Meriofert: Uses, Dosage & Side Effects

What Is Meriofert and What Is It Used For?

Meriofert contains the active substance menotropin, a highly purified preparation of human menopausal gonadotropin (hMG) extracted from the urine of postmenopausal women through an advanced purification process. Menotropin provides both follicle-stimulating hormone (FSH) and luteinizing hormone (LH) activity in a balanced 1:1 ratio, with each vial containing 75 International Units (IU) of FSH activity and 75 IU of LH activity. These two gonadotropins work in concert to stimulate the ovaries to grow and mature follicles, the fluid-filled structures that contain developing eggs (oocytes).

Follicle-stimulating hormone is the primary driver of follicular growth in the ovaries. It acts on granulosa cells, the cells that surround and nurture the developing oocyte within each follicle. FSH stimulates granulosa cells to proliferate, produce estradiol (the primary form of estrogen), and express receptors for luteinizing hormone. Without adequate FSH stimulation, follicles cannot develop beyond the early antral stage and will undergo atresia (programmed cell death). Luteinizing hormone, on the other hand, acts primarily on theca cells, which form the outer layer of the follicle. Theca cells produce androgens (primarily androstenedione and testosterone) in response to LH stimulation. These androgens are then transported to granulosa cells, where they are converted to estradiol by the enzyme aromatase under FSH regulation. This two-cell, two-gonadotropin model of follicular steroidogenesis is fundamental to understanding how Meriofert works.

The combined FSH and LH activity provided by Meriofert is considered particularly beneficial for certain patient populations. While FSH alone can drive follicular growth, adequate LH activity is essential for optimal steroidogenesis, endometrial development, and oocyte maturation. Patients with profound LH deficiency (such as those with hypogonadotropic hypogonadism or those undergoing deep pituitary suppression with GnRH agonists) may particularly benefit from the LH component in Meriofert. Several clinical studies have suggested that the presence of LH activity during ovarian stimulation may improve oocyte quality, fertilization rates, and endometrial receptivity in certain patient subgroups.

Meriofert is indicated for the following clinical situations:

• Ovulation induction: For women who are unable to ovulate naturally (anovulation) and have not responded to first-line treatment with clomiphene citrate. This includes women with World Health Organization (WHO) Group II anovulatory infertility, particularly polycystic ovary syndrome (PCOS), as well as women with WHO Group I anovulation (hypogonadotropic hypogonadism) who have insufficient endogenous gonadotropins.
• Controlled ovarian stimulation for ART: For stimulating the development of multiple follicles in women undergoing assisted reproductive technology procedures, including in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), and gamete intrafallopian transfer (GIFT). In these protocols, the goal is to retrieve multiple mature oocytes to maximize the chances of successful fertilization and embryo development.
• Controlled ovarian stimulation for intrauterine insemination (IUI): For mild ovarian stimulation in conjunction with timed intercourse or intrauterine insemination in couples with unexplained infertility or mild male factor infertility.

The development of gonadotropin therapy represents one of the most significant milestones in reproductive medicine. The original hMG preparations were first introduced in the 1960s and have undergone continuous refinement in purification technology. Meriofert represents a modern, highly purified hMG preparation with consistent batch-to-batch quality and low levels of urinary contaminants. The high purification level allows for subcutaneous administration, which is more convenient for patients compared to the intramuscular route required by older, less purified preparations.

What Should You Know Before Taking Meriofert?

Contraindications

Meriofert must not be used in the following situations, as treatment could be ineffective or pose significant health risks:

