what fertility and metabolic medications cost and how to compare pharmacy prices, our other guides on access and pricing can help you budget realistically.
Side Effects and Safety
The most common side effects of HMG are injection-site reactions (pain, redness, bruising), abdominal pain and bloating, headache, nausea, and breast tenderness. The clinically important risks are ovarian hyperstimulation syndrome and multiple pregnancy.
Ovarian Hyperstimulation Syndrome (OHSS)
OHSS happens when the ovaries over-respond to stimulation and, after the HCG trigger, leak fluid into the abdomen. In the Menopur clinical trial, OHSS occurred in about 7.2% of the 373 treated women.[1] Across IVF generally, OHSS affects roughly 3 to 6% of cycles, with severe cases in well under 1% of women undergoing stimulation.[5][6] Injectable gonadotropins like HMG carry the highest OHSS risk of any fertility drug class.[6]
Warning signs to call your clinic about. Rapid weight gain (more than about 1 kg / 2.2 lb per day, or 10 lb / 4.5 kg in 3 to 5 days), severe abdominal pain or swelling, persistent nausea and vomiting, decreased urination, shortness of breath, or calf pain and swelling can signal moderate-to-severe OHSS or a blood clot and need urgent evaluation.[5]
Multiple Pregnancy and Other Risks
Because HMG grows several follicles, twins or higher-order multiples are more likely than in a natural cycle. In the Menopur trial, 35.3% of pregnancies were multiples.[1] Other label cautions include ovarian torsion, thromboembolic events, and the standard contraindications: primary ovarian failure (high FSH), pregnancy, hormone-sensitive reproductive tumors, uncontrolled endocrine disease, and undiagnosed abnormal uterine bleeding.[1]
Who Should and Should Not Use HMG
| HMG may be appropriate for | HMG is generally not appropriate for |
|---|---|
| Women doing IVF/ICSI who need multiple follicles | Women with primary ovarian failure (high FSH) |
| Women not ovulating on oral agents (clomiphene-resistant) | Anyone currently pregnant |
| Some PCOS patients under specialist care[7] | People with hormone-sensitive reproductive tumors |
| Men with hypogonadotropic hypogonadism (with HCG)[3] | Uncontrolled thyroid or adrenal disease |
| Patients who can attend frequent monitoring | Those unable to commit to ultrasound/blood monitoring |
Frequently Asked Questions
The Bottom Line
HMG (human menopausal gonadotropin) is one of the workhorse fertility hormones: a dual FSH-plus-LH preparation that grows multiple follicles for IVF, induces ovulation when oral drugs fail, and, paired with HCG, can restart sperm production in men with hypogonadotropic hypogonadism. Its efficacy is broadly comparable to recombinant FSH at a lower price point, and its main risk, ovarian hyperstimulation, is manageable with careful monitoring. Because dosing is individualized and the safety stakes are real, HMG should only be used under the supervision of a reproductive endocrinologist or fertility specialist. To go deeper on the related hormones, compare it with gonadorelin, the GnRH analog that works one level upstream, and our HCG fertility and TRT guide.
References
- DailyMed (U.S. National Library of Medicine). MENOPUR (menotropins for injection) prescribing information: composition, indication, source.
- DailyMed. MENOPUR label, Dosage and Administration: starting dose, adjustment increments, maximum dose, treatment duration.
- Optimal treatment for spermatogenesis in male patients with hypogonadotropic hypogonadism. PMC (NIH), 2019.
- Efficacy of follitropin-alpha versus human menopausal gonadotropin for male congenital hypogonadotropic hypogonadism. PMC (NIH), 2020.
- MedlinePlus Medical Encyclopedia (NIH). Ovarian hyperstimulation syndrome.
- Cleveland Clinic. Ovarian Hyperstimulation Syndrome (OHSS): Causes & Treatment.
- Weiss NS, et al. Gonadotropins for ovulation induction in women with polycystic ovary syndrome. Cochrane Database of Systematic Reviews, 2025 (PMID 40193219).
- Male hypogonadotropic hypogonadism: factors influencing response to hCG and hMG, including prior exogenous androgens. J Clin Endocrinol Metab, 1985 (PMID 3928676).
- GoodRx. Menopur (menotropins) prices, coupons and savings; manufacturer HEART assistance program.
- Drugs.com. Menotropins Monograph for Professionals: uses, adverse effects, OHSS.