Adult Dosing
Assisted reproductive technology
- Menopur
- Start 225 IU (each of FSH/LH) SC qd, adjust dose in increments of 150 IU q2 days
- Max dose: 450 IU/day; Max duration: 20 days
- After follicular development, administer hCG for follicle maturation (avoid in case of abnormal ovarian enlargement)
- Repronex
- Start 225 IU (each of FSH/LH) IM/SC qd, adjust dose in increments of 75-150 IU q2 days
- Max dose: 450 IU/day; Max duration: 12 days
- After follicular development, administer hCG (5000-10000 U) for follicle maturation (avoid in case of abnormal ovarian enlargement)
Notes:- Reconstitute with 0.9% NaCl. Not indicated for IV use
- Individualize therapy based on clinical monitoring
Ovulation induction
- Repronex
- Start 150 IU (each of FSH/LH) IM/SC x 5 days, adjust dose in increments of 75-150 IU q2 days
- Max dose: 450 IU/day; Max duration: 12 days
- After follicular development, administer hCG (5000-10000 U) for follicle maturation (avoid in case of abnormal ovarian enlargement, abdominal pain, serum estradiol >2000 pg/mL)
Notes:- Reconstitute with 0.9% NaCl. Not indicated for IV use
- Individualize therapy based on clinical monitoring
- Monitor patients for 2 days after hCG adminstration. If results are inadequate, repeat course
- Advise patients to have intercourse daily starting from day prior to hCG administration
Induction of spermatogenesis in males [Not FDA approved]
- Menopur
- 75-150 IU (each of FSH/LH) SC 3x/wk, along with hCG
- Max: 300 IU/dose
- Repronex
- 75-150 IU (each of FSH/LH) IM/SC 3x/wk, along with hCG
- Max: 300 IU/dose
Notes:- Reconstitute with 0.9% NaCl. Not indicated for IV use
- Individualize therapy based on clinical monitoring
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
[Outline]
See Supplemental Patient Information
- Menotropins should be administered in an appropriate clinical setting by physicians experienced in infertility treatment
- Mild-moderate ovarian enlargement along with abdominal distension and/or abdominal pain has been reported following treatment with menotropins. Use lowest effective dose and monitor ovarian response to minimize the risk of ovarian enlargement
- If abnormal enlargement of ovaries is seen on last day of menotropin therapy, avoid administration of hCG as it may lead to ovarian hyperstimulation syndrome (OHSS)
- OHSS may progress into a serious medical condition manifested by hypovolemia, hemoconcentration, electrolyte imbalances, ascites, hemoperitoneum, pleural effusions, hydrothorax, acute pulmonary distress, thromboembolic events and hepatic dysfunction
- OHSS usually occurs following treatment with menotropins and spontaneously resolves at start of menses. If OHSS develops prior to hGC administration, discontinue menotropin therapy and initiate appropriate treatment
- Ovarian torsion has been reported after treatment with gonadotropins. This may be related to OHSS, pregnancy, previous abdominal surgery, past history of ovarian torsion, previous or current ovarian cyst and polycystic ovaries
- Multi-fetal gestation and births have been reported with all gonadotropin therapy including therapy with menotropins
- Since infertile women undergoing ART often have tubal abnormalities, the incidence of ectopic pregnancy may be increased. Early confirmation of intrauterine pregnancy should be determined by beta-hCG testing and transvaginal ultrasound
- Increased risk of spontaneous abortion has been reported with therapy
- Treatment with menotropins may cause serious pulmonary conditions such as atelectasis and acute respiratory distress syndrome
- Intravascular thromboembolic events have been reported with use of menotropins. Such events can reduce blood flow to vital organs and limbs leading to life-threatening conditions, loss of limb and death
- Multiple pregnancies have been reported after treatment with menotropins. Alert patients about the risk of multiple pregnancies prior to treatment
- Hypersensitivity/anaphylactic reactions characterized by urticaria, facial edema, angioneurotic edema, dyspnea, laryngeal edema have been reported in few patients with use of menotropins
- Monitor estradiol levels and ultrasonography during therapy. Ovulation may be confirmed by evidence of rise in body temperature followed by menstruation, increased serum progesterone, fluid in cul-de-sac, ovarian stigmata and collapsed follicle
Cautions: Use cautiously in
- Pulmonary conditions
- Thromboembolic conditions
Supplemental Patient Information
- Advise patients to have intercourse daily starting from day prior to hCG administration to improve chances of conception
- Advise patients to get their husbands' fertility potential evaluated prior to initiating treatment
Pregnancy Category:X
Breastfeeding: Safety unknown. As many drugs are excreted in human milk, manufacturer advises caution.
