Menotron (Menotropin)

Pharmacologic Category

Gonadotropin; Ovulation Stimulator

Dosing: Adult

Ovulation induction (females): IM, SubQ: Initial: 150 units once daily for the first 5 days of treatment. Adjustments should not be made more frequently than once every 2 days and should not exceed 75-150 units per adjustment based on ultrasound monitoring of ovarian response and/or measurement of serum estradiol levels. Maximum daily dose: 450 units; treatment >12 days is not recommended. If patient’s response is appropriate, administer hCG one day following the last dose. Hold dose if serum estradiol is >2000 pg/mL, if the ovaries are abnormally enlarged, or if abdominal pain occurs; the patient should also be advised to refrain from intercourse. May repeat process if follicular development is inadequate or if pregnancy does not occur.

Assisted reproductive technologies (ART) (females):

IM, SubQ: Initial: 225 units once daily; adjustments in dose based on ultrasound monitoring of ovarian response and/or measurement of serum estradiol levels should not be made more frequently than once every 2 days and should not exceed more than 75-150 units per adjustment. Maximum daily dose: 450 units; treatment >12 days is not recommended. Once adequate follicular development is evident, hCG should be administered to induce final follicular maturation in preparation for oocyte retrieval. Withhold the hCG dose if ovarian monitoring suggests an increased risk of OHSS.

Spermatogenesis (males) (off-label use): IM: Following pretreatment with hCG: 75 units 3 times per week with hCG twice weekly until sperm is detected in the ejaculate (4-6 months); if response is inadequate after 6 months, may increase menotropins dosage to 150 units 3 times per week for another 6 months (AACE, 2002)

Dosing: Renal Impairment

There are no dosage adjustments provided in manufacturer’s labeling (has not been studied).

Dosing: Hepatic Impairment

There are no dosage adjustments provided in manufacturer’s labeling (has not been studied).

Dosage Forms



SubQ: Administer to alternating sites of the lower abdomen. May also be administered IM


In conjunction with hCG to for multiple follicular development (controlled ovarian stimulation) and ovulation induction in women who have previously received GnRH agonist or antagonist for pituitary suppression

Limitations of use: Prior to therapy, preform a complete gynecologic exam and endocrinologic evaluation to diagnose the cause of infertility; exclude the possibility of pregnancy; evaluate the fertility status of the male partner; exclude a diagnosis of primary ovarian failure.

Use: Off-Label

Stimulation of spermatogenesis

Adverse Reactions

Adverse effects may vary according to specific product, route, and/or dosage.


Central nervous system: Headache (≤34%)

Gastrointestinal: Abdominal pain (≤18%), nausea (≤12%)

Endocrine & metabolic: Ovarian hyperstimulation syndrome (≤13%; dose related)

Local: Injection site reaction (4% to 12%)

1% to 10%:

Cardiovascular: Flushing

Central nervous system: Dizziness, malaise, migraine

Endocrine & metabolic: Hot flash, menstrual disease, ovarian disease

Gastrointestinal: Abdominal cramps, constipation, diarrhea, enlargement of abdomen, gastrointestinal fullness, vomiting

Genitourinary: Breast tenderness, ectopic pregnancy, vaginal hemorrhage

Infection: Infection

Local: Pain at injection site, swelling at injection site

Neuromuscular & skeletal: Back pain

Respiratory: Cough, flu-like symptoms, respiratory tract disease

Frequency not defined:

Cardiovascular: Cerebrovascular accident, embolism, tachycardia, thrombosis (arterial or venous)

Dermatologic: Skin rash, urticaria

Endocrine & metabolic: Ovary enlargement

Hematologic & oncologic: Hemoperitoneum

Hypersensitivity: Anaphylaxis, angioedema, hypersensitivity reaction

Local: Local tissue necrosis (limb necrosis)

Respiratory: Acute respiratory distress, atelectasis, dyspnea, laryngeal edema, tachypnea

Miscellaneous: Organ infarction (lung), ovarian torsion


Hypersensitivity to menotropins or any component of the formulation; primary ovarian failure as indicated by a high follicle-stimulating hormone (FSH) level; uncontrolled nongonadal endocrinopathies (eg, thyroid, adrenal, pituitary); pituitary or hypothalamic tumors; abnormal uterine bleeding of undetermined origin; ovarian cyst or enlargement not due to polycystic ovary syndrome; pregnancy

It is also contraindicated with sex hormone-dependent tumors of the reproductive tract and accessory organs.

It is also contraindicated with infertility due to any cause other than anovulation (except candidates for in vitro fertilization).


Concerns related to adverse effects:

Hypersensitivity: Hypersensitivity and anaphylactic reactions have been reported; discontinue use for serious reactions and treat appropriately.

Ovarian enlargement: May be accompanied by abdominal distention and/or abdominal pain and generally regresses without treatment within 2-3 weeks. If ovaries are abnormally enlarged on the last day of treatment, withhold hCG to reduce the risk of ovarian hyperstimulation syndrome (OHSS). Intercourse should be avoided with significant ovarian enlargement.