• Hypersensitivity: Known allergy to menotropin, FSH, LH, human chorionic gonadotropin (hCG), or any of the excipients in the formulation. Allergic reactions to gonadotropin preparations can range from mild injection site reactions to serious systemic hypersensitivity.
• Ovarian enlargement or cysts: Enlarged ovaries or ovarian cysts not caused by polycystic ovary syndrome, as gonadotropin stimulation could lead to further enlargement and potentially rupture or torsion (twisting) of the ovary.
• Unexplained vaginal bleeding: Undiagnosed gynecological bleeding must be investigated and the underlying cause identified before initiating gonadotropin therapy, as it may indicate uterine pathology including malignancy.
• Hormone-dependent tumors: Known or suspected tumors of the ovary, uterus, breast, hypothalamus, or pituitary gland that are stimulated by sex hormones. Gonadotropin therapy increases estrogen levels, which could accelerate the growth of hormone-dependent cancers.
• Primary ovarian insufficiency: Women whose ovaries have exhausted their follicular reserve (premature ovarian insufficiency or primary ovarian failure), as evidenced by elevated baseline FSH levels and absent antral follicles on ultrasound. Gonadotropin stimulation cannot recruit follicles when the ovarian reserve is depleted.
• Uterine malformations: Severe uterine abnormalities that are incompatible with pregnancy, as the purpose of fertility treatment would be undermined.
• Uterine fibroids: Fibroids that are incompatible with pregnancy due to their size, location, or number.
• Pregnancy and breastfeeding: Meriofert is absolutely contraindicated during pregnancy and breastfeeding. There is no therapeutic indication for gonadotropin use during pregnancy.

Warnings and Precautions

Before starting treatment with Meriofert, your fertility specialist will conduct a thorough evaluation including:

• Complete fertility assessment: Both partners should undergo a comprehensive fertility workup, including semen analysis for the male partner, assessment of tubal patency (fallopian tube function), evaluation of the uterine cavity, and hormonal profile testing.
• Ovarian reserve testing: Assessment of your ovarian reserve through measurement of anti-Müllerian hormone (AMH), antral follicle count (AFC) on ultrasound, and baseline FSH and estradiol levels. This helps determine the appropriate starting dose and predict your likely response to stimulation.
• Thyroid and adrenal function: Thyroid disorders and adrenal gland abnormalities should be identified and treated before starting gonadotropin therapy, as they can affect fertility and ovarian response.
• Hyperprolactinemia: Elevated prolactin levels should be corrected before starting treatment, as high prolactin can impair ovarian response and ovulation.

During treatment, the following risks must be carefully managed through monitoring:

Ovarian hyperstimulation syndrome (OHSS) is the most serious complication associated with gonadotropin therapy. Mild OHSS occurs in up to 20% of stimulation cycles and is characterized by mild abdominal distension, discomfort, and ovarian enlargement. Moderate OHSS involves more pronounced symptoms with nausea, vomiting, and ultrasonographic evidence of ascites (fluid in the abdomen). Severe OHSS, which occurs in 1–5% of ART cycles, is a medical emergency characterized by massive ovarian enlargement (ovaries greater than 12 cm in diameter), large-volume ascites, pleural effusion (fluid around the lungs), hemoconcentration, electrolyte imbalances, hypercoagulability with risk of thromboembolism, renal insufficiency, and in rare cases, death. Risk factors for OHSS include young age, low body weight, polycystic ovary syndrome, high antral follicle count, high AMH levels, previous episodes of OHSS, and rapidly rising or elevated estradiol levels during stimulation.

Multiple pregnancy is a well-known consequence of gonadotropin therapy, particularly in ovulation induction cycles where multiple follicles may develop and ovulate. Multiple pregnancies carry significantly higher risks for both the mother and the babies, including premature delivery, low birth weight, pre-eclampsia, gestational diabetes, postpartum hemorrhage, and neonatal complications. In ART cycles, the risk of multiple pregnancy is primarily managed through embryo transfer policy (single embryo transfer is recommended in most cases). In ovulation induction and IUI cycles, cycle cancellation is recommended when more than 2–3 follicles reach mature size (typically 17–18 mm in diameter).

Ectopic pregnancy: Women undergoing fertility treatment have a slightly increased risk of ectopic pregnancy (implantation outside the uterus, usually in the fallopian tube), particularly if they have a history of tubal disease. Early ultrasound confirmation of intrauterine pregnancy is important.

Ovarian torsion: Enlarged ovaries resulting from stimulation are at increased risk of torsion (twisting on their blood supply), which is a surgical emergency. Patients should avoid vigorous physical activity during and immediately after ovarian stimulation.

