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Highly Purified Human Menopausal Gonadotropin (Menopur®): A Profile of Its Use in Infertility

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Abstract

Menopur® is a highly purified, urine-derived, human menopausal gonadotropin containing both follicle stimulating hormone (FSH) and luteinizing hormone (LH) activity. It is an effective option for controlled ovarian stimulation (COS) in assisted reproductive technology protocols and for ovulation induction (OI) in anovulatory infertility, and is associated with a different endocrine profile from that of recombinant (r) FSH in these settings (in terms of serum levels of FSH, androgens and/or estradiol). When used for COS in women undergoing in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI), Menopur® was as good as rFSH in terms of pregnancy rates (despite being associated with a lower oocyte yield) and was found to improve some aspects of embryo quality in the IVF (but not ICSI) setting; using Menopur® in combination with highly purified urinary FSH resulted in similar reproductive outcomes as Menopur® alone. Data for Menopur® in OI are limited, but suggest ovulation rates may be as good as those with rFSH + rLH (in type 1 anovulation) and rFSH (in type 2 anovulation). Moreover, compared with rFSH, Menopur® appeared to be associated with a less pronounced follicular response and a lower risk of ovarian overstimulation.

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References

  1. Homburg R. Ovulation induction and controlled ovarian stimulation: a practical guide. 2nd ed. Cham: Springer; 2014.

    Book  Google Scholar 

  2. Ghumman S, editor. Principles and practice of controlled ovarian stimulation in ART. New Dheli: Springer; 2015.

    Google Scholar 

  3. Wolfenson C, Groisman J, Couto AS, et al. Batch-to-batch consistency of human-derived gonadotrophin preparations compared with recombinant preparations. Reprod Biomed Online. 2005;10(4):442–54.

    Article  CAS  Google Scholar 

  4. Ferring Lægemidler A/S. Menopur: EU summary of product characteristics. Copenhagen: Ferring Lægemidler A/S; 2013.

    Google Scholar 

  5. Ferring Pharmaceuticals Inc. Menopur® (menotropins for injection) for subcutaneous use: US prescribing information. 2017. http://www.ferringusa.com. Accessed 3 Sept 2018.

  6. Ferring Pharmaceuticals Co Ltd. Menopur: Japanese prescribing information. 2016.

  7. Smitz J, Andersen AN, Devroey P, et al. Endocrine profile in serum and follicular fluid differs after ovarian stimulation with HP-hMG or recombinant FSH in IVF patients. Hum Reprod. 2007;22(3):676–87.

    Article  CAS  Google Scholar 

  8. Devroey P, Pellicer A, Nyboe Andersen A, et al. A randomized assessor-blind trial comparing highly purified hMG and recombinant FSH in a GnRH antagonist cycle with compulsory single-blastocyst transfer. Fertil Steril. 2012;97(3):561–71.

    Article  CAS  Google Scholar 

  9. Diedrich K. Efficacy and safety of highly purified menotropin versus recombinant follicle-stimulating hormone in in vitro fertilization/intracytoplasmic sperm injection cycles: a randomized, comparative trial. Fertil Steril. 2002;78(3):520–8.

    Article  Google Scholar 

  10. Hompes PGA, Broekmans FJ, Hoozemans DA, et al. Effectiveness of highly purified human menopausal gonadotropin vs. recombinant follicle-stimulating hormone in first-cycle in vitro fertilization-intracytoplasmic sperm injection patients. Fertil Steril. 2008;89(6):1685–93.

    Article  CAS  Google Scholar 

  11. Andersen AN, Devroey P, Arce JC. Clinical outcome following stimulation with highly purified hMG or recombinant FSH in patients undergoing IVF: a randomized assessor-blind controlled trial. Hum Reprod. 2006;21(12):3217–27.

    Article  CAS  Google Scholar 

  12. Platteau P, Andersen AN, Balen A, et al. Similar ovulation rates, but different follicular development with highly purified menotrophin compared with recombinant FSH in WHO Group II anovulatory infertility: a randomized controlled study. Hum Reprod. 2006;21(7):1798–804.

