Menotropin
A gonadotropin extracted from the urine of postmenopausal women, still competitive with recombinant hormones
Menotropins carry both FSH and LH activity in one vial, purified from urine rather than made in cells. Menopur is FDA-approved for ovarian stimulation in IVF, and trials comparing it with recombinant FSH mostly find the two about equal on pregnancy and live birth.
What is it?
Menotropins are the old way of making a fertility drug, and they have not been displaced. Postmenopausal urine is rich in gonadotropins, and purifying it yields a preparation carrying both FSH and LH activity, the LH part largely from chorionic gonadotropin. Recombinant FSH carries no LH activity at all, so the comparison between the two is in effect a test of whether that extra LH activity helps.
The US label is narrower than the drug's reputation. Menopur is indicated for the development of multiple follicles and pregnancy in ovulatory women as part of an assisted reproductive technology cycle, and nothing else. The first cycle starts at 225 IU a day under the skin, is adjusted after five days by no more than 150 IU at a time, and is never given above 450 IU a day; the label tells prescribers to use the lowest effective dose with ultrasound or oestradiol monitoring, and to withhold hCG if the ovaries are abnormally enlarged.
Three large randomised, assessor-blind trials frame the evidence. In the 2006 trial in long agonist cycles, recombinant FSH retrieved more eggs (11.8 against 10.0), but a higher share of embryos were top quality with highly purified menotropins (11.3% against 9.0%), and ongoing pregnancy was 27% against 22%, enough to show non-inferiority though not superiority. In a 749-woman antagonist trial with compulsory single-blastocyst transfer, ongoing pregnancy after the fresh cycle was 30% against 27%.
The most useful result for patients came from women expected to over-respond. In MEGASET-HR, high responders undergoing ICSI had ongoing pregnancy rates of 35.5% with menotropins and 30.7% with recombinant FSH, again non-inferior, but ovarian hyperstimulation syndrome fell from 21.4% to 9.7% and cumulative early pregnancy loss from 25.5% to 14.5%. Cumulative live birth was the same (50.6% against 51.5%) even though the recombinant group had 43 more transfers.
The differences that show up are in the endocrine profile rather than the result. With recombinant FSH, oestradiol at the end of stimulation was lower and progesterone higher, even after adjusting for the number of follicles, and the endometrium looked different on ultrasound. With menotropins the follicular response is smaller, there are often fewer eggs, and pregnancy rates hold up.
Its risks are those of any ovarian stimulation. The label's warnings cover abnormal ovarian enlargement, ovarian hyperstimulation syndrome with possible lung and blood-clot complications, ovarian torsion, multiple pregnancy, ectopic pregnancy, miscarriage and congenital malformations, and it says no drug interaction studies have been done in humans.
Mechanism of Action
Menotropins supply FSH, which stimulates ovarian follicles to grow, together with LH activity, largely from chorionic gonadotropin; the label's aim is the development of multiple follicles in an IVF cycle.
FSH: more follicles
Stimulating several follicles at once is the purpose of the drug in IVF (label) and the source of its hyperstimulation and multiple-pregnancy risks.
LH activity, mostly from hCG
The urine extract carries LH activity largely as chorionic gonadotropin; recombinant FSH has none, which is the main pharmacological difference between them.
A different hormone profile
In the 2006 trial, women on recombinant FSH ended stimulation with lower oestradiol and higher progesterone than women on menotropins, even after allowing for follicle numbers.
Monitored, not fixed
Doses are adjusted to ultrasound and oestradiol, and hCG is withheld if the ovaries are abnormally enlarged (label).
Published Research
The studies behind menotropins, read from their PubMed abstracts: the three large comparisons with recombinant FSH and a comparison of two menotropin products.
MEGASET-HR: high responders undergoing ICSI
Ongoing pregnancy per cycle start was 35.5% with highly purified menotropin and 30.7% with recombinant FSH (non-inferior); OHSS was 9.7% against 21.4% and cumulative early pregnancy loss 14.5% against 25.5%, with cumulative live birth 50.6% against 51.5%.
Long agonist cycles: HP-hMG against recombinant FSH
Recombinant FSH retrieved more eggs (11.8 against 10.0), but top-quality embryos were more frequent with HP-hMG (11.3% against 9.0%); ongoing pregnancy was 27% against 22%, establishing non-inferiority but not superiority.
749 women, single-blastocyst transfer
A randomised assessor-blind trial across 25 centres compared highly purified menotropins with recombinant FSH in antagonist cycles. Ongoing pregnancy after the fresh cycle was 30% against 27%, and the cumulative live birth rate from one stimulation was 40% against 38%.
Two menotropin preparations compared
150 women aged 21 to 40 in their first or second IVF cycle were randomised to Gynogen HP or Menopur. Eggs retrieved averaged 6.3 and 6.7, meeting the non-inferiority margin, and fertilisation, implantation and clinical pregnancy were similar.
A profile of the approved product
Menopur matched recombinant FSH on pregnancy rates in IVF and ICSI despite yielding fewer eggs, and improved some measures of embryo quality in IVF. Its follicular response was less pronounced and the risk of over-stimulation lower.