Pregnancy and Breastfeeding

Meriofert is contraindicated during pregnancy and should not be used once pregnancy is confirmed. While there is no evidence that inadvertent exposure to gonadotropins during early pregnancy causes birth defects, there is no therapeutic indication for their use in pregnant women. If pregnancy occurs during an ovulation induction cycle, treatment must be discontinued immediately.

Meriofert should not be used during breastfeeding. It is not known whether menotropin or its components are excreted in human breast milk. Furthermore, lactation is typically associated with suppressed ovarian function, and gonadotropin therapy during breastfeeding would be inappropriate. Women who wish to undergo fertility treatment should complete breastfeeding before starting a stimulation cycle.

Thromboembolic Events

Women undergoing ovarian stimulation, and particularly those who develop OHSS, are at increased risk of thromboembolic events (blood clots in veins or arteries). These events can occur during treatment or in the early weeks of pregnancy. Risk factors include obesity, personal or family history of thromboembolism, thrombophilia (inherited clotting disorders), immobilization, and OHSS. Patients at high risk may be prescribed prophylactic anticoagulant therapy (such as low-molecular-weight heparin) during and after ovarian stimulation. Report any symptoms of thromboembolism (leg swelling, pain, redness, chest pain, shortness of breath) immediately.

How Does Meriofert Interact with Other Drugs?

Meriofert, as a protein hormone preparation, is not metabolized by cytochrome P450 (CYP) enzymes in the liver. Therefore, it does not have the typical pharmacokinetic drug interactions seen with many small-molecule medications. However, there are several important pharmacodynamic interactions and co-medications that are relevant in the context of fertility treatment protocols:

Major Interactions

There are no absolute drug contraindications for co-administration with Meriofert in the traditional pharmacological sense. However, the use of clomiphene citrate prior to or concurrently with gonadotropin therapy can significantly amplify ovarian response. This combination (sometimes called a "sequential" or "step-up" protocol) requires particularly careful dose titration and monitoring, as the ovaries may respond more vigorously than expected, increasing the risk of OHSS and multiple pregnancy. The fertility specialist will determine whether such a combination is appropriate based on the patient's individual clinical profile.

Drugs that affect pituitary-gonadal axis function should be used with caution. High-dose corticosteroids, certain antipsychotic medications (particularly those that raise prolactin levels), and some antidepressants can potentially affect ovarian response to gonadotropin stimulation. Women taking these medications should inform their fertility specialist before starting treatment with Meriofert.

Minor Interactions

No clinically significant interactions have been identified between Meriofert and common over-the-counter medications, vitamins, or dietary supplements. However, patients are generally advised to inform their fertility specialist about all medications, supplements, and herbal products they are taking. Certain herbal supplements (such as vitex/chasteberry, dong quai, and black cohosh) may have hormonal effects and could theoretically influence ovarian response, although formal drug interaction studies have not been conducted.

Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen should generally be avoided during the periovulatory period, as they can inhibit ovulation through prostaglandin synthesis inhibition. Paracetamol (acetaminophen) is the preferred analgesic during fertility treatment if pain relief is needed.

What Is the Correct Dosage of Meriofert?

Meriofert dosing is one of the most critical aspects of fertility treatment and must be individualized for each patient. The goal is to stimulate the development of an optimal number of mature follicles while minimizing the risk of complications, particularly OHSS and multiple pregnancy. Your fertility specialist will determine your starting dose based on your age, body weight, ovarian reserve markers (AMH, antral follicle count, baseline FSH), previous response to gonadotropins, and the treatment indication. Doses are then adjusted during the stimulation cycle based on your individual ovarian response, as assessed by transvaginal ultrasound and serum estradiol measurements.

