Daily Focus: HMG (Human Menopausal Gonadotropin) — A Decades-Old Fertility Workhorse Back in the Trial Spotlight

Human menopausal gonadotropin (hMG, menotropins) is a urine-derived preparation that delivers both follicle-stimulating hormone (FSH) and luteinizing hormone (LH) activity, with modern highly purified versions such as Menopur also carrying hCG-driven LH activity. It has been a core ovarian-stimulation drug in assisted reproduction for decades, and the long-running question has been whether that LH component offers any real advantage over recombinant FSH alone.

That question is getting a fresh look. The GRACE study (NCT07216742), a Phase 3, randomized, quadruple-masked trial listing an estimated 659 participants, is evaluating daily subcutaneous hMG with a primary endpoint of cumulative live birth after transfer of a single euploid (chromosomally normal) blastocyst over 12 months. Building the endpoint around euploid frozen transfers is notable: it attempts to separate any effect of the drug on egg and embryo competence from the confounding influence of embryo aneuploidy.

A second, smaller Phase 4 trial from Spain's Fundacion Dexeus (NCT07691073), listed with a September 2026 start, plans to randomize about 240 women aged 38 to 41 to two different rFSH-plus-hMG dosing strategies and compare embryo quality. Older patients are the group in whom clinicians most often add LH activity, yet the evidence for doing so remains mixed.

Historical head-to-head trials such as MEGASET and the earlier European and Israeli multicenter study generally found highly purified hMG broadly comparable to recombinant FSH on pregnancy outcomes, with differences in hormonal profiles and oocyte yield. hMG is a prescription fertility drug used under specialist supervision; the new trials are years from reporting, so current practice is unlikely to shift soon.