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Pharmacologic class: Hormone
Therapeutic class: Exogenous gonadotropin
Pregnancy risk category X
Simulates action of follicle-stimulating hormone (FSH) by promoting follicular growth and maturation
Injection (powder or pellet for reconstitution): 75 international units luteinizing hormone (LH); 150 international units LH and 150 international units FSH activity/vial
Indications and dosages
➣ Controlled ovarian stimulation in patients with oligoanovulation
Women: Dosage individualized. Recommended dosage is 150 international units I.M. or subcutaneously daily during first 5 days of treatment, with subsequent dosages adjusted based on response. Adjust dosage no more often than every 2 days, and don't exceed 75 to 150 international units per adjustment. Maximum daily dosage is 450 international units. Dosing beyond 12 days is not recommended. If response is appropriate, human chorionic gonadotropin (hCG) should be given I.M. 1 day after last menotropins dose.
➣ Assisted reproductive technologies
Women: In patients who've received gonadotropin-releasing hormone agonists or antagonist pituitary suppression, recommended initial dosage is 225 international units I.M. or subcutaneously, with subsequent dosage adjustments based on response. Adjust dosage no more often than every 2 days, and don't exceed 75 to 150 international units per adjustment. Maximum daily dosage is 450 international units. Dosing beyond 12 days isn't recommended. Once adequate follicular development appears, hCG is given to induce follicular maturation in preparation for oocyte retrieval.
• Hypersensitivity to drug
• High FSH levels (indicating primary ovarian failure)
• Abnormal bleeding of undetermined origin
• Uncontrolled thyroid or adrenal dysfunction
• Organic intracranial lesion (such as pituitary tumor)
• Causes of infertility other than anovulation (unless patient is candidate for in vitro fertilization)
• Ovarian cysts or enlargement not caused by polycystic ovarian syndrome
Use cautiously in:
• renal or hepatic insufficiency (safety and efficacy not established)
• breastfeeding patients.
• Know that drug may be given either I.M. or subcutaneously.
• To reconstitute powder or pellet for injection, add accompanying 2 ml of 0.9% sodium chloride injection to vial.
• Inject immediately after reconstitution. Discard unused portion.
• Rotate injection sites.
• Use lower abdomen for subcutaneous injection.
• Withhold hCG if serum estradiol level exceeds 2,000 pg/ml or abdominal pain occurs.
CNS: headache, malaise, dizziness, cerebrovascular accident
CV: tachycardia, venous thrombophlebitis, arterial occlusion, arterial thromboembolism
GI: nausea, vomiting, diarrhea, abdominal cramps and distention, hemoperitoneum
GU: ovarian enlargement with pain, gynecomastia, ovarian cysts, multiple births, ovarian hyperstimulation syndrome (OHSS), ectopic pregnancy
Metabolic: electrolyte imbalances
Musculoskeletal: muscle aches, joint pain
Respiratory: dyspnea, tachypnea, atelectasis, adult respiratory distress syndrome, pulmonary embolism, pulmonary infarction
Other: fever, hypersensitivity reaction, anaphylaxis
• Know that before starting menotropins/hCG therapy to induce ovulation and pregnancy, patient should undergo gynecologic and endocrine evaluation with hysterosalpingogram to rule out pregnancy and neoplastic lesions.
• Assess patient to confirm anovulation. Obtain urinary gonadotropin levels as ordered to rule out primary ovarian failure. (Male partner's fertility should be evaluated, also).
• In older females (who have greater risk of anovulatory disorders and endometrial cancer), assess cervical dilation and curettage results.
• Evaluate patient for expected ovarian stimulation without hyperstimulation.
☞ Monitor for early indications of OHSS-severe pelvic pain, nausea, vomiting, and weight gain. OHSS usually occurs 2 weeks after treatment ends, peaks 7 to 10 days after ovulation, and resolves with menses onset.