Adults

For ovulation induction, the recommended starting dose is 75–150 IU of Meriofert daily, administered by subcutaneous or intramuscular injection. Treatment typically begins on day 2 or 3 of the menstrual cycle (or at any time in patients with amenorrhea after excluding pregnancy). The dose is maintained for at least 7 days before the first assessment of ovarian response. If the response is insufficient (no follicular growth observed on ultrasound), the dose is increased by small increments of 37.5–75 IU at intervals of 7–14 days. This "low-dose step-up" protocol is designed to find the individual FSH threshold — the lowest dose that initiates follicular development — and minimize the risk of excessive response. Stimulation continues until one (or at most two or three) follicles reach a diameter of 17–18 mm on ultrasound. At this point, a single injection of human chorionic gonadotropin (hCG) is administered to trigger final oocyte maturation and ovulation.

For controlled ovarian stimulation in ART (IVF/ICSI), higher starting doses are typically used because the goal is to develop multiple follicles. The recommended starting dose is 150–225 IU daily, beginning on day 2 or 3 of the cycle (or after adequate pituitary suppression with a GnRH agonist). The dose is adjusted based on ultrasound assessment and estradiol levels, typically with monitoring visits every 2–3 days from around day 5–6 of stimulation. Treatment continues until multiple follicles reach a mean diameter of 17–18 mm, at which point hCG (or a GnRH agonist in antagonist protocols) is administered as the ovulation trigger, and oocyte retrieval is scheduled approximately 36 hours later.

Children

Meriofert is not indicated for use in children. Fertility treatment with gonadotropins is only appropriate for adults of reproductive age. There is no pediatric indication for menotropin, and it should not be used in individuals who have not completed puberty or who are under 18 years of age.

Elderly

Meriofert is not typically used in elderly patients, as its primary indication is fertility treatment in women of reproductive age. Ovarian response to gonadotropin stimulation decreases significantly with advancing age, particularly after age 40, due to declining ovarian reserve. Women over 40 who undergo gonadotropin stimulation typically require higher doses, have fewer follicles recruited, lower oocyte quality, and lower pregnancy rates. The decision to proceed with fertility treatment in women of advanced reproductive age should be made on an individual basis, considering the patient's ovarian reserve, overall health, and realistic expectations.

Missed Dose

If you miss a dose of Meriofert, contact your fertility clinic for specific instructions. The impact of a missed dose depends on the timing within your stimulation cycle. Generally, if you remember within a few hours, administer the injection as soon as possible. If it is nearly time for your next dose, your clinic may advise skipping the missed dose and continuing with your regular schedule. Do not double the dose to compensate for a missed injection. Missing a dose can affect follicular development and may require adjustment of your treatment plan, so prompt communication with your fertility team is essential.

Overdose

Overdose with Meriofert is primarily a concern in terms of ovarian overstimulation rather than systemic toxicity. An excessive dose can lead to the development of too many follicles and significantly increase the risk of severe OHSS and high-order multiple pregnancy. Acute overdose effects are not typically seen immediately but manifest over the following days as excessive follicular growth and rising estradiol levels.

If an overdose is suspected or if monitoring reveals an excessive response (too many large follicles or very high estradiol levels), the treatment cycle may need to be cancelled. The hCG trigger injection should be withheld, as administering hCG when the ovaries are hyperstimulated would dramatically increase the risk of severe OHSS. The patient should be advised to abstain from intercourse or use barrier contraception, and close monitoring for signs and symptoms of OHSS should continue for at least two weeks. There is no specific antidote for gonadotropin overdose; management is supportive and focused on preventing and treating OHSS if it develops.

What Are the Side Effects of Meriofert?

Like all medicines, Meriofert can cause side effects, although not everybody gets them. The side effects of gonadotropin therapy are primarily related to ovarian stimulation and the physiological consequences of elevated hormone levels. Most side effects are mild and temporary, resolving after treatment is completed. However, some can be serious and require immediate medical attention.

It is important to distinguish between expected pharmacological effects of the medication (such as mild ovarian enlargement and increased estradiol levels, which are the intended therapeutic response) and adverse effects that represent an undesirable extension of the pharmacological action (such as OHSS and multiple pregnancy). Your fertility specialist will monitor you carefully during treatment to detect and manage any adverse effects promptly.

