hMG (Menotropins): Uses, Off-Label Male Fertility Use and Side Effects
hMG (menotropins, Menopur): its FDA-approved fertility use in women, the off-label male-fertility use researchers describe, and label side effects.
The short version
Human menopausal gonadotropin (hMG), sold as Menopur, is an FDA-approved injection that supplies both FSH and LH activity. Its approved use is growing several ovarian follicles in women during IVF-style treatment. It has no approved use in men, but some prescribers use it off-label with hCG to support sperm production in hypogonadal men, including men coming off testosterone therapy.
- FDA-approved (Menopur) for one thing: follicle development in women during an ART/IVF cycle.
- Supplies both FSH and LH activity in a single injection, unlike hCG which acts mainly like LH.
- No approved use in men. Off-label, it is paired with hCG in men with hypogonadotropic hypogonadism.
- OHSS occurred in 7.2% of the 373 women in the label's IVF trial, and the label carries Pregnancy Category X.
Human Menopausal Gonadotropin at a glance
- What it is
- Glycoprotein hormone combination purified from human urine (FSH and LH activity)
- Main use
- FDA-approved prescription injection (Menopur) for development of multiple follicles and pregnancy in ovulatory women as part of an Assisted Reproductive Technology (ART) cycle. Not approved for any indication in men.
- Generic name
- menotropins
- Brand names
- Menopur (Ferring Pharmaceuticals); Repronex (discontinued in the US) Label
- Also called
- hMG
- Evidence
- Strong human evidence
- US status
- FDA-approved · prescription only
- Half-life
- FSH activity: 11-13 hours in the multiple-dose phase, per the label. No half-life is stated for LH activity.
- Dose
- Set by the FDA label Dosing page
Human menopausal gonadotropin (hMG), sold as Menopur and also called menotropins, is an FDA-approved fertility injection. It supplies both follicle-stimulating hormone (FSH) and luteinizing hormone (LH) activity, and is purified from the urine of postmenopausal women.
Its approved use is fertility treatment in women. This page covers that use first, then the off-label use some prescribers turn to for male fertility. Dosing: the label schedule.
US legal status - FDA-approved · prescription only
Menotropins for injection (Menopur) is FDA-approved by prescription for follicle development in women during an ART cycle. It needs a prescriber and fertility monitoring. No use is approved in men.
What is hMG approved for?
| Use | Population | What it does |
|---|---|---|
| Follicle development, ART cycle | Ovulatory women without primary ovarian failure | Stimulates growth and maturation of multiple ovarian follicles |
That is the only approved use. hMG grows and matures follicles but does not release the egg; a separate hCG dose is needed afterward to trigger ovulation. There is no approved use in men, and none for weight loss, muscle building or testosterone-therapy support at any dose.
How it works
hMG supplies FSH and LH activity in one injection. In women, FSH drives the growth of several follicles and LH helps them mature before ovulation. The label says treatment “produces ovarian follicular growth and maturation” and that hCG “must be given” afterward to induce ovulation.
So the two drugs work in sequence: hMG through the growth phase, then hCG as a single trigger. hCG acts almost entirely like LH, though its label says it “appears to have a small degree of FSH activity” as well.
hMG in men: the off-label use
FDA has not approved hMG for any use in men. The label’s trial data, dosing and safety findings all come from women in ART cycles.
Off-label, some prescribers pair hMG with hCG in men with hypogonadotropic hypogonadism, meaning low LH and FSH from the pituitary. Testosterone-replacement therapy (TRT) causes the same state in most men, because outside testosterone suppresses that signal. The idea is that hCG stands in for LH and keeps the testes making testosterone, while hMG’s FSH activity supports the Sertoli cells that sperm production depends on.
How well this works varies a lot between studies:
- A 2019 study of 220 men with hypogonadotropic hypogonadism (Lin 2019 - Lin J, Mao J, Wang X et al. Optimal treatment for spermatogenesis in male patients with hypogonadotropic hypogonadism. Medicine (Baltimore). 2019;98(31):e16616., in the references below) split them between 2 treatments; the abstract doesn’t say the split was randomised. Sperm production appeared in 26 men on combined hCG/hMG against 62 on a GnRH pump, given as 25% against 53%, though the paper’s group sizes don’t match those percentages. Sperm first appeared after an average of 10.9 months on hCG/hMG against 6.2 months on the pump, so hCG/hMG was slower and less successful here.
- A 2024 review of fertility in hypogonadal men on TRT (Fink 2024 - Fink J, Ide H, Horie S. Management of Male Fertility in Hypogonadal Patients on Testosterone Replacement Therapy. Medicina (Kaunas). 2024;60(2)., in the references below) describes other groups on combined gonadotropins. Most men recovered sperm production, and a substantial share of couples achieved pregnancy.
