Recombinant Gonadotropin

Aka: Recombinant Gonadotropin, Synthetic Pituitary Gonadotropin, Recombinant Follicle Stimulating Hormone, Synthetic FSH, Recombinant Luteinizing Hormone, Synthetic LH, Menotropin, Human Menopausal Gonadotropin, Urofollitropin, Pergonal, Menopur, Follitropin Alfa, Gonal-f, Follitropin Beta, Follistim AQ

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II. Indications

  1. Ovulation Induction (Female Infertility due to Anovulation)
    1. Follitropin Alfa (FSH, Gonal-f)
    2. Follitropin Beta (FSH, Follistim AQ)
  2. Spermatogenesis induction (Male Infertility)
    1. Follitropin Alfa (FSH, Gonal-f)
    2. Follitropin Beta (FSH, Follistim AQ)

III. Mechanism

  1. Gonadotropin-Releasing Hormone (GnRH)
    1. GnRH is generated within hypothalamic Neurons (infundibular nucleus, arcuate nucleus)
    2. GnRH is released typically in pulses in men and women
      1. GnRH is also released in a surge before Ovulation
    3. GnRH binds receptors on the Pituitary Gland triggering release of gonadotropins (LH and FSH)
  2. Pituitary Gonadotropins
    1. Gonadotropins are glyoproteins secreted by Basophil cells in the anterior Pituitary Gland
    2. Gonadotropins (LH, FSH) stimulate release of sex Hormones (e.g. Estrogen, Testosterone)
      1. Luteinizing Hormone (LH)
      2. Follicle Stimulating Hormone (FSH)
    3. Stimulation (releasing factors)
      1. Hypothalamic Gonadotrophic Releasing Hormone (GnRH)
    4. Inhibition (negative feedback loop to Hypothalamus and Pituitary Gland)
      1. Testosterone (Males)
      2. Estrogen
      3. Progesterone
      4. Inhibin (from corpus luteum in women, spermatogenesis in men)
  3. Follicle Stimulating Hormone (FSH)
    1. Follicle Stimulating Hormone (FSH) effects in women
      1. Stimulates ovarian follicle growth
        1. Ovarian follicle then secretes Estradiol
      2. Functions in concert with LH which stimulates ovarian follicles to ovulate and mature into a corpus luteum
        1. Corpus luteum in turn secretes Estrogen and Progesterone
    2. Follicle Stimulating Hormone (FSH) effects in men
      1. Stimulates spermatogenesis and sperm maturation within Sertoli Cells
      2. Functions in concert with LH which stimulates Leydig Cells within Testes to produce Testosterone
  4. Luteinizing Hormone (LH)
    1. Luteinizing Hormone (LH) effects in women
      1. Stimulates ovarian follicles to ovulate and mature into a corpus luteum
      2. Corpus luteum in turn secretes Estrogen and Progesterone
      3. Functions in concert with FSH which stimulates ovarian follicle growth and Estradiol secretion
    2. Luteinizing Hormone (LH) effects in men
      1. Stimulates Leydig Cells within Testes to produce Testosterone
      2. Functions in concert with FSH which stimulates spermatogenesis and maturation within Sertoli Cells
  5. Images
    1. hypothalamusPituitaryHormones.png

IV. Medications: Recombinant Gonadotropins

  1. Follitropin Alfa (FSH, Gonal-f)
    1. Available in multidose vials and prefilled multi-dose pens: 300, 450, 900, 1050 IU Follicle Stimulating Hormone (FSH)
    2. Administered as Subcutaneous Injections in lower Abdomen
  2. Follitropin Beta (FSH, Follistim AQ)
    1. Available in with cartridge for use in pen: 300, 600, 900 IU Follicle Stimulating Hormone (FSH)
    2. Administered as Subcutaneous Injections in lower Abdomen

V. Medications: Human Gonadotropin Urine Extracts

  1. Urine extracts have largely been replaced in U.S. by Recombinant Gonadotropins (see above)
  2. Menotropin (e.g. Pergonol, Menopur, Human Menopausal Gonadotropin, Pergonal)
    1. Purified urine samples of postmenopausal women that contain high concentrations of FSH and LH
    2. Used in Female Infertility as IM Injections (for 10 days), followed by HCG to stimulate Ovulation
  3. Urofollitropin (FSH, Bravelle)
    1. Discontinued in U.S.
    2. Follicle Stimulating Hormone (FSH) extracted from purified urine of postmenopausal women
      1. Was available as powder fo injection, containing 75 IU of FSH activity
    3. Luteinizing Hormone (LH) has been removed from the Menotropin sample
    4. Administered as Subcutaneous Injections in lower Abdomen

