HMG

Overview

HMG is the older sibling of recombinant FSH, originally purified from the urine of postmenopausal women (where LH and FSH rise because the ovaries have stopped responding). Each vial contains roughly equal LH and FSH activity, which makes it functionally distinct from HCG (LH-only) and from rFSH (FSH-only). In male fertility work, HMG is almost always added to HCG rather than used alone — HCG gives you the Leydig-cell signal, HMG gives you the Sertoli-cell support that drives mature spermatogenesis. The catch is patience: full sperm-parameter recovery on HCG + HMG takes 10–24 weeks, not 4, and escalating earlier than that mostly costs money rather than buying speed.

Evidence quality

Benefits & timeline

Dosage protocols

Titration & adjustment

Injection timing

2–3× weekly, same time-of-day each dose. Co-time with HCG if pairing — the two work synergistically and combining injection schedules is more convenient.

Side effects & contraindications

Reconstitution & injection

HMG comes lyophilised, typically 75 IU per vial. Reconstitute with 1 ml bacteriostatic water for 75 IU per ml. A 75 IU dose is the full ml, which is 100 units on a U-100 insulin syringe (use a longer-barrel insulin syringe or split into two 50-unit injections). Subcutaneous into abdomen or thigh. Refrigerate after reconstitution; use within 28 days. Like HCG, swirl gently — don't shake.

Open calculator pre-filled

Storage after reconstitution

Refrigerate at 2–8 °C after reconstitution. Do not freeze. Light-protected. Like HCG, hMG is a glycoprotein and thermolabile — 28–30 days at fridge temperature is the practical window. The dose is small (75 IU per injection typically), so reconstitution volume should match the dosing cadence; if you only inject 2–3 times per week, a smaller mix volume avoids carrying old solution into week 5.

Common mistakes

• Running HMG alone for fertility.

  Better approach: HMG contains LH activity, but the LH dose per ampoule is small relative to what HCG delivers. The proven protocol is HCG (LH signal) + HMG (FSH signal). Using HMG monotherapy in men is rarely effective and rarely indicated.

• Escalating dose at week 6 because counts haven't moved.

  Better approach: Spermatogenesis takes 10–24 weeks. The signal you added today doesn't show up in semen until those cells have matured through the cycle. Hold the dose at 75 IU two or three times weekly until at least week 12 before deciding whether to escalate.

• Stopping HMG the day a partner conceives.

  Better approach: If the goal is more than one child, or if sperm parameters are still climbing, stopping abruptly often resets the protocol. Many fertility specialists taper rather than stop cold, or maintain HCG monotherapy after HMG is withdrawn.

• Ignoring estradiol because 'HMG isn't HCG.'

  Better approach: HMG's LH activity also drives Leydig cells, and the combined HCG + HMG protocol stacks two LH signals. Estradiol can climb faster than expected. Check at 6 and 12 weeks.

Real-world tips

When something else is the better tool

• Recombinant FSH (Gonal-F, Follistim)

  Use instead when: Pure FSH supply is what you want, without the additional LH activity. Cleaner pharmacology, often cheaper per IU. The right pick when HCG is already supplying enough LH signal.

• HCG monotherapy

  Use instead when: Spermatogenesis is recovering steadily on HCG alone — common in men with shorter suppression histories. Adding HMG buys little when HCG is doing the job.

• SERM-based protocol (clomiphene/enclomiphene)

  Use instead when: The pituitary is suppressed but functional, and you want endogenous LH/FSH output instead of exogenous supply. Oral, lower cost, and often the first-line move in younger men.