    Article  CAS  Google Scholar 

  13. Bosch E, Labarta E, Crespo J, et al. Circulating progesterone levels and ongoing pregnancy rates in controlled ovarian stimulation cycles for in vitro fertilization: analysis of over 4000 cycles. Hum Reprod. 2010;25(8):2092–100.

    Article  CAS  Google Scholar 

  14. Witz CA, Doody K, Park J, et al. Highly purified human menotropin (HP-HMG) versus recombinant follicle stimulating hormone (RFSH) in high responders undergoing in vitro fertilization (IVF): Megaset-HR trial outcomes [abstract no. O-49]. Fertil Steril. 2017;108(3 Suppl):e21-e2.

    Article  Google Scholar 

  15. Ziebe S, Lundin K, Janssens R, et al. Influence of ovarian stimulation with HP-hMG or recombinant FSH on embryo quality parameters in patients undergoing IVF. Hum Reprod. 2007;22(9):2404–13.

    Article  CAS  Google Scholar 

  16. Jee BC, Suh CS, Kim YB, et al. Clinical efficacy of highly purified hMG versus recombinant FSH in IVF/ICSI cycles: a meta-analysis. Gynecol Obstet Invest. 2010;70(2):132–7.

    Article  CAS  Google Scholar 

  17. Bjercke S, Tanbo T, Abyholm T, et al. Clinical outcome following stimulation with highly purified hMG or recombinant FSH in patients undergoing their first treatment cycle of IVF or ICSI. Acta Obstet Gynecol Scand. 2010;89(8):1053–60.

    Article  CAS  Google Scholar 

  18. Shavit T, Shalom-Paz E, Samara N, et al. Comparison between stimulation with highly purified hMG or recombinant FSH in patients undergoing IVF with GnRH antagonist protocol. Gynecol Endocrinol. 2016;32(8):629–33.

    Article  CAS  Google Scholar 

  19. Esteves SC, Schertz JC, Verza S Jr, et al. A comparison of menotropin, highly-purified menotropin and follitropin alfa in cycles of intracytoplasmic sperm injection. Reprod Biol Endocrinol. 2009;7:111.

    Article  Google Scholar 

  20. Miller CE, Shapiro D, Witz CA, et al. A comparison of the efficacy and safety of combined highly purified human menopausal gonadotropin (HP-hMG) and highly purified urinary follicle stimulating hormone (HP-uFSH) versus hphmg alone for ovarian stimulation [abstract no. P-631]. Fertil Steril. 2015;104(3 Suppl):e322-e3.

  21. US National Institutes of Health. ClinicalTrials.gov identifier NCT01417195. 2014. https://clinicaltrials.gov. Accessed 14 May 2018.

  22. Carone D, Caropreso C, Vitti A, et al. Efficacy of different gonadotropin combinations to support ovulation induction in WHO type I anovulation infertility: clinical evidences of human recombinant FSH/human recombinant LH in a 2:1 ratio and highly purified human menopausal gonadotropin stimulation protocols. J Endocrinol Invest. 2012;35(11):996–1002.

    CAS  PubMed  Google Scholar 

  23. Keye WR, Webster B, Dickey R, et al. Subcutaneously administered Menopur, a new highly purified human menopausal gonadotropin, causes significantly fewer injection site reactions than Repronex in subjects undergoing in vitro fertilization. Reprod Biol Endocrinol. 2005;3:62.

    Article  Google Scholar 

  24. NICE. Fertility problems: assessment and treatment. Clinical guideline. 2013. https://www.nice.org.uk. Accessed 3 Sept 2018.

  25. Alviggi C, Cognigni GE, Morgante G, et al. A prospective, randomised, investigator-blind, controlled, clinical study on the clinical efficacy and tolerability of two highly purified hMG preparations administered subcutaneously in women undergoing IVF. Gynecol Endocrinol. 2013;29(7):695–9.

    Article  CAS  Google Scholar 

  26. Lockwood G, Cometti B, Bogstad J, et al. A randomized controlled trial comparing the efficacy and safety of two HMG preparations gaining their LH bioactivity from different HCG sources. Reprod Biomed Online. 2017;35(1):17–27.

