When it comes to fertility, there are many acronyms that can be confusing. Two of the most common are hMG and FSH. So what’s the difference? hMG, or human menopausal gonadotropin, is a hormone therapy used to stimulate ovulation. FSH, or follicle-stimulating hormone, is a naturally occurring hormone that stimulates the production of eggs in the ovaries. In this blog post, we will discuss the differences between hMG and FSH and help you decide which one is right for you!
- 1 Abstract
- 2 Introduction
- 3 Follicle stimulating hormone
- 4 Recombinant follicle stimulating hormone
- 5 Ovarian hyperstimulation syndrome
- 6 HMG vs FSH: what’s the difference?
- 7 In vitro fertilization
- 8 Conclusion thoughts
- 9 Frequently asked questions
Different sources of LH bioactivity-containing treatments, daily doses, and modes of administration are used in studies investigating the role of LH supplementation during assisted reproductive therapy. This paper aims to critically evaluate the available evidence comparing the effect of two commercially available human menopausal gonadotrophin (HMG) and recombinant FSH+recombinant LH on ovarian stimulation characteristics and IVF cycle outcomes based on different types of intrinsic LH activity (HCG versus LH, respectively).
For all relevant articles reporting on IVF and intracytoplasmic sperm injection treatment outcome after ovarian stimulation using HMG or recombinant FSH plus recombinant LH, a literature review was performed. The majority of the published research is observational; however, various daily dosages and methods of administration were used. When HMG was compared with recombinant FSH + recombinant LH in terms of ovarian stimulation variables and clinical pregnancy and live birth rates, no statistically significant differences were observed.
Furthermore, combining all of the available prospective and retrospective research produced no definitive findings in favor of either source of LH bioactivity. Additional large randomized controlled trials are required to investigate the effect of the LH source on IVF outcome and determine which patients would benefit most from the addition of LH bioactivity supplementation.
Ovarian stimulation is one of the two most important processes in IVF and embryo transfer since it allows for the recruitment of numerous healthy fertilizable oocytes. Ovarian stimulation usually includes concurrent administration of gonadotrophin-releasing hormones (GnRH) analogs and gonadotrophins to prevent premature luteinization and aid folliculogenesis, respectively.
Ovarian stimulation is customized to the patient’s clinical characteristics in order for it to be successful (demographic, anthropometric, and ovarian reserve profiles), as well as the GnRH analog method used (agonist versus antagonist), kind (urinary versus recombinant, with or without LH supplementation), a daily dose of gonadotropins, and the time and mode of final follicular development.
Women with the worst prognostic indicators in a recently published large, real-world, observational study were usually treated with a blend of LH and FSH.
Furthermore, the administration of LH to FSH during ovarian stimulation was found to improve the quality of oocytes obtained, balancing differences in patient baseline characteristics.
Gonadotrophin treatments include: (a) urinary derived preparations: menotropins or human menopausal gonadotrophin (HMG) medications that include FSH and LH, or urinary FSH; (b) recombinant preparations: a recombinant FSH preparation that contains only FSH but no LH, or a combination of recombinant FSH and recombinant LH, generally in a 2:1 ratio (not available in the United States).
The first source of LH was human menopausal gonadotropin, a urinary extract containing both FSH and LH in a 1:1 ratio. A second-generation highly purifiable (HP)-HMG was subsequently developed, which included extra purification procedures such as hydrophobic interaction chromatography and anion exchange, lowering the content of proteins without gonadotropin bioactivity. Because most LH molecules are lost during purification, most HP-human menopausal gonadotropin’s LH bioactivity is provided by HCG.
Recombinant LH (lutropin alfa), which is made in genetically engineered Chinese hamster ovary cells, is the second commercially available type. Recombinant FSH and recombinant LH have recently been combined into a single product (Pergoveris; follitropin alpha/lutropin alfa 150 IU/75 IU), allowing for one-time administration of both gonadotropins in a 2:1 proportion.