Dosing Data
Menopur is injected under the skin daily during an IVF stimulation cycle, starting at 225 IU and adjusted to the ovarian response.
Educational information, not medical advice. Each dose above is tagged with its source: an approved label, a published human study, animal data, or amounts reported by users. None is a recommendation for you. An unapproved compound has no established safe or effective human dose, and products sold for “research use only” are not made or tested for people. Talk to a doctor before acting on anything on this site, including before you start, stop or change any medicine or dose. Full medical disclaimer.
Side Effects & Contraindications
Reported Side Effects
From the trials above and the Menopur prescribing information (Ferring; DailyMed set 22c8db95, version 47, effective May 31, 2018).
Contraindications & Cautions
A prescription fertility drug used under ultrasound and hormone monitoring.
Legal Status
Menotropins are approved in the US as Menopur.
Frequently Asked Questions
?What are menotropins?
Gonadotropins purified from the urine of postmenopausal women, carrying both FSH and LH activity. Menopur is the US product.
?What is Menopur approved for?
The development of multiple follicles and pregnancy in ovulatory women as part of an assisted reproductive technology cycle. That is the only indication on the current US label.
?What dose does the label give?
225 IU a day to start in a first cycle after GnRH agonist suppression, adjusted after five days by no more than 150 IU at a time, never above 450 IU a day.
?Is it better or worse than recombinant FSH?
Mostly neither on pregnancy: three large trials found menotropins non-inferior. In women likely to over-respond, it caused less ovarian hyperstimulation (9.7% against 21.4%) with the same cumulative live birth rate.
?Are different menotropin products interchangeable?
One 2025 trial compared two highly purified products, Gynogen HP and Menopur, in 150 women in their first or second IVF cycle: eggs retrieved averaged 6.3 and 6.7, within the non-inferiority margin, and fertilisation, implantation and clinical pregnancy were similar. Only Menopur is approved in the US.
?Why might it suit women likely to over-respond?
In MEGASET-HR, women predicted to respond strongly had the same cumulative live birth rate on menotropins as on recombinant FSH, with less than half the rate of ovarian hyperstimulation and fewer early pregnancy losses.
?Does the LH activity matter?
It changes the hormonal profile (higher oestradiol, lower progesterone at the end of stimulation) and, in one trial, embryo quality, but not pregnancy rates in a way the trials could separate.
?Does it interact with other drugs?
The label says no human drug interaction studies have been done.
References
- [fda-pi] Menopur (menotropins for injection) Prescribing Information, sections 1 and 2. Ferring Pharmaceuticals (DailyMed version 47, effective May 31, 2018; read September 30, 2026).
- [pubmed] Witz CA, et al. "Randomized, assessor-blinded trial comparing highly purified human menotropin and recombinant follicle-stimulating hormone in high responders undergoing intracytoplasmic sperm injection." Fertil Steril, 2020;114(2):321-330. PMID: 32416978.
- [pubmed] Andersen AN, et al. "Clinical outcome following stimulation with highly purified hMG or recombinant FSH in patients undergoing IVF: a randomized assessor-blind controlled trial." Hum Reprod, 2006;21(12):3217-27. PMID: 16873892.
- [pubmed] Devroey P, et al. "A randomized assessor-blind trial comparing highly purified hMG and recombinant FSH in a GnRH antagonist cycle with compulsory single-blastocyst transfer." Fertil Steril, 2012;97(3):561-71. PMID: 22244781.
- [pubmed] Rao KA, et al. "Clinical efficacy and safety of two highly purified human menopausal gonadotropins in women undergoing in vitro fertilization." Reprod Fertil, 2025;6(2). PMID: 40445794.
- [pubmed] Deeks ED. "Highly Purified Human Menopausal Gonadotropin (Menopur(®)): A Profile of Its Use in Infertility." Clin Drug Investig, 2018;38(11):1077-1084. PMID: 30264288.
- [pubmed] Filicori M, et al. "Luteinzing hormone activity in menotropins optimizes folliculogenesis and treatment in controlled ovarian stimulation." J Clin Endocrinol Metab, 2001;86(1):337-43. PMID: 11232021.
- [pubmed] Kirshenbaum M, et al. "Recombinant follicular stimulating hormone plus recombinant luteinizing hormone versus human menopausal gonadotropins- does the source of LH bioactivity affect ovarian stimulation outcome?." Reprod Biol Endocrinol, 2021;19(1):182. PMID: 34886872.
- [pubmed] Al-Inany H, et al. "Recombinant versus urinary gonadotrophins for triggering ovulation in assisted conception." Hum Reprod, 2005;20(8):2061-73. PMID: 16024539.
- [other] US FDA, Drugs@FDA (openFDA): MENOPUR (menotropins for injection), BLA 021663, Ferring, prescription. Read September 30, 2026.
Sources & Citations
Studies were read from their PubMed records (October 5, 2026); the label and Drugs@FDA are listed below with their read dates.
Medical Disclaimer: This content is for educational and informational purposes only. It is not medical advice, and nothing here is an instruction to obtain or use any compound. Talk to a licensed clinician about your own situation.