The gap mostly reflects differences in the men studied: inborn versus acquired hypogonadism, undescended testes in the past, and starting testicular size. Neither study enrolled men made hypogonadal by testosterone therapy who then stopped it. For that exact situation, treat any specific timeline or success rate as unverified until a study tests it.
hMG side effects
This section is based on the current FDA label for Menopur, from DailyMed. The common-reaction figures come from 2 trials in 434 women having IVF or ICSI. The OHSS and multiple-pregnancy figures come from the label’s IVF trial of 373 women. There are no label side-effect data for men, because no trial enrolled them.
- Most common (2% or more of 434 women in 2 trials): abdominal pain (6.7%), headache (6.2%), OHSS (6.2%), injection-site pain or reaction (3.9%), abdominal cramps (3.0%), abdominal enlargement (2.3%) and injection-site inflammation (2.3%).
- Ovarian hyperstimulation syndrome (OHSS): 7.2% of the 373 treated women. The label describes a dramatic, sometimes rapid rise in blood-vessel leakiness, with fluid collecting in the abdomen, chest or, rarely, around the heart. Early signs are severe pelvic pain, nausea, vomiting and weight gain.
- Lung and blood-clot events: serious lung conditions and clots, including venous thrombophlebitis, pulmonary embolism, stroke and arterial occlusion, have been reported, with or without OHSS. They are rarely fatal. Risk is higher with a personal or family history of thrombosis, obesity or thrombophilia.
- Ovarian torsion, ectopic pregnancy and miscarriage: ovarian torsion has been reported after treatment. Ectopic pregnancy may be more common because infertile women having ART often have tubal problems. Miscarriage risk is higher with gonadotropins, though the label says cause is not established and it may reflect the underlying infertility.
- Multiple pregnancy: in the 373-woman IVF trial, 35.3% of the 85 pregnancies were multiple on ultrasound.
For redness, itching or swelling at the injection site, see injection-site reactions.
Dosing detail from the same label: hMG dosage.
Is hMG legal?
Yes, by prescription. Menopur is FDA-approved for follicle development in women during an ART cycle, and it needs a prescriber, a diagnosis and ongoing fertility monitoring. It has no approved use in men.
A licensed prescriber can legally choose to use it off-label for male fertility in an individual patient. This page doesn’t recommend that or give a protocol beyond what the cited sources describe.
Related
- hMG dosage: the approved label schedule
- hCG: the FDA-approved trigger-dose drug and hCG dosage
- Peptides and TRT: what has (and has not) been studied
- Gonadorelin
- Are peptides safe?
Regulatory changes for this compound and others, as they happen: US peptide regulation tracker.
How Human Menopausal Gonadotropin compares
Reproductive hormones. Doses for unapproved compounds are common practice, not trial-established. All hormones and sexual health peptides →
| Compound | Main use | Evidence | Usual dose | US status |
|---|---|---|---|---|
| Kisspeptin | Studied in hospital-based human research as a reproductive-hormone signal - it stimulates LH and FSH release upstream of GnRH - and, in a small number of academic trials, for its effect on sexual and romantic brain processing. Sold to consumers for sexual desire and fertility use, a use no regulator has evaluated as safe or effective. | Limited human data | 50-200 mcg, once or twice daily, 50-200 mcg per injection | Research use only |
| Gonadorelin | FDA approved decades ago as a diagnostic test of pituitary function (Factrel) and as a pulsatile treatment for hypothalamic amenorrhea (Lutrepulse). Both approved products are discontinued. Today it is mainly sold through compounding pharmacies and research-peptide sellers to men on testosterone therapy, paired with TRT to keep the pituitary-testicular signal running - a use no trial has tested. | Moderate human evidence | 50-100 mcg, 2-3 times weekly, subcutaneous, spaced through the week (e.g. Monday/Thursday or Monday/Wednesday/Friday), alongside testosterone therapy | Unapproved drug |
| Human Chorionic Gonadotropin | FDA-approved prescription injection for prepubertal cryptorchidism, selected cases of male hypogonadotropic hypogonadism, and induction of ovulation in anovulatory, infertile women pretreated with menotropins. | Strong human evidence | FDA label | FDA-approved · prescription only |
| Human Menopausal Gonadotropin | FDA-approved prescription injection (Menopur) for development of multiple follicles and pregnancy in ovulatory women as part of an Assisted Reproductive Technology (ART) cycle. Not approved for any indication in men. | Strong human evidence | FDA label | FDA-approved · prescription only |
| Oxytocin | An approved injectable medicine in obstetrics. Sold online as a nasal spray for libido, connection and anxiety. | Moderate human evidence | FDA label | FDA-approved · prescription only |
Where to get Human Menopausal Gonadotropin legally
Human Menopausal Gonadotropin is an FDA-approved prescription medicine, so the legal route is a licensed prescriber, in person or by telehealth, and a licensed pharmacy.
How telehealth prescribing works, what it costs and what to check: telehealth peptide prescribing.
Common questions
What is hMG?
Human menopausal gonadotropin (hMG), also called menotropins and sold as Menopur, is a hormone mix purified from the urine of postmenopausal women. One injection supplies both follicle-stimulating hormone (FSH) and luteinizing hormone (LH) activity. FDA has approved it by prescription for follicle development in women having Assisted Reproductive Technology (ART).