VI. Dosing

  1. See other references for specific Infertility regimens
  2. Use is typically limited to Infertility specialists

VII. Adverse Effects

  1. Multiple Pregnancy
  2. Ectopic Pregnancy
  3. Ovarian Hyperstimulation Syndrome
  4. Hypercoagulable state
  5. Ovarian Torsion
  6. Ovarian Cysts
  7. Ovarian Enlargement
  8. Ovarian Neoplasm

VIII. Safety

  1. Avoid in Lactation
  2. Contraindicated in pregnancy
    1. Associated with congenital abnormalities when used AFTER pregnancy is established
    2. No known increased risk of congenital abnormalities when used to induce Ovulation for Infertility

IX. Resources

  1. Follitropin Alfa (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ae85b9c3-e7eb-4981-a5d9-346050e8f189
  2. Follitropin Beta (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=96f11b5d-cc7b-48aa-830a-a28e1962d871
  3. Menotropin - Menopur
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=22c8db95-c3db-1770-8086-31356fbabe35

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Related Studies

Ontology: Menotropins (C0025326)

Definition (CHV) a kind of fertility medication
Definition (CHV) a kind of fertility medication
Definition (CHV) a kind of fertility medication
Definition (CHV) a kind of fertility medication
Definition (CHV) a kind of fertility medication
Definition (CHV) a kind of fertility medication
Definition (NCI) Follicle-Stimulating Hormone and Luteinizing Hormone excreted in the urine of post-menopausal women.
Definition (MSH) Extracts of urine from menopausal women that contain high concentrations of pituitary gonadotropins, FOLLICLE STIMULATING HORMONE and LUTEINIZING HORMONE. Menotropins are used to treat infertility. The FSH:LH ratio and degree of purity vary in different preparations.
Concepts Pharmacologic Substance (T121) , Hormone (T125) , Amino Acid, Peptide, or Protein (T116)
MSH D008596
SnomedCT 8203003, 55830003, 346565008
English Gonadotropins, Human Menopausal, Menotropins, Gonadotropin, menopausal, Menotrophin, menotropins, menotropins (medication), gonadotropin menotropins, Human menopausal gonadotropins, Menotropins [Chemical/Ingredient], menotropin, menotrophin, hmg, human menopausal gonadotropins, Recombinant Human Menopausal Gonadotropin, human menopausal gonadotrophin, MENOTROPINS, Human menopausal gonadotrophin, Human menopausal gonadotrophins, Human menopausal gonadotropin, Menotropin, Menotropin preparation, hMG, Human menopausal gonadotrophins (product), Human menopausal gonadotropin (substance), Menotropin preparation (product), human menopausal gonadotropin, Human menopausal gonadotrophins (substance), Menotropin preparation (substance), HMG, Human Menopausal Gonadotropins, Human Menopausal Gonadotropin, Therapeutic HMG
Swedish Menotropiner
Czech menotropiny
Finnish Menotropiinit
French hMG (Human menopausal gonadotropin), Ménotrophines, Ménotropines, Gonadotrophines humaines de la ménopause, Gonadotrophines urinaires ménopausiques, Gonadotrophines ménopausiques humaines
Russian MENOTROPINY, GONADOTROPINY MENOPAUZY ZHENSHCHINY, GONADOTROPINY KLIMAKTERICHESKOGO PERIODA ZHENSHCHINY, FSG CHELOVEKA, FOLLITROPIN CHELOVEKA, ГОНАДОТРОПИНЫ КЛИМАКТЕРИЧЕСКОГО ПЕРИОДА ЖЕНЩИНЫ, ГОНАДОТРОПИНЫ МЕНОПАУЗЫ ЖЕНЩИНЫ, МЕНОТРОПИНЫ, ФОЛЛИТРОПИН ЧЕЛОВЕКА, ФСГ ЧЕЛОВЕКА
Japanese ヒト閉経期ゴナドトロピン, メノトロピン, 閉経婦人尿性腺刺激ホルモン, ヒト閉経期尿性性腺刺激ホルモン, 性腺刺激ホルモン-ヒト閉経期尿性, ウロゴナドトロピン
Spanish menotrofina, preparado de menotrofina (producto), menotrofina (producto), preparado de menotropina, gonadotropinas menopáusicas humanas, preparado de menotrofina, gonadotrofina menopáusica humana (sustancia), gonadotrofina menopáusica humana, gonadotrofinas menopáusicas humanas (producto), gonadotrofinas menopáusicas humanas, gonadotropina menopáusica humana, menotropina, preparado de menotrofina (sustancia), Gonadotropinas Menopausicas Humanas, Menotropinas
Italian Menotropina, HMG, Gonadotropine menopausali umane, Gonadotropine umane della menopausa, Menotropine
Croatian MENOTROPINI
Polish Gonadotropina menopauzy ludzka, Menotropiny
Norwegian Humant menopausegonadotropin, Menotropin, HMG, Humant menopausalt gonadotropin, Menotropiner
Portuguese Gonadotrofinas da Menopausa Humana, Gonadotropinas da Menopausa Humana, Menotropinas
German Gonadotropine der menschlichen Menopause, Menotropine
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: follitropin beta (C0060787)