Ovarian hyperstimulation syndrome: Ovarian hyperstimulation syndrome (OHSS) is a rare exaggerated response to ovulation induction therapy (Corbett 2014; Fiedler 2012). This syndrome may begin within 24 hours of treatment but may become most severe 7 to 10 days after therapy (Corbett 2014). Symptoms of mild/moderate OHSS may include abdominal distention/discomfort, diarrhea, nausea, and/or vomiting. Severe OHSS symptoms may include severe abdominal pain, anuria/oliguria, ascites, severe dyspnea, hypotension, or nausea/vomiting (intractable). Decreased creatinine clearance, hemoconcentration, hypoproteinemia, elevated liver enzymes, elevated WBC, and electrolyte imbalances may also be present (ASRM 2016; Corbett 2014; Fiedler 2012). Treatment is primarily symptomatic and includes fluid and electrolyte management, analgesics, and prevention of thromboembolic complications (ASRM 2016; SOGC-CFAS 2011). Therapy with gonadotropins should be stopped.

Ovarian neoplasms: Benign and malignant neoplasms have been reported (infrequently) in women receiving multiple-drug therapy for controlled ovarian stimulation; causal effect has not been established.

Ovarian torsion: Has been reported following gonadotropin treatment; may be related to OHSS, prior ovarian torsion, prior or current ovarian cyst, polycystic ovaries, pregnancy, or prior abdominal surgery. Early diagnosis and prompt detorsion may limit the extent of ovarian damage.

Pulmonary effects: Serious pulmonary conditions (atelectasis, acute respiratory distress syndrome, and exacerbation of asthma) have been reported.

Thromboembolism: In association with and separate from ovarian hyperstimulation syndrome (OHSS), thromboembolic events have been reported. Use caution in women with personal or family risk factors for thrombosis.

Disease-related concerns:

Hepatic impairment: Use with caution in patients with hepatic impairment; safety and efficacy have not been established.

Renal impairment: Use with caution in patients with renal impairment; safety and efficacy have not been established.

Other warnings/precautions:

Appropriate use: To minimize risks, use only at the lowest effective dose. Monitor ovarian response with serum estradiol and vaginal ultrasound on a regular basis.

Experienced physician: These medications should only be used by physicians who are thoroughly familiar with infertility problems and their management.

Multiple births: May result from the use of these medications; advise patients of the potential risk of multi-fetal gestation and multiple births before starting the treatment.

Drug Interactions

There are no known significant interactions.

Pregnancy Risk Factor


Pregnancy Implications

Ectopic pregnancy, congenital abnormalities, spontaneous abortion, and multi-fetal gestations/births have been reported. The incidence of congenital abnormality may be slightly higher after ART than with spontaneous conception; higher incidence may be related to parenteral characteristics (maternal age, genetics, sperm characteristics). Menotropins are used for the induction of ovulation and with ART; use is contraindicated in women who are already pregnant.

Breast-Feeding Considerations

It is not known if menotropins is excreted in breast milk. Due to the potential for serious adverse reactions in the nursing infant, breastfeeding is not recommended by the manufacturer.

Monitoring Parameters

Monitor sufficient follicular growth and maturation. This may be directly estimated by transvaginal sonographic visualization of the ovaries and endometrial lining. The combination of both ultrasonography and measurement of estradiol levels is useful for monitoring for the growth and development of follicles and timing hCG administration.

The clinical evaluation of estrogenic activity (changes in vaginal cytology and changes in appearance and volume of cervical mucus) provides an indirect estimate of the estrogenic effect upon the target organs and, therefore, it should only be used adjunctively with more direct estimates of follicular development (ultrasonography and serum estradiol determinations).

The clinical confirmation of ovulation is obtained by direct and indirect indices of progesterone production, as well as sonographic evidence of ovulation. The direct or indirect indices of progesterone production most generally used are: Rise in serum or urine LH, rise in basal body temperature, increase in serum progesterone, and menstruation following the shift in basal body temperature. Sonographic evidence of ovulation includes collapsed follicle, fluid in the cul-de-sac, features consistent with corpus luteum formation, and secretory endometrium.

Monitor for signs and symptoms of ovarian hyperstimulation syndrome (OHSS) for at least 2 weeks following hCG administration.

OHSS: Monitoring of hospitalized patients should include abdominal circumference, albumin, cardiorespiratory status, electrolytes, fluid balance, hematocrit, hemoglobin, serum creatinine, urine output, urine specific gravity, vital signs, weight (daily or as necessary) and liver enzymes (weekly) (SOGC-CFAS 2011).

Mechanism of Action

Menotropins is a purified combination of follicle stimulating hormone (FSH) and luteinizing hormone (LH) extracted from the urine of postmenopausal women. Treatment provides ovarian follicular growth and maturation in females who do not have primary ovarian failure. Also stimulates spermatogenesis in males (off-label use)


Half-life elimination: FSH ~54-59 hours (following a single dose)

Time to peak: FSH (following a single dose): 12 hours (SubQ), 18 hours (IM)

Excretion: Urine

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