Gonadotropin preparations

# Overview
Gonadotropin preparations are drugs that mimic the physiological effects of gonadotropins, used therapeutically mainly as fertility medication for ovarian hyperstimulation and reversal of anovulation. 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 (human Menopausal Gonadotrophins), FSH and LH prepared from human urine collected from postmenopausal women. First extracted in 1953.  Injected intra-muscularily (IM) or subcutaneously (SC).
Generic
Brands
- Menopur, 5 mL vials containing 75 IU FSH and 75 IU LH.
- Repronex, vials containing either 75 IU FSH and 75 IU LH, or 150 IU FSH and 150 IU LH.
The more 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
Preparations of follicle-stimulating hormone (FSH) mainly include those derived from the urine of menopausal women, as well as recombinant preparations.  The recombinant preparations are more pure and more easily administered, but they are more expensive.  The urinary preparations are equally effective and less expensive, but are not as convenient to administer as they are available in vials versus injection pens.   One study reported that users of the purified urinary FSH preparation Bravelle experienced less injection site pain compared to the recombinant preparation Follistim.

## Urinary preparations
- Bravelle, U.S., ( 2 IU LH)
- Metrodin, U.S. and Canada, ( 1 IU LH)
- Fertinorm Hp, (Canada)

## Recombinant preparations
- Follistim
- Puregon
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 is 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 (E2) 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 (hFSH).  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.

## 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 Analogs
Corifollitropin alfa
Merck received approval on February 15, 2010 from the European Commission for ELONVA (corifollitropin alfa) 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 (human Chorionic Gonadotropin) preparations
Used to induce final maturation of follicle and subsequent ovulation.  Also used for luteal phase support.  Typically a single injection of 10,000 international units is used to induce ovulation.   Recent data has shown that subcutaneous injection works as well as intramuscular injection, however this form of administration is not FDA approved.

## Urinary preparations
Derived from the urine of pregnant women.
- Pregnyl (Merck/Schering-Plough)
- Follutein
- Profasi
- Novarel

## Recombinant preparations