Definition (NCI) A pharmacologic form of follicle-stimulating hormone used in the treatment of infertility.
Concepts Hormone (T125) , Amino Acid, Peptide, or Protein (T116) , Pharmacologic Substance (T121)
MSH C571802
SnomedCT 109044007
English follitropin beta (medication), Follitropin beta, follitropin beta, FSH Beta Polypeptide, Follicle Stimulating Hormone Beta Polypeptide, Follitropin Beta, follitropin beta,recomb, FOLLICLE STIMULATING HORMONE BETA POLYPEPTIDE, follitropin-beta, Follitropin beta preparation (product), Follitropin beta preparation, Follitropin beta preparation (substance), FOLLITROPIN BETA
Spanish preparado con beta folitropina, preparado con beta folitropina (producto), preparado con beta folitrofina, beta folitrofina, beta folitropina, folitropina beta, beta folitrofina (producto), folitropina beta (producto), preparado de beta folitrofina (producto), preparado de beta folitrofina (sustancia), preparado de beta folitrofina, preparado de beta folitropina, preparado con beta folitrofina (producto)
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Urofollitropin (C0524639)

Definition (MSH) A protein extract of human menopausal urine in which LUTEINIZING HORMONE has been partially or completely removed. Urofollitropin represents FOLLICLE STIMULATING HORMONE from the urine.
Concepts Pharmacologic Substance (T121) , Hormone (T125) , Amino Acid, Peptide, or Protein (T116)
MSH D050477
SnomedCT 109039000, 126185008, 395920003
Russian ФОЛЛИКУЛ-СТИМУЛИРУЮЩИЙ ГОРМОН МОЧИ ЧЕЛОВЕКА, UROFOLLITROPIN, FOLLIKUL-STIMULIRUIUSHCHII GORMON MOCHI CHELOVEKA, УРОФОЛЛИТРОПИН
Italian Urofollitropina, FSH umano urinario, Ormone follicolo-stimolante (FSH) urinario umano
German Follitrin, Neo Fertinorm, Fertinorm, FSH, Humanurin, Humanes urinäres follikelstimulierendes Hormon, Urinäres humanes FSH, Follikelstimulierendes Hormon, Humanurin, Follikel-stimulierendes Hormon, human-urinäres, Humanes FSH, urinäres, Urofollitropin
Swedish Urofollitropin
Czech urofolitropin
Finnish Urofollitropiini
English urofollitropin (medication), urofollitropin, Urofollitropin [Chemical/Ingredient], urofollitrophin, Follitropin Human, Urofollitropin preparation (product), Urofollitropin preparation, Urofollitrophin, Urofollitropin (product), Urofollitropin (substance), Urofollitropin preparation (substance), Urofollitropin, Follicle Stimulating Hormone, Human Urine, Follicle-Stimulating Hormone, Human Urine, Human FSH, Urinary, Urinary Human FSH, UROFOLLITROPIN
Polish Urofolitropina
Japanese ウロフォリトロピン
Norwegian Humant FSH, fra urin, Urofollitropin, Follikkelstimulerende hormon, human urin
Portuguese Hormônio Foliculoestimulante de Urina Humana, Hormônio Estimulador do Folículo de Urina Humana, Urofolitropina
Spanish preparado con urofolitrofina, preparado con urofolitropina, preparado con urofolitrofina (producto), Folitropina de la Orina Humana, preparado de urofolitrofina (producto), preparado de urofolitrofina (sustancia), preparado de urofolitrofina, preparado de urofolitropina, urofolitropina (producto), urofolitropina (sustancia), urofolitropina, Hormona Estimuladora del Folículo de la Orina Humana, Urofolitropina
French FSH urinaire humaine, FSH urinaire, Urofollitropine
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Menopur (C0595531)

