hMG (human Menopausal Gonadotrophins), FSH and LH prepared from human urine collected from postmenopausal women. First extracted in 1953.[3] Injected intra-muscularily (IM) or subcutaneously (SC).
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.[5]
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.[15][16] However, a more recent study showed there 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.[17]
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).[18] Further, the ogliosaccharide side chains are very similar, but not completely identical to that of natural hFSH.[19] However, these small differences do not affect the bioactivity compared to natural hFSH.[medical citation needed]
Gonal-f was approved for medical use in the European Union in October 1995.[6]
Puregon was approved for medical use in the European Union in February 1996.[12]
Rekovelle was approved for medical use in the European Union in December 2016.[13]
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.[22][23]
Human chorionic gonadotropin (hCG) can be recovered from the urine of pregnant women or be produced from recombinant DNA. It acts similarly to LH, but the larger supply makes it less costly; it also has a longer half-life. In veterinary medicine, equine chorionic gonadotropin (eCG) extracted from pregnant mare serum is used instead on a variety of mammals, sometimes eliciting an immune response in non-horse species.[24]
In men:
Used to treat select cases of Hypogonadotropic Hypogonadism in adult males.[25] In off-label use, some urologists prescribe hCG in low doses in combination with testosterone replacement to preserve fertility.[26]
In male children: Also used to treat prepubertal cryptorchidism not due to anatomical obstruction. Therapy is usually administered between ages 4 and 9.[25]
^"Gonadotropins", LiverTox: Clinical and Research Information on Drug-Induced Liver Injury, Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases, 2012, PMID31644163, archived from the original on 2023-09-26, retrieved 2023-12-11
^ ab"AusPAR: Follitropin alfa". Therapeutic Goods Administration (TGA). 19 May 2021. Archived from the original on 20 May 2021. Retrieved 12 June 2021.
^Williams, R. Stan; et al. (2003). "Pregnancy rates in varying age groups after in vitro fertilization: a comparison of follitropin alfa (Gonal F) and follitropin beta (Follistim)". American Journal of Obstetrics and Gynecology. 189 (2): 342–346. doi:10.1067/s0002-9378(03)00728-2. PMID14520188.
