Gonadotropin preparations
Gonadotropin preparations are drugs that mimic the physiological effects of gonadotropins, used therapeutically mainly as fertility medication for ovarian hyperstimulation and ovulation induction. For example, the so-called menotropins consist of LH and FSH extracted from human urine from menopausal women. There are also recombinant variants.

FSH and LH preparations
hMG (human Menopausal Gonadotrophins), FSH and LH prepared from human urine collected from postmenopausal women. First extracted in 1953.  Injected intra-muscularily (IM) or subcutaneously (SC).
Generic

menotropins for injections, USPBrands

Menopur, 5 mL vials containing 75 IU FSH and 75 IU LH.
Repronex, vials containing either 75 IU FSH and 75 IU LH, or 150 IU FSH and 150 IU LH.The more common side effects of preparations containing FSH and LH are:
Mild bloating
Pain, swelling, or irritation injection site
Rash at injection site or other part of body
Stomach pain or pelvic pain

FSH preparations
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.

Urinary preparations
Purified urinary FSH (75 IU FSH and ≤ 2 IU of LH)Generic
urofollitropin for injection, purified.Brands
Bravelle, U.S., (≤ 2 IU LH)
Metrodin, U.S. and Canada, (≤ 1 IU LH)
Fertinorm Hp, (Canada)Highly purified urinary FSH (75 IU FSH and ≤ 0.1 IU LH/1000 IU FSH)Generic
urofollitropin for injection, (highly) purified.Dosage
typically 75 - 300, but as high as 600 IU / dayBrands
Fertinex (≤ 0.1 IU LH/1000 IU FSH)

Recombinant preparations
Follitropin alfaGeneric
Follitropin alfa injectionBrandsGonal-f
Cinnal-f
Fertilex
Ovaleap
BemfolaFollitropin betaGeneric
follitropin beta injectionBrands
Follistim AQ
PuregonFollitropin deltaGeneric
follitropin delta injectionBrands
RekovelleThe 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. 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.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).  Further, the ogliosaccharide side chains are very similar, but not completely identical to that of natural hFSH.  However, these small differences do not affect the bioactivity compared to natural hFSH.
Gonal-f was approved for medical use in the European Union in October 1995.Puregon was approved for medical use in the European Union in February 1996.Rekovelle was approved for medical use in the European Union in December 2016.

Biosimilars
Ovaleap was approved for medical use in the European Union in September 2013. It was approved for medical use in Australia in March 2021.Bemfola was approved for medical use in the European Union in March 2014.

Side effects of FSH preparations
Side effects of FSH preparations include:
Local irritation at the injection site
Feeling of fullness, bloating, and tenderness in the lower abdomen due to increasing size of the ovaries.
Mood swings
Fatigue

FSH analogues
Corifollitropin alfa
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.

LH (Luteinizing hormone) preparations
Prepared from recombinant DNA.

Generic
lutropin alfa for injection
Brands
Luveris

hCG preparations
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.In Women:
Used to induce final maturation of follicle and subsequent ovulation.  Also used for luteal phase support.  Typically a single injection of 10,000 international units is used to induce ovulation.
In men:
Used to treat select cases of Hypogonadotropic Hypogonadism in adult males. Typical dosages are 500-1000IU three times weekly, or 4,000IU three times weekly for 6–9 months until atrophy is reversed and the dose is reduced to 2,000IU three times weekly. These doses are starting guidelines for treatment, and variable depending on individual response. In off-label use, some urologists prescribe hCG in low doses in combination with Testosterone replacement to preserve fertility.In male children: Also used to treat prepubertal cryptorchidism not due to anatomical obstruction. therapy is usually administered between ages 4 and 9.

Urinary preparations
Derived from the urine of pregnant women.

Generic
(human) chorionic gonadotropin for injection, USPBrands
Pregnyl (Merck/Schering-Plough)
Follutein
Profasi
Novarel

Recombinant preparations
Generic
choriogonadotropin alfa for injection (recombinant human Chorionic Gonadotropin, r-hCG).
Brands
Ovidrel


== References ==