Rooted in pre-assisted reproductive technology times menotropins are still used today: a narrative review of literature

Abstract

Human menopausal gonadotropins (hMGs) had been developed long before the advent of assisted reproductive technology (ART) for the induction of ovulation in women suffering from hypogonadotropic hypogonadism. The advent of ART offered a new application for hMGs, for inducing multiple follicular ovarian stimulation (OS) in generally normally ovulating women. The advent of follicle-stimulating hormone (FSH) preparations obtained by genetic recombination techniques in the early 1990s, recombinant FSH, was originally seen as an imminent death knell for hMG preparations obtained from menopausal urine. Yet, 25 years later, hMG preparations—now in a highly purified form—are still part of our treatment options for OS in ART.

Over the years, meta-analyses have generally shown a similar or slight advantage in terms of ART outcomes (implantation, ongoing pregnancy, and live birth rates) for hMG preparations, albeit small in magnitude. Yet, recently, mounting evidence has indicated that certain women whose endogenous luteinizing hormone (LH) levels are low, who are older, and/or who are prone to hyper-respond to OS are likely to benefit from receiving hMGs for OS. Today, hMG preparations gain their LH bioactivity from human chorionic gonadotropin obtained from a pituitary or chorionic source, with higher numbers of matured metaphase-II oocytes obtained in the latter case.