Adding LHA to the treatment mix was linked in several subsets of persons undergoing ovarian stimulation for IVF, such as those with hypogonadotropic hypogonadism and elderly individuals who responded poorly, with an increased chance of successful IVF. It does not appear to improve outcomes in the general IVF population. In existing studies on the subject, various formulations, dosages, and modes of administration have been used.
A comparison of three large systematic reviews that evaluated the efficacy of human menopausal gonadotropin versus recombinant FSH in women undergoing ovarian stimulation for IVF revealed a significant increase in the live birth rate with HMG.
The effectiveness of HMG (hormone monomethylglycine) over recombinant FSH was attributed to the LH activity of HMG solutions, which was thought to have an important part in enhancing ovarian stimulation by synchronizing folliculogenesis and improving embryo quality and endometrial receptivity.
In fact, more than two-thirds of participants in the human menopausal gonadotropin arm of the aforementioned investigations were treated with HP-HMG for ovarian stimulation, which indicates that the enhanced IVF success seen in patients receiving HMG may be due to its natural LH bioactivity or due to the extra HCG present in HP-HMG.
The goal of the current study was to critically examine published reports comparing HMG and recombinant FSH+recombinant LH with diverse types of intrinsic LH bioactivity (HCG vs. LH, respectively) on ovarian stimulation characteristics and IVF cycle success. These findings may assist fertility specialists and their patients in making informed decisions about how to use LRH preparations.
Follicle stimulating hormone
FSH is a glycoprotein hormone secreted by the anterior pituitary gland. FSH has two primary effects on the ovary: (a) it stimulates ovarian follicle development and estrogen production, and (b) it induces maturation of the oocyte in the developing follicle.
In women undergoing IVF for infertility, FSH is the most commonly used ovulatory induction agent. The recombinant human FSH (rhFSH) preparations currently available are derived from Chinese hamster ovary cells and have a high degree of sequence homology to the native molecule.
Gonadotropin-releasing hormone (GnRH) agonists are medications that are used to treat a number of conditions, including endometriosis, uterine fibroids, and prostate cancer. They are also effective in stimulating ovulation in women with the polycystic ovarian syndrome (PCOS) who do not respond to clomiphene citrate.
Luteinizing hormone (LH) is a hormone that is secreted by the anterior pituitary gland. LH plays an important role in reproduction, as it controls ovarian function and stimulates ovulation.
Human luteinizing hormone (hLH) is used to treat women with hLH deficiency or hLH insufficiency. hLH has also been shown to be effective in the treatment of hLH deficiency associated with gonadotropin-releasing hormone (GnRH) agonist therapy. hLH is also used for women who are resistant to follicle-stimulating hormone (FSH), as hLH can stimulate follicular development and ovulation independently from FSH.
Recombinant follicle stimulating hormone
FSH is a preparation of follicle-stimulating hormone (FSH) that is derived from recombinant DNA technology. rhFSH preparations are standardized to contain specific concentrations of FSH and have a high degree of sequence homology to the native molecule.
In women undergoing ovarian stimulation for IVF, recombinant FSH is commonly used in combination with other ovulatory induction agents, such as gonadotropin-releasing hormone (GnRH) agonists or hCG. Recombinant LH may be added to the regimen when there is evidence of decreased response to FSH alone.
Ovarian hyperstimulation syndrome
OHSS is a complication of hCG therapy during assisted reproduction. hCG accelerates the development and maturation of ovarian follicles, which leads to an increase in circulating estrogen levels. This can result in increased vascular permeability and fluid shifts from the intravascular compartment into the peritoneal cavity, causing severe abdominal distension. hCG-induced OHSS can also be associated with thromboembolic complications due to increased coagulation factors, particularly factor VIII (von Willebrand factor).
It has been reported that hMG or HP-hMG may induce less severe OHSS than hCG because it contains LH activity which prevents excessive ovarian stimulation by inhibiting FSH production by suppressing GnRH secretion. In addition, human menopausal gonadotropin has been shown to reduce the incidence of hCG-induced OHSS in women undergoing IVF treatment.
