Menotropin: Difference between revisions

{{Short description|Pharmaceutical drug}}

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'''Menotropin''' (also called '''human menopausal gonadotropin''' or '''hMG''') is a [[hormone|hormonally]] active medication for the treatment of [[fertility disturbances]]. Frequently the plural is used as the medication is a mixture of [[gonadotropin]]s. Menotropins are extracted from the urine of [[postmenopause|postmenopausal]] women.<ref name=Weijer2003>{{cite journal | vauthors = van de Weijer BH, Mulders JW, Bos ES, Verhaert PD, van den Hooven HW | title = Compositional analyses of a human menopausal gonadotrophin preparation extracted from urine (menotropin). Identification of some of its major impurities | journal = Reproductive Biomedicine Online | volume = 7 | issue = 5 | pages = 547–557 | date = November 2003 | pmid = 14680547 | doi = 10.1016/S1472-6483(10)62071-8 | doi-access = free }}</ref>

==Description and usage==

Urine of postmenopausal women reflects the hypergonadotropic state of [[menopause]] -levels of [[follicle stimulating hormone]] (FSH) and [[luteinizing hormone]] (LH) are high - and contain a mixture of these gonadotropins.<ref name=mesh>{{MeshName|Menotropins}}</ref><ref>[http://medical-dictionary.thefreedictionary.com/menotropin TheFreeDictionary > Menotropin] Citing: Dorland's Medical Dictionary for Health Consumers. 2007</ref><ref name=lunenfeld/> Other [[protein]] substances may be present, including small amounts of [[human chorionic gonadotropin]] (hCG).<ref name=Weijer2003/> In 1949 Piero Donini found a relatively simple method to extract gonadotropins from urine of postmenopausal women.<ref name=lunenfeld/><ref name=serono>{{cite web| url=http://www.lifesciencesfoundation.org/printer_events-item-818.html| author=Unknown| title=Serono goes recombinant| publisher=Serono Laboratories, 2011| access-date=2013-11-24| url-status=dead| archive-url=https://web.archive.org/web/20131202225817/http://www.lifesciencesfoundation.org/printer_events-item-818.html| archive-date=2013-12-02}}</ref> Menotropins were successfully introduced into clinical use by Bruno Lunenfeld in 1961.<ref name=lunenfeld>{{cite journal | vauthors = Lunenfeld B | title = Historical perspectives in gonadotrophin therapy | journal = Human Reproduction Update | volume = 10 | issue = 6 | pages = 453–467 | year = 2004 | pmid = 15388674 | doi = 10.1093/humupd/dmh044 | doi-access = free }}</ref> While earlier menotropin medications contained FSH and LH at a 1:1 ratio, the recognition that it is FSH that is critical for follicle stimulation has led to development of newer preparations that contain a much higher FSH/LH ratio, Fertinex being an example.<ref name=lunenfeld/>

Menotropin preparations are designed for use in selected women where they stimulate the ovaries to mature follicles, thus making them more fertile. They are administered by typically daily injection, intramuscularly or subcutaneously, for about ten days under close supervision to adjust dose and duration of therapy. They can also be used in [[hypogonadism|hypogonadal]] men to stimulate sperm production.

Human urinary-derived menotropin preparations are exposed to the theoretical risk of infection from menopausal donors of urine. Nevertheless, the failure to irrefutably demonstrate infectivity following intracerebral inoculation with urine from [[transmissible spongiform encephalopathy]] (TSE)-infected hosts suggests that the risk associated with products derived from urine is merely theoretical.<ref>{{cite journal | vauthors = Reichl H, Balen A, Jansen CA | title = Prion transmission in blood and urine: what are the implications for recombinant and urinary-derived gonadotrophins? | journal = Human Reproduction | volume = 17 | issue = 10 | pages = 2501–2508 | date = October 2002 | pmid = 12351519 | doi = 10.1093/humrep/17.10.2501 | doi-access = }}</ref>

