Gonadotropin preparations
Gonadotropin preparations are drugs that mimic the physiological effects of gonadotropins, used therapeutically mainly as fertility medication for ovarian hyperstimulation and ovulation induction. For example, the so-called menotropins consist of LH and FSH extracted from human urine from menopausal women. There are also recombinant variants.
FSH and LH preparations
hMG, FSH and LH prepared from human urine collected from postmenopausal women. First extracted in 1953. Injected intra-muscularily or subcutaneously.Generic
Brands
Common side effects of preparations containing FSH and LH are:
- Mild bloating
- Pain, swelling, or irritation injection site
- Rash at injection site or other part of body
- Stomach pain or pelvic pain
FSH preparations
Urinary preparations
Recombinant preparations
The package insert for Gonal-f states that based on physio-chemical tests and bioassays that follitropin beta and follitropin alfa are indistinguishable. Two studies showed no difference. However, a more recent study showed there may be a slight clinical difference, with the alfa form tending towards a higher pregnancy rate and the beta form tending towards a lower pregnancy rate, but with significantly higher estradiol levels.The package insert for Puregon states that structural analysis shows that the amino acid sequence of follitropin beta is identical to that of natural human follicle stimulating hormone. Further, the ogliosaccharide side chains are very similar, but not completely identical to that of natural hFSH. However, these small differences do not affect the bioactivity compared to natural hFSH.
Gonal-f was approved for medical use in the European Union in October 1995.
Puregon was approved for medical use in the European Union in February 1996.
Rekovelle was approved for medical use in the European Union in December 2016.
Biosimilars
Ovaleap was approved for medical use in the European Union in September 2013. It was approved for medical use in Australia in March 2021.Bemfola was approved for medical use in the European Union in March 2014.
Side effects of FSH preparations
Side effects of FSH preparations include:- Local irritation at the injection site
- Feeling of fullness, bloating, and tenderness in the lower abdomen due to increasing size of the ovaries.
- Mood swings
- Fatigue
FSH analogues
Merck received approval on February 15, 2010, from the European Commission for ELONVA a long lasting single injection fusion protein lacking LH activity. Only one injection is required for the first seven days, replacing the first seven daily injections of conventional FSH. Initial results demonstrates similar pregnancy rates as daily recombinant FSH injections.
LH (Luteinizing hormone) preparations
Prepared from recombinant DNA.hCG preparations
can be recovered from the urine of pregnant women or be produced from recombinant DNA. It acts similarly to LH, but the larger supply makes it less costly; it also has a longer half-life. In veterinary medicine, equine chorionic gonadotropin extracted from pregnant mare serum is used instead on a variety of mammals, sometimes eliciting an immune response in non-horse species.In Women:
Used to induce final maturation of follicle and subsequent ovulation. Also used for luteal phase support.
In men:
Used to treat select cases of Hypogonadotropic Hypogonadism in adult males. In off-label use, some urologists prescribe hCG in low doses in combination with testosterone replacement to preserve fertility.
In male children: Also used to treat prepubertal cryptorchidism not due to anatomical obstruction. Therapy is usually administered between ages 4 and 9.