Menopur Risks, Warnings, and Complications

Abnormal Ovarian Enlargement: Menopur treatment can lead to abnormal enlargement of the ovaries. Your doctor will prescribe this medication at the lowest effective dose to minimize this risk. They will perform ultrasound monitoring and measure serum estradiol levels to assess ovarian response and individualize your therapy. If your ovaries show signs of abnormal enlargement on the last day of Menopur therapy, hCG will not be administered to lower the risk of ovarian hyperstimulation syndrome (OHSS). You may need to avoid sexual intercourse if you have significant ovarian enlargement because it can lead to rupture of the ovarian cysts and hemoperitoneum (leakage of blood into the abdominal cavity). 

Ovarian Hyperstimulation Syndrome (OHSS): OHSS is a complication of assisted reproductive technology (ART) that is separate from uncomplicated ovarian enlargement. OHSS can progress quickly and become serious. It is characterized by significantly increased vascular permeability (leaky blood vessels), resulting in rapid accumulation of fluid in the abdomen and chest cavities. Early warning signs of OHSS include severe pelvic pain, nausea, vomiting, and weight gain. Additional symptoms may include stomach pain, bloating, distention, vomiting, diarrhea, difficulty breathing, and reduced urination. OHSS occurs after Menopur has been discontinued and can develop rapidly, reaching its peak 7-10 days after treatment. Most of the time, it resolves spontaneously when menses start. If there is evidence of OHSS after Menopur therapy, your doctor will withhold hCG administration for ovulation induction. Rarely, OHSS can be more severe and prolonged (if pregnancy occurs) and may require hospitalization. 

Pulmonary and Vascular Complications: Gonadotropin therapy has been linked to serious pulmonary complications, including atelectasis (collapse of the lung), acute respiratory distress syndrome, and asthma exacerbation. In addition, gonadotropins can also cause thromboembolic events (blood clots) in association with or separately from OHSS. Women who have risk factors for blood clots, such as personal or family history of thrombosis, severe obesity, or blood disorders, are at an increased risk of this complication of gonadotropins. Blood clots can result in venous thrombophlebitis (vein inflammation), pulmonary embolism (blood clot in the lung), cerebral vascular occlusion (stroke), arterial occlusion resulting in limb loss, and rarely, myocardial infarction (heart attack). These complications of gonadotropins can be fatal. Your healthcare provider will carefully weigh the benefits versus risks of using Menopur. 

Ovarian Torsion: Ovarian torsion (twisting of the ovary) has been reported after gonadotropin therapy. Risk factors include OHSS, ovarian cysts, polycystic ovary syndrome (PCOS), pregnancy, previous abdominal surgery, or a past history of ovarian torsion. Tell your doctor immediately if you develop severe pelvic pain, nausea, and vomiting. Early diagnosis and detorsion is critical to limit damage to the ovary from a reduced blood supply.

Multiple Pregnancies: Menopur can cause multifetal gestation and births in approximately one-third of all successful pregnancies. Before beginning Menopur, your healthcare provider will counsel you and your partner about this possibility.

Congenital Malformations: The risk of congenital malformations (birth defects) is slightly higher after assisted reproductive technologies such as in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) compared to spontaneous conception. This risk may be due to factors such as maternal age, sperm quality, and maternal and paternal genetics, as well as multifetal gestations. However, there is no direct evidence linking the use of gonadotropins with an increased risk of congenital malformations.

Ectopic Pregnancy: Infertile women undergoing ART often have tubal abnormalities. Therefore, there is a risk that an ectopic pregnancy will occur (implantation of the fertilized egg outside the uterus). Your healthcare provider will perform β-hCG testing and transvaginal ultrasound for early confirmation of intrauterine pregnancy.

Spontaneous Abortion: The use of gonadotropins such as Menopur increases the risk of spontaneous abortion (miscarriage). However, no direct link has been established. This increased risk may be due to the underlying infertility.

Ovarian Neoplasms: There are rare reports of benign and malignant ovarian neoplasms in women who have taken multi-drug therapy for controlled ovarian stimulation. However, no direct link has been established between using Menopur and ovarian neoplasms.

Laboratory Tests: Menopur therapy results in follicular growth and maturation in the ovaries in most cases. If there is no endogenous LH surge, hCG is given when monitoring indicates sufficient follicular development. Monitoring for follicular maturation may include ultrasound alone or ultrasound combined with serum estradiol level measurement. This helps in timing the ovulatory trigger (hCG), detecting ovarian enlargement, and minimizing the risk of OHSS and multiple gestation. That’s why it’s very important to keep all your medical and laboratory appointments during Menopur therapy