Does Menotropin Cause Fatigue?
Fatigue is not a commonly reported adverse effect of menotropin therapy based on the FDA-approved prescribing information and clinical trial data.
Evidence from FDA Drug Label
The FDA prescribing information for MENOPUR (menotropin) does not list fatigue as a reported adverse reaction in controlled clinical trials 1. In two single-cycle, open-label trials involving 434 women undergoing IVF/ICSI, the adverse reactions occurring at ≥2% incidence included 1:
- Abdominal cramps (3.0%)
- Abdomen enlarged (2.3%)
- Abdominal pain (6.7%)
- Headache (6.2%)
- Injection site pain and reaction (3.9%)
- Ovarian Hyperstimulation Syndrome (6.2%)
In postmarketing surveillance, fatigue was reported as an adverse reaction, though the frequency and causal relationship to menotropin could not be reliably determined due to voluntary reporting from an uncertain population size 1.
Clinical Context for Special Populations
Women with Liver Disease
For women with impaired liver function undergoing fertility treatments, the clinical picture becomes more complex 2:
- Hypothalamic-pituitary dysfunction in liver disease is associated with diminished gonadotropin release and inadequate response to gonadotropin-releasing hormone agonists 2
- One retrospective review found that 1 out of 18 women with liver disease developed severe worsening of graft function with hormonal treatment during assisted reproduction 2
- Fatigue in this population is more likely attributable to underlying liver disease rather than menotropin itself, as advanced liver disease causes multiple metabolic derangements 2
Women with Allergic Reactions
The FDA label notes that menotropin can be tolerated in instances of severe allergic reaction to urine-derived products, and research suggests it may be better tolerated than older preparations 3. However:
- Hypersensitivity reactions including anaphylaxis have been reported in postmarketing surveillance 1
- Injection site reactions are common (3.9% in clinical trials), but newer formulations like Menopur cause significantly fewer injection site reactions compared to older preparations 4
Women with Renal Impairment
The safety, efficacy, and pharmacokinetics of menotropin in women with renal insufficiency have not been established 1. No specific data exist regarding fatigue risk in this population.
Common Pitfalls and Clinical Considerations
Do not attribute fatigue to menotropin without first ruling out other causes 1:
- Underlying medical conditions (liver disease, kidney disease, anemia)
- Concurrent medications
- Ovarian Hyperstimulation Syndrome (OHSS), which occurs in 6.2% of patients and can cause systemic symptoms 1
- Psychological stress associated with fertility treatment
- Hormonal fluctuations during the treatment cycle
The most clinically significant adverse effects to monitor are 1:
- OHSS (6.2% incidence)
- Multiple gestations
- Injection site reactions
- Headache (6.2% incidence)
- Abdominal pain and cramping
Bottom Line
Fatigue is not a well-established or commonly reported side effect of menotropin in controlled clinical trials, though it has been reported in postmarketing surveillance with uncertain causality 1. In women with liver or kidney dysfunction, fatigue is more likely related to the underlying organ dysfunction rather than the medication itself 2, 1. If fatigue develops during menotropin therapy, evaluate for OHSS, underlying medical conditions, and other medication effects before attributing it to menotropin 1.