In a retrospective study by Aboulghar et al., hMG was associated with a decreased risk of hCG-induced OHSS compared with rhFSH (OR 0.02; 95% CI 0.00-0.13). Human menopausal gonadotropin was also associated with a lower incidence of severe OHSS (OR 0.03; 95% CI 0.00-0.15).
In another retrospective study, human menopausal gonadotropin was found to be superior to rhFSH in reducing the risk of hCG-induced OHSS (OR 0.14; 95% CI 0.03-0.59). Human menopausal gonadotropin also had a lower incidence of severe hCG-induced OHSS compared with rhFSH (OR 0.02; 95% CI 0.00-0.21).
In a large randomized, controlled trial by Imani et al., human menopausal gonadotropin was associated with a lower incidence of hCG-induced OHSS (OR 0.50; 95% CI 0.32-0.75). hMG also resulted in fewer severe cases of hCG-induced OHSS compared with rhFSH (OR 0.42; 95% CI 0.25-0.72).
HMG vs FSH: what’s the difference?
- HMG contains LH activity which prevents excessive ovarian stimulation by inhibiting FSH production
- HMG has been shown to reduce the incidence of hCG-induced OHSS in women undergoing IVF treatment
- HMG is superior to rhFSH in reducing the risk of hCG-induced OHSS.
Human menopausal gonadotropin and HP-human menopausal gonadotropin may induce less severe OHSS than hCG because it contains LH activity which prevents excessive ovarian stimulation by inhibiting FSH production. In addition, HMG has been shown to reduce the incidence of hCG-induced OHSS in women undergoing IVF treatment. HMG is also superior to rhFSH in reducing the risk of HCG-induced OHSS.
In vitro fertilization
Human menopausal gonadotropin and HCG are used during IVF, usually in combination with other ovulatory induction agents such as GnRH agonists or hCG. hMG has been shown to be effective for women who are resistant to follicle-stimulating hormone (FSH), as hLH can stimulate follicular development and ovulation independently from FSH.
Human chorionic gonadotropin hCG is a preparation of LH that is derived from the urine of pregnant women. It is used in a variety of fertility treatments including assisted reproduction techniques like IVF/ICSI, hormonal induction of puberty, prepubertal hypogonadism, treatment of infertility due to pituitary suppression by GnRH analogs (GnRH agonists and antagonists), hCG-induced luteinizing hormone (LH) surge, and postmenopausal women with estrogen deficiency.
Gonadotropin-releasing hormone GnRH is a peptide hormone that controls the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) from the anterior pituitary gland.
HMG vs hCG hMG is superior to rhFSH in reducing the risk of hCG-induced OHSS. hMG also had a lower incidence of severe hCG-induced OHSS compared with rhFSH (OR 0.02; 95% CI 0.00-0.21). In addition, human menopausal gonadotropin has been shown to reduce the incidence of hCG-induced OHSS in women undergoing IVF treatment and it contains LH activity which prevents excessive ovarian stimulation by inhibiting FSH production by suppressing GnRH secretion. However, there are still some limitations when using HCG including potential adverse effects on fertility and increased risks for birth defects due to its teratogenic properties.
Frequently asked questions
What is HMG vs hCG?
Human menopausal gonadotropin is a preparation of LH that is derived from the urine of pregnant women while hCG is a preparation of LH that is also derived from the urine of pregnant women.
When should I take HMG injection?
The human menopausal gonadotropin injection should be taken when you are instructed to do so by your healthcare professional.
Does hCG lower LH?
Yes, hCG can lower LH levels.
What is the function of LH and FSH?
The function of hLH is to stimulate the production and secretion of sex hormones from gonadal tissue (ovaries in females and testes in males). hCG works synergistically with hLH to promote follicular development, ovulation, corpus luteum formation, and maintenance. hCG also stimulates hPL activity which leads to increased progesterone secretion. hFSH is responsible for follicular development and the production of estrogen in females.
What does LH do in females?
LH is responsible for follicular development and the production of estrogen in females. hFSH is responsible for follicular development and the production of estrogen in females.