Menotrophin 75 IU FSH + 75 IU LH

Indications

Menotrophin 75 IU FSH + 75 IU LH is used for: Infertility, Assisted reproductive technologies, Polycystic ovarian disease, In vitro fertilisation procedures

Adult Dose

Parenteral Female infertility Adult: Dosage and schedule depends on patient's needs. Dose is given via IM/SC admin to provide 75-150 units of FSH daily. Adjust dose gradually until adequate response is achieved. Once reached, stop menotrophin admin and induce ovulation by administering chorionic gonadotrophin 1-2 days later at doses of 5,000-10,000 units. In menstruating patients, start treatment within the 1st 7 days of the menstrual cycle; may repeat cycle at least twice more if needed. Alternatively, admin 3 equal doses of menotrophin (each providing 225-375 units of FSH) on alternate days, followed by chorionic gonadotrophin 1 wk after the 1st dose. In vitro fertilisation procedures or other assisted conception techniques Adult: As monotherapy or in conjunction with clomiphene citrate or gonadorelin agonist: Dose providing 75-300 units of FSH is admin daily via IM/SC inj to stimulate follicular growth, usually started on the 2nd or 3rd of the menstrual cycle and continued until adequate response is obtained. After the final inj of menotrophin, this is followed by chorionic gonadotrophin 1-2 days later to stimulate egg maturation. Admin human chorionic gonadotrophin only if there are at least 3 follicles >17 mm in diameter with 17-?-oestradiol levels ?3500 pmol/L (920 picograms/ml). Egg retrieval may be carried out 32-36 hr after the human chorionic gonadotrophin inj. Male infertility Adult: In conjunction with chorionic gonadotrophin (1000 - 2000 IU 2-3 times wkly): Menotrophin is admin at a dose providing 75 or 150 units of FSH via IM/SC inj 2-3 times wkly, continue treatment for at least 3-4 mth.

Child Dose

Renal Dose

Administration

Contra Indications

Females: Pregnancy, enlargement of the ovaries or cysts that is not caused by polycystic ovarian syndrome, gynaecological bleeding of unknown cause and tumors in the uterus, ovaries and breasts. Males: Carcinoma of the prostate and tumors in the testes. The following conditions must be properly treated before therapy with HMG is begun: Dysfunctions of the thyroid gland and of the cortex of the suprarenal gland, a rise in the serum level of prolactin with different causes (hyperprolactinaemia), tumors in the pituitary gland (hypophysis) or in part of the diencephalon (hypothalamus).

Precautions

In females: Monitor ovarian activity and measure urinary oestrogen at regular intervals, until stimulation occurs. Discontinue menotrophin treatment and withhold human chorionic gonadotrophin if urinary oestrogen levels >540 nmol/24 hr, or if plasma 17 β-oestradiol levels >3000 pmol/l, or if there is any sharp rise in values. Refrain from sexual intercourse or use barrier contraception methods for at least 4 days and pelvic examinations to be avoided or carried out with care. Lactation: Not known whether drug is excreted in breast milk; use caution

Pregnancy-Lactation

Interactions

Increased follicular response with clomiphene citrate. Higher dose of menotrophin needed when gonadotropin-releasing hormone agonist is used for pituitary desensitisation.

Side Effects

Side effects of Menotrophin 75 IU FSH + 75 IU LH : >10% Heachache (34%), Abdominal pain (18%), Nausea (12%), OHSS (13%-dose related), Injection site pain (4-12%) 1-10% Flushing (2.4%), Dizziness (2.6%), Malaise (2.8%), Migraine (2.4%), Breast tenderness (1.8%), Hot flashes (0.6-2.6%), Menstrual irregularities (3.2%), Abdominal cramping/fullness (6%), Constipation (1.6%), Diarrhea (2.8%), Ovarian disease (3.8%), Vaginal hemorrhage (3.2%), Back pain (3.2%), Cough increased (1.6-2.6%), Respiratory disorder (3.9-5.8%), Flu-like syndrome (1.3-2.6%) <1% Ovarian enlargement & hyperstimulation Frequency Not Defined Arterial thromboembolism (rare but potentially fatal), Gynecomastia in males, Hemoperitoneum

Mode of Action

Menotrophins, a purified extract of human post-menopausal urine, contain follicle-stimulating hormone (FSH) and luteinising hormone (LH) in a ratio of 1:1. The biological effectiveness of menotrophins is mainly due to its FSH content. In the ovaries, the FSH-component increases the quantity of growing follicles and stimulates their development. Under the influence of LH, FSH increases oestradiol production in the granulosa cells. In the testes, FSH induces the maturation of Sertoli cells and the seminal canals and the development of the spermatozoa.