Long-term safety data on gonadotropin therapy, including hMG preparations like Meriofert, have been reassuring. Large epidemiological studies and meta-analyses have not found a convincing association between fertility drug use and increased risk of ovarian, breast, endometrial, or other cancers, although continued surveillance is ongoing. The overall safety profile of highly purified hMG preparations is well-established through decades of clinical use and post-marketing surveillance involving millions of treatment cycles worldwide.

How Should You Store Meriofert?

Proper storage of Meriofert is essential to maintain its potency and safety. As a biological product containing protein hormones, Meriofert is sensitive to temperature extremes, light exposure, and microbial contamination once reconstituted. Follow these storage guidelines carefully:

• Unopened vials: Store below 25°C (77°F) in the original outer carton to protect from light. Do not refrigerate or freeze. The powder is stable at room temperature when stored according to these conditions.
• After reconstitution: The reconstituted solution should be used immediately. Meriofert does not contain preservatives, so any unused solution should be discarded after injection. Do not store reconstituted Meriofert for later use.
• Solvent vials: The solvent (sodium chloride solution for injection) should also be stored below 25°C. Inspect the solvent before use for clarity and absence of particles.
• Expiry date: Do not use Meriofert after the expiry date printed on the outer carton and vial label. The expiry date refers to the last day of that month.
• Disposal: Do not dispose of medications in wastewater or household waste. Ask your pharmacist how to dispose of medicines you no longer use, including used needles and syringes. These should be placed in a sharps container.

Before reconstitution, visually inspect the powder. It should be a white to off-white lyophilized (freeze-dried) powder or pellet. If the powder appears discolored, contains visible particles, or appears damaged, do not use the vial. After reconstitution with the provided solvent, the solution should be clear and free of visible particles. If the solution appears cloudy, contains particles, or is discolored, do not inject it and contact your pharmacist or fertility clinic.

Keep all medications, including Meriofert and its needles and syringes, out of the sight and reach of children. Store the medication in a cool, dry place away from direct sunlight and heat sources. Do not leave Meriofert in a car or other location where temperatures may exceed 25°C, as excessive heat can degrade the active hormones and reduce the medication's effectiveness.

What Does Meriofert Contain?

Active Ingredient

The active substance in Meriofert is menotropin (also known as highly purified human menopausal gonadotropin, HP-hMG). Each vial of Meriofert powder contains:

• Menotropin corresponding to 75 IU of follicle-stimulating hormone (FSH) activity
• Menotropin corresponding to 75 IU of luteinizing hormone (LH) activity

Menotropin is a complex mixture of glycoprotein hormones extracted from the urine of postmenopausal women. Postmenopausal women have elevated levels of FSH and LH in their urine because the negative feedback loop from ovarian hormones (estradiol and inhibin) is no longer active after menopause. The urine undergoes extensive purification using chromatographic techniques to produce a highly purified preparation with a high specific activity (ratio of biological activity to protein content). The high purification level of Meriofert minimizes the presence of urinary contaminant proteins, which contributes to improved tolerability and allows for subcutaneous administration.

Excipients

In addition to the active substance, Meriofert contains the following inactive ingredients (excipients) that serve various pharmaceutical functions:

• Lactose monohydrate: Used as a bulking agent and stabilizer for the lyophilized powder. Patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency, or glucose-galactose malabsorption should not take this medicine.
• Sodium hydroxide or hydrochloric acid: May be used for pH adjustment during manufacturing.

The solvent provided for reconstitution is:

• Sodium chloride 0.9% solution for injection: A sterile isotonic saline solution used to dissolve the powder before administration.

Meriofert does not contain preservatives. The reconstituted solution is for single use only. Multiple vials of powder can be dissolved in a single ampoule of solvent to reduce the injection volume when higher doses are prescribed, which can improve patient comfort. For example, if a dose of 225 IU is prescribed, three vials of Meriofert 75 IU can be reconstituted sequentially in a single 1 mL ampoule of solvent, allowing the entire dose to be administered as a single injection rather than three separate injections.