Comparing Gonadotropin Potency

Gonadotropins are the workhorse of IVF stimulation. Multiple options exist, each with distinct properties. This guide helps patients understand the differences.

Quick Comparison

• Gonal-F / Puregon — rFSH from CHO cells. Standard, widely used.
• Menopur — hMG (FSH + LH from urine). Best for older patients or poor LH.
• Elonva — Long-acting FSH, one injection covers 7 days.
• Rekovelle — rFSH from human PER.C6 cells. Individualized AMH+weight dosing.

Potency Differences

Gonal-F and Puregon are functionally interchangeable. Rekovelle has a more acidic isoform profile, longer half-life, and higher potency per μg. Ferring recommends dosing by AMH and weight rather than IU-equivalence.

Menopur provides both FSH and LH activity — helpful in patients with low endogenous LH or poor response.

How Doctors Choose

• Young patient, normal AMH — rFSH alone (Gonal-F, Puregon, or Rekovelle)
• Older patient / poor responder — Add LH activity via Menopur or hMG
• PCOS / high OHSS risk — Rekovelle (individualized dose) with antagonist + GnRH agonist trigger
• Prefers fewer injections — Elonva for the first 7 days

Clinical Outcomes

Meta-analyses show no significant difference in pregnancy rates between rFSH and hMG. Rekovelle shows lower OHSS incidence while maintaining pregnancy rates.

No single "best" drug exists. Individualization based on age, AMH, weight, previous response, and OHSS risk is essential.