Menopur: Patient’s Manual for Ovarian Stimulation in IVF

Menopur is one of the medicines used in the controlled ovarian stimulation of an assisted reproduction process, whether it is artificial insemination or in vitro fertilization (IVF).

It is an injectable gonadotropin that can be found in three forms: menopur 75, menopur 600 and menopur 1200.

The different sections of this article have been assembled into the following table of contents.

Composition

The active ingredient of Menopur is menotropin, also called human menopausal gonadotropin or hMG-HP, whose activity corresponds to that of FSH (Follicle Stimulating Hormone) and LH (Luteinizing Hormone).

This drug is a highly purified concentrate of the urine of menopausal women that contains:

Menopur 75

each vial of powder contains 75 International Units (IU) of FSH and 75 International Units (IU) per vial of LH.

Menopur 600

each vial of powder contains 600 International Units (IU) of FSH and 600 International Units (IU) per vial of LH.

Menopur 1200

each vial of powder contains 1200 International Units (IU) of FSH and 1200 International Units (IU) per vial of LH.

In addition to its main component it includes lactose, sodium hydroxide, polysorbate 20 and hydrochloric acid as excipients. As for the composition of the solvent, it contains sodium chloride, dilute hydrochloric acid and water for injection.

Presentation and price

In the case of Menopur 75, the most widely used, there are two types of presentation:

• Package with 5 lyophilized vials (2 ml glass ampoules: dry substance) and 5 1 ml glass ampoules (solvent). It costs around £115.00 in the U.K. and $435 in the U.S.
• Package with 10 lyophilized vials (2 ml glass ampoules: dry substance) and 10 1 ml glass ampoules (solvent). It costs around £230.00 in the U.K. and $870 in the U.S.

On the other hand, Menopur 600 and Menopur 1200 are sold in single vial freeze-dried and solvent containers in a pre-filled syringe.

The cost of Menopur 600 is £184 and that of Menopur 1200 is approximately £368.

Formats and ingredients of Menopur

Indications

Menopur can only be purchased with a doctor's prescription. It is used in assisted reproduction treatments, specifically in the following cases:

• Female sterility with hypo or normogonadotropic ovarian failure for the stimulation of the growth of ovarian follicles.
• Male sterility with hypo- or normogonadotropic hypogonadism It is combined with hCG to stimulate spermatogenesis (sperm formation).
• Assisted reproduction techniques such as conventional IVF, ICSI, etc.

The appropriate doses of Menopur should be indicated by the specialist. In an in vitro fertilization treatment, it is usual to start with a daily dose of 75 or 150 IU.

How is Menopur applied?

First, the dry substance must be reconstituted with the solvent. We will use one or two vials of dry substance for each vial of solvent, depending on the doctor's instructions.

Once reconstituted, it is aspirated into the syringe and administered subcutaneously, i.e. under the skin. Usually, the patient injects the medication herself, usually in the abdominal area.

How to apply menopur

It is a painless injection because the needle is small. However, the puncture may cause slight discomfort in the administration area.

It is common for the first injection to be placed in the fertility clinic where the treatment is carried out so that the patient understands how the administration should be and can do it herself or a relative at home.

When is Menopur contraindicated?

Menopur consumption can be a risk in some cases. Menopur should not be taken in the following situations:

• Tumor in the breast, uterus, or ovaries.
• Increase in ovaries or cysts not caused by PCOS (polycystic ovary syndrome).
• Having malformations in the sexual organs that make natural pregnancy impossible.
• Vaginal bleeding for unknown reason.
• Presence of fibroids in the uterine womb
• Pregnancy or breastfeeding.
• Early menopause.

It is also not recommended to use menopur in the following situations due to lack of effectiveness: primary ovarian failure, malformations of the sexual organs incompatible with pregnancy or uterine fibroids incompatible with pregnancy.

Men should not be treated with menopur if they have a carcinoma of the prostate or a tumor of the testicles.

Side effects

Take special care when taking menopur and consult your health care provider if the following symptoms occur:

• Pain in the abdomen
• Swelling of the abdomen
• Nausea, vomiting, and/or diarrhea
• Weight gain
• Difficulty breathing
• Decreased urine

FAQs from users

What is the purpose of menopur in fertility treatments?

Menopur is a drug used in assisted reproduction techniques for controlled ovarian stimulation.

It is a highly purified menotropin (human menopausal gonadotropin, HMG-hP), with follicle-stimulating hormone (FSH) and luteinizing hormone (LH) activity. Human chorionic gonadotropin (hCG), a hormone naturally present in the urine of menopausal women, is the major contributor to the LH activity of this drug.

When compared with recombinant gonadotropin products, no differences in safety, purity, or clinical efficacy have been observed.

When is Menopur used in a fertility treatment?

There are two groups of patients in whom a deficit of the LH hormone may prevent proper follicular development:

• Women over 35: As the years go by, the LH produced by the body is less powerful and the LH receptors are less functional.
• Women who, in spite of having good ovarian reserve parameters, have shown a low response in a previous ovarian stimulation cycle. One of the causes, among others, that can provoke this unexpected low response is a genetic variant of LH that makes the hormone biologically inactive. Thus, if we measure the LH levels in the blood they will be normal, but the hormone will not be able to exert its function.

These are the patients in whom it will be necessary to add LH activity in ovarian stimulation, since they do not have enough endogenous LH to complement FSH in folliculogenesis.
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Do I gain weight with Menopur?

You may notice a slight weight gain. Since this is a hormonal medication, you may feel bloated or retain more fluid during its administration. In any case, after the treatment is over, you will usually return to your normal weight.

How should I store menopur? Should I store it in the fridge?

Menopur should be kept at a temperature below 25º C, so it can be kept at room temperature or in the refrigerator. It should never be frozen. Further, it is important to avoid direct exposure to light and to keep it in its original packaging.

How long do I have to take Menopur?

This will depend on the protocol followed by the doctor as well as your body's response to menopause stimulation. Depending on how the ovarian development goes, the treatment will last more or less days. It usually lasts about 6-12 days.

References