Concepts Pharmacologic Substance (T121) , Hormone (T125) , Amino Acid, Peptide, or Protein (T116)
MSH D008596
English Menopur, Menogon, Ferring Brand of Menotropins, HMG Ferring, Menotropins Ferring Brand
French Menopur, Menogon
Norwegian Menopur
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Pergonal (C0700188)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D008596
French Pergonal
English menotropins (Pergonal), pergonal, Pergonal, Menotropins Serono Brand, Serono Brand of Menotropins
Norwegian Pergonal
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Recombinant Follicle Stimulating Hormone (C0724588)

Definition (NCI) A therapeutic glycoprotein hormone synthesized by recombinant DNA technology or purified from biological sources, whose endogenous counterpart follicle stimulating hormone (FSH) stimulates and maintains the normal functions of reproductive system in males and females. (NCI04)
Concepts Pharmacologic Substance (T121) , Amino Acid, Peptide, or Protein (T116) , Hormone (T125)
English FSH,Recomb. (Obsolete), recombinant follicle stimulating hormone, recombinant follicle stimulating hormone (FSH), recombinant follicle stimulating hormone (medication), follicle stimulating hormone, recombinant, Therapeutic Follicle Stimulating Hormone, Therapeutic FSH, Recombinant Follicle Stimulating Hormone
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Follitropin Alfa (C1268876)

Concepts Pharmacologic Substance (T121) , Amino Acid, Peptide, or Protein (T116)
MSH C571801
SnomedCT 109042006
English follitropin alfa (medication), Follitropin alfa, follitropin alpha, alfa follitropin, follitropin alfa, recomb, follitropin alfa, Follitropin alfa preparation (product), Follitropin alfa preparation, Follitropin alfa preparation (substance), Follitropin Alfa, FOLLITROPIN ALFA
Spanish preparado con alfa folitropina, preparado con alfa folitropina (producto), alfa folitropina, alfa folitrofina, preparado con folitropina alfa (producto), preparado con folitropina alfa, preparado con alfa folitrofina, alfa folitrofina (producto), preparado de alfa folitrofina (producto), preparado de alfa folitrofina (sustancia), preparado de alfa folitrofina, preparado de alfa folitropina, preparado con alfa folitrofina (producto)
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Recombinant Gonadotropin (C1522385)

Definition (NCI) A class of formulated therapeutic analogs of the endogenous gonadotropin that stimulates or promotes the function of the gonads. Therapeutic gonadotropins are derived from animal or recombinant sources. Gonadotropins include follicle-stimulating hormone, luteinizing hormone and chorionic gonadotropin. These agents stimulate discrete cellular components of the gonads, exerting effects in both males and females. (NCI04)
Concepts Amino Acid, Peptide, or Protein (T116) , Hormone (T125) , Pharmacologic Substance (T121)
English Therapeutic Gonadotropin, Gonadotropins, Gonadotropic Hormone, Recombinant Gonadotropin
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Recombinant Luteinizing Hormone (C1704298)

Definition (NCI_NCI-GLOSS) A hormone made in the pituitary gland. In females, it acts on the ovaries to make follicles release their eggs and to make hormones that get the uterus ready for a fertilized egg to be implanted. In males, it acts on the testes to cause cells to grow and make testosterone.
Concepts Amino Acid, Peptide, or Protein (T116) , Hormone (T125) , Pharmacologic Substance (T121)
English Recombinant Luteinizing Hormone, interstitial cell-stimulating hormone, LH, lutropin, Interstitial Cell-Stimulating Hormone, Luteinizing Hormone, Lutropin, Leuteinizing Hormone, Therapeutic LH
Derived from the NIH UMLS (Unified Medical Language System)

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