What is the usual hMG dose?
For its approved use, the label starts at 225 International Units a day injected under the skin. After 5 days it can be adjusted by no more than 150 IU at a time, up to 450 IU a day, for no more than 20 days, managed by a fertility specialist with ultrasound and estradiol monitoring. There is no FDA-approved dose for men. Full detail: [hMG dosage](/hmg-dosage/).
What are the side effects of hMG?
On the current FDA label, ovarian hyperstimulation syndrome (OHSS) occurred in 7.2% of 373 women in the IVF trial. Across 2 trials of 434 women, abdominal pain, headache and injection-site reactions each affected several percent. The label also warns of blood clots and lung events, ovarian torsion, and possibly higher risk of multiple pregnancy, ectopic pregnancy and miscarriage. Full detail is on the dosing page.
What is the difference between hMG and hCG?
They act on different receptors. hMG supplies FSH and LH activity and, in women, drives follicle growth in the phase before ovulation. hCG acts almost entirely like LH (its label notes a small degree of FSH activity) and is given afterward as a single trigger dose to release the egg. In IVF the two are used in sequence, not interchangeably; see the [hCG guide](/hcg/) and [hCG dosage](/hcg-dosage/).
Can men use hMG?
There is no FDA-approved use in men. Off-label, some prescribers pair it with hCG in men with hypogonadotropic hypogonadism (low LH and FSH from the pituitary or hypothalamus, the same axis that testosterone therapy suppresses) to support sperm production. Reported success rates vary widely by study and population; the guide below has the sourcing and caveats.
What is OHSS?
Ovarian hyperstimulation syndrome is a sharp rise in blood-vessel leakiness after gonadotropin treatment, with fluid collecting in the abdomen, chest or, rarely, around the heart. Early warning signs on the label are severe pelvic pain, nausea, vomiting and weight gain. It occurred in 7.2% of women in the main MENOPUR trial and is managed by a prescriber, sometimes in hospital.
How much MENOPUR is used for IVF, and how long do you take it for?
On the FDA label, MENOPUR starts at 225 IU a day injected under the skin in the first cycle. After 5 days it can be adjusted by no more than 150 IU at a time, up to 450 IU a day. Treatment lasts 7 to 20 days and should not exceed 20. A fertility specialist sets the dose using ultrasound and estradiol monitoring.
What is the brand name of menotropins?
Menotropins is sold under the brand name Menopur, made by Ferring Pharmaceuticals. Menopur is approved for development of multiple follicles and pregnancy in ovulatory women as part of an assisted reproductive technology (ART) cycle. Repronex (Ferring Pharmaceuticals) was sold in the US but has been discontinued.
What is the generic name for Menopur?
The generic name for Menopur is menotropins. Menopur is Ferring Pharmaceuticals's brand, approved for development of multiple follicles and pregnancy in ovulatory women as part of an assisted reproductive technology (ART) cycle.
What is the generic name for Repronex?
The generic name for Repronex is menotropins. Repronex is Ferring Pharmaceuticals's brand, approved for with hCG, multiple follicular development and ovulation induction in women who have previously received pituitary suppression. It has been discontinued in the US.
Is Menopur the same as menotropins?
Yes. Menopur is a brand of menotropins, made by Ferring Pharmaceuticals: the active ingredient is menotropins. It comes as a subcutaneous injection (vial of 75 IU FSH and 75 IU LH activity, reconstituted), dosed at 225 IU daily to start, adjusted by no more than 150 IU at a time, up to 450 IU daily for no more than 20 days. Compounded or research-vial menotropins is not Menopur and has not been through its FDA review.
References (5 sources)
Bibliographic detail is fetched from PubMed, not written by me - so a citation here cannot drift from the paper it names. Study design comes from PubMed's own tags rather than my judgement.
- 1.Lin J, Mao J, Wang X et al. Optimal treatment for spermatogenesis in male patients with hypogonadotropic hypogonadism. Medicine (Baltimore). 2019;98(31):e16616.Randomised trialPMID 31374027full text
- 2.Fink J, Ide H, Horie S. Management of Male Fertility in Hypogonadal Patients on Testosterone Replacement Therapy. Medicina (Kaunas). 2024;60(2).ReviewPMID 38399562full text
- 3.MENOPUR (menotropins for injection) - full prescribing information: indications, dosage and administration, contraindications, warnings including OHSS, and adverse reactions.- DailyMed, National Library of Medicinelabel
- 4.NOVAREL (chorionic gonadotropin) for injection - prescribing information, including the clinical pharmacology statement that hCG acts almost identically to LH with a small degree of FSH activity.- DailyMed, National Library of Medicinelabel
- 5.REPRONEX (menotropins for injection), BLA 021047 - marketing status Discontinued; 1999 approved label- Drugs@FDA, U.S. Food and Drug Administrationlabel