[[Recombinant DNA|Recombinant]] gonadotropins have to a large degree replaced hMG in fertility treatments. The recombinant process allows for the production of pure FSH or LH not "contaminated" by other proteins that may be present after urinary extraction. While some head-on studies seem not to suggest that "pure FSH" gives better results than hMG,<ref>{{cite journal | vauthors = Bagratee JS, Lockwood G, López Bernal A, Barlow DH, Ledger WL | title = Comparison of highly purified FSH (metrodin-high purity) with pergonal for IVF superovulation | journal = Journal of Assisted Reproduction and Genetics | volume = 15 | issue = 2 | pages = 65–69 | date = February 1998 | pmid = 9513843 | pmc = 3455420 | doi = 10.1007/BF02766827 }}</ref> others claim that recombinant FSH is more efficient and reduces costs.<ref>{{cite journal | vauthors = Daya S, Ledger W, Auray JP, Duru G, Silverberg K, Wikland M, Bouzayen R, Howles CM, Beresniak A | display-authors = 6 | title = Cost-effectiveness modelling of recombinant FSH versus urinary FSH in assisted reproduction techniques in the UK | journal = Human Reproduction | volume = 16 | issue = 12 | pages = 2563–2569 | date = December 2001 | pmid = 11726575 | doi = 10.1093/humrep/16.12.2563 | doi-access = free }}</ref> A [[Cochrane Collaboration]] analysis did not reveal major differences in clinical outcomes when comparing urinary versus recombinant FSH.<ref>{{cite journal | vauthors = van Wely M, Kwan I, Burt AL, Thomas J, Vail A, Van der Veen F, Al-Inany HG | title = Recombinant versus urinary gonadotrophin for ovarian stimulation in assisted reproductive technology cycles | journal = The Cochrane Database of Systematic Reviews | volume = 2011 | issue = 2 | pages = CD005354 | date = February 2011 | pmid = 21328276 | pmc = 7388278 | doi = 10.1002/14651858.CD005354.pub2 | veditors = Van Wely M }}</ref>

The Practice Committee of the [[American Society for Reproductive Medicine]] reported:<ref>{{cite journal | title = Gonadotropin preparations: past, present, and future perspectives | journal = Fertility and Sterility | volume = 90 | issue = 5 Suppl | pages = S13–S20 | date = November 2008 | pmid = 19007609 | doi = 10.1016/j.fertnstert.2008.08.031 | doi-access = free | author1 = Practice Committee of American Society for Reproductive Medicine, Birmingham, Alabama }}</ref> ''“Compared with earlier crude animal extracts, modern highly purified urinary and recombinant gonadotropin products have clearly superior quality, specific activity, and performance. There are no confirmed differences in safety, purity, or clinical efficacy among the various available urinary or recombinant gonadotropin products.”''

==List of hMG preparations==

A number of drug companies have and had marketed hMG preparations that include:<ref>{{cite book | vauthors = Fuller MA, Sajatovic M | title = Drug Information Handbook for Psychiatry | edition = 4 | publisher = Lexi-Comp, Inc. | year = 2003 | isbn = 978-1-59195-064-6 | page = 711}}</ref>

* Gynogen HP (Sanzyme (P) Limited)

::Highly purified urinary FSH and LH in 1:1 ratio

* Humog (Bharat Serums And Vaccines Ltd)

::highly purified urinary FSH and LH in 1:1 ratio

* Humegon ([[Organon International|Organon]])

* Menopur (Ferring Pharmaceuticals), 75 IU FSH and 75 IU LH activity

* Merional, Meriofert (IBSA Institut)

* Menogon

* Metrodin ([[Serono]])

::highly purified urinary FSH

* [[Repronex]] (Ferring Pharmaceuticals), 75 IU FSH and 75 IU LH

* Pergonal (Serono),

::Pergonal was the major hMG prior to the arrival of recombinant gonadotropins containing 75 IU FSH and 75 IU LH.

* HMG [[Massone (company)|Massone]], 75 IU FSH and 75 IU LH

== See also ==

* [[Gonadotropin preparations]]

== References ==

{{Reflist}}

{{GnRH and gonadotropins}}

{{Assisted reproductive technology}}

{{GnRH and gonadotropin receptor modulators}}

[[Category:Drugs acting on the genito-urinary system]]

[[Category:Gonadotropin-releasing hormone and gonadotropins]]

[[Category:Human female endocrine system]]