☞ If OHSS occurs, drug is withdrawn and patient is hospitalized for bed rest, fluid and electrolyte management, and analgesics. Monitor daily fluid intake and output, weight, abdominal girth, hematocrit, serum and urinary electrolytes, urine specific gravity, blood urea nitrogen, and creatinine. Watch for hemoconcentration caused by fluid loss into peritoneal, pleural, and pericardial cavities.
☞ Stay alert for pulmonary and thromboembolic complications.
• Assess male patient for pituitary insufficiency as possible cause of infertility.
• Before therapy, teach patient about duration of treatment and necessary monitoring.
• Inform patient about risk of multiple births with menotropins and hCG use.
• For infertile females, encourage daily intercourse starting on day before hCG administration.
• As appropriate, review all other significant and life-threatening adverse reactions.
Time/action profile (effects on reproductive function†)
|IM, subcut (women)||unknown||18 hr||unknown|
|IM (men)||unknown||4 mo||unknown|
Adverse Reactions/Side Effects
- thromboembolism (life-threatening)
- abdominal pain (most frequent)
- bloating (most frequent)
- pelvic pain (most frequent)
- multiple births
- ovarian enlargement
- gynecomastia (men)
Drug-Drug interactionNone significant.
- Female Infertility: Gynecologic and endocrine examinations to determine the cause of infertility should be completed before therapy. The patient’s partner should also be evaluated for possible decreased fertility. An endometrial biopsy should be performed in older patients to rule out the presence of endometrial carcinoma.
- Ultrasound exams are recommended during menotropin therapy and before administration of chorionic gonadotropin.
- Male Infertility: Urologic and endocrine examinations to determine the cause of infertility should be completed before therapy.
- Lab Test Considerations: In female infertility, cervical mucus volume and character, serum estradiol levels, serum or urine progesterone concentrations, and ultrasound may be used to determine whether follicular maturation has occurred.
- In male infertility, serum testosterone, sperm count, and motility should be evaluated before and after course of therapy.
Potential Nursing DiagnosesSexual dysfunction (Indications)
Disturbed body image (Indications)
- Female infertility—chorionic gonadotropin is usually administered 1 day after course of human menotropins. Male infertility—chorionic gonadotropin is administered alone until secondary sex characteristics develop, then administered concurrently with menotropins.
- Subcutaneous: Alternating sites in the lower abdomen should be used for subcut injection.
- Intramuscular: Reconstitute powder with 2-mL vial of 0.9% NaCl for injection provided by manufacturer. Use immediately; discard any unused portion of dose.
- Instruct patient in correct technique for medication reconstitution and administration of IM injection. Ensure that patient understands medication administration schedule.
- Female Infertility: Instruct patient in the correct method for measuring basal body temperature. A record of the daily basal body temperature should be maintained before and throughout course of therapy.
- Reinforce physician’s instructions regarding timing of sexual intercourse (usually daily beginning 1 day after administration of chorionic gonadotropin).
- Emphasize the importance of close monitoring by the physician throughout course of therapy (daily pelvic examinations are indicated after estrogen levels rise and for 2 wk after chorionic gonadotropin therapy).
- Inform patient before therapy of the potential for multiple births.
- Instruct patient to notify physician immediately if pregnancy is suspected (menses do not occur when expected and basal body temperature is biphasic).
- Advise patient to report to physician signs and symptoms of fluid retention (swelling of ankles and feet, weight gain), thromboembolic disorders (pain, swelling, tenderness in extremities, headache, chest pain, blurred vision), or abdominal or pelvic pain or bloating.
- Male Infertility: Inform patient that breast enlargement may occur. Physician should be consulted if this is problematic.
- Follicular maturation in women. Menotropin therapy is followed by human chorionic gonadotropin, which should lead to ovulation with subsequent pregnancy. If ovulation does not occur after any cycle, therapeutic regimen should be re-evaluated. If ovulation does not occur after 3 cycles, appropriateness of continuation of menotropin therapy should be reconsidered.
- Increased spermatogenesis after 4 mo of therapy in men.