HMG injection in IVF and IUI: what it is, why it is used and how it is given

Watch on YouTube if the player does not load.

This video is in Hindi; the guide on this page is in English.

An IