HMG

What it is

HMG is not a peptide in the research-chemical sense. It is a purified mix of gonadotropin hormones (large proteins) taken from the urine of post-menopausal women. It carries follicle-stimulating hormone (FSH) activity and luteinising hormone (LH) activity, the two signals that drive egg development in women and sperm production in men.

It is a licensed prescription medicine (Menopur is the best-known brand) used in IVF and ovulation induction, and in some men with hypogonadotropic hypogonadism (a pituitary signalling problem). It is generally used alongside or instead of HCG and FSH in clinics.

Outside of a fertility clinic, there is very little reason to use it, and plenty of reasons not to without monitoring.

History

Urinary menopausal gonadotropins were first used to induce ovulation in the early 1960s, and HMG helped lead to the first IVF programmes. Modern versions are highly purified and can be given under the skin, instead of the muscle injections used in early decades.

How it works

FSH tells follicles in the ovary to grow and mature, and in men tells the testes to support sperm production. The LH activity in HMG mostly comes from HCG that is added to or present in the preparation, and supports hormone production in the ovary or testes. Together they replace the pituitary signals that are missing or too weak.

Dosage

• Doses are in IU of FSH/LH activity. A 75 IU vial typically means 75 IU FSH activity and 75 IU LH activity.
• In IVF, women typically start at around 150-225 IU a day, adjusted by ultrasound and bloods. This is clinic-managed and can be very different person to person.
• In men with hypogonadotropic hypogonadism, protocols vary, commonly around 75-150 IU two to three times a week after HCG pre-treatment, adjusted by semen analysis and hormones.
• There is no sensible self-directed dosing for this drug. Doses are individual and guided by scans and blood tests.

How it is taken

• Subcutaneous injection into belly fat with a fine insulin-type needle is the standard route for Menopur-type products.
• Rotate the injection site. Use a fresh vial each time for products without preservative.

How to reconstitute

• For a 75 IU vial, adding 1 ml of sterile water or saline gives 75 IU/ml, or 0.75 IU per unit on a 1 ml syringe. A 37.5 IU dose is 50 units, and a full 75 IU dose is 100 units (a full syringe).
• Licensed Menopur comes with 1 ml of saline and is single-use. If your vial is a research product with bacteriostatic water, remember the benzyl alcohol is not usually used in licensed IVF cycles.
• Add the liquid slowly down the vial wall and swirl gently. Do not shake.

How it should arrive

Sealed glass vial with a white to off-white lyophilised cake. Licensed products come in a sealed box with a batch number, expiry date and a supplied solvent ampoule.

How it should look once reconstituted

Clear and colourless when dissolved. Do not use if cloudy or if it contains particles.

What to expect, and when

• In IVF cycles, stimulation usually runs about 8-12 days, with scans to track follicles.
• In men with hypogonadotropic hypogonadism, sperm production takes around 3-6 months to rebuild, and sometimes longer.
• Nothing about this works quickly or without monitoring.

Side effects

• Injection-site redness, bruising and soreness.
• Headache, nausea, abdominal bloating and pelvic discomfort in women.
• Mood changes and tiredness.
• In men: breast tenderness or enlargement, acne.

Risks

• Ovarian hyperstimulation syndrome (OHSS) is a serious risk in women, and can cause fluid build-up, severe pain and clotting problems. Multiple pregnancies are also more likely.
• It is a prescription-only medicine in the UK. Research-grade or imported vials are unlicensed, with no guarantee of quality, sterility or accurate potency.
• It is made from human urine, and licensed products are tightly purified. Unlicensed product carries a higher contamination risk.
• Not suitable in pregnancy, with ovarian, uterine, breast, pituitary or hypothalamic tumours, or with unexplained vaginal bleeding.
• There is little point in taking it unless your own pituitary signalling is the problem. In a healthy man it will simply shut down his natural production.

Potential gains

• Ovulation induction and IVF stimulation, where it is a standard, well-studied treatment.
• Restoring sperm production in men with hypogonadotropic hypogonadism, usually after HCG.
• There is no evidence for use in performance, bodybuilding or anti-ageing contexts.

Other useful information

Unlike a lot of the compounds on this site, HMG does have decades of trial data, and almost all of it is within supervised fertility care. If you are thinking about it for fertility, speak to a fertility clinic. They have the scanning and bloods that make the dose safe.