    Article  CAS  Google Scholar 

  27. Koo HS, Kwon H, Choi DS, et al. Clinical utility of newly developed highly purified human menopausal gonadotrophins: a randomized controlled trial. Reprod Biomed Online. 2017;34(5):499–505.

    Article  CAS  Google Scholar 

  28. Kumar P, Sait SF. Luteinizing hormone and its dilemma in ovulation induction. J Hum Reprod Sci. 2011;4(1):2–7.

    Article  CAS  Google Scholar 

  29. Raju GA, Chavan R, Deenadayal M, et al. Luteinizing hormone and follicle stimulating hormone synergy: a review of role in controlled ovarian hyper-stimulation. J Hum Reprod Sci. 2013;6(4):227–34.

    Article  CAS  Google Scholar 

  30. Hill MJ, Levens ED, Levy G, et al. The use of recombinant luteinizing hormone in patients undergoing assisted reproductive techniques with advanced reproductive age: a systematic review and meta-analysis. Fertil Steril. 2012;97(5):1108–14 e1.

    Article  Google Scholar 

  31. Ho JY, Guu HF, Yi YC, et al. The serum follicle-stimulating hormone-to-luteinizing hormone ratio at the start of stimulation with gonadotropins after pituitary down-regulation is inversely correlated with a mature oocyte yield and can predict “low responders”. Fertil Steril. 2005;83(4):883–8.

    Article  CAS  Google Scholar 

  32. Bhat AM, Feichtinger W, Kemeter P. The importance of the FSH/LH ratio in ovarian stimulation therapy regime for in vitro fertilization. Acta Eur Fertil. 1984;15(6):449–53.

    CAS  PubMed  Google Scholar 

  33. Tepper R, Tadir Y, Kaplan-Kraicer R, et al. Comparison of different follicle-stimulating hormone and luteinizing hormone ratios for ovulation induction during in vitro fertilization. Int J Fertil. 1992;37(6):335–8.

    CAS  PubMed  Google Scholar 

  34. Keye WR Jr, Marrs RP, Check JH, et al. Evaluation of mixed protocols with Bravelle (human-derived FSH) and Repronex (hMG) to assess clinical efficacy (EMBRACE) in women undergoing in vitro fertilization. Fertil Steril. 2004;82(2):348–57.

    Article  CAS  Google Scholar 

  35. Fragoulakis V, Pescott CP, Smeenk JM, et al. Economic evaluation of three frequently used gonadotrophins in assisted reproduction techniques in the management of infertility in the Netherlands. Appl Health Econ Health Policy. 2016;14(6):719–27.

    Article  Google Scholar 

  36. Wex J, Abou-Setta AM. Economic evaluation of highly purified human menopausal gonadotropin versus recombinant human follicle-stimulating hormone in fresh and frozen in vitro fertilization/intracytoplasmic sperm-injection cycles in Sweden. Clinicoecon Outcomes Res. 2013;5:381–97.

    Article  Google Scholar 

  37. Papaleo E, Alviggi C, Colombo GL, et al. Cost-effectiveness analysis on the use of rFSH + rLH for the treatment of anovulation in hypogonadotropic hypogonadal women. Ther Clin Risk Manag. 2014;10:479–84.

    CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The manuscript was reviewed by: L. P. Shulman, Department of Obstetrics and Gynecology, Feinberg School of Medicine of Northwestern University, Chicago, IL, USA and L. Bahamondes, Department of Obstetrics and Gynecology, University of Campinas, Faculty of Medical Sciences, Campinas, Brazil. During the peer review process, Ferring, the marketing-authorization holder of Menopur®, was also offered an opportunity to provide a scientific accuracy review of their data. Changes resulting from comments received were made on the basis of scientific and editorial merit.

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    Emma D. Deeks

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  1. Emma D. Deeks
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Correspondence to Emma D. Deeks.

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The preparation of this review was not supported by any external funding.

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E D. Deeks is a salaried employee of Adis/Springer, is responsible for the article content and declares no relevant conflicts of interest.

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Deeks, E.D. Highly Purified Human Menopausal Gonadotropin (Menopur®): A Profile of Its Use in Infertility. Clin Drug Investig 38, 1077–1084 (2018). https://doi.org/10.1007/s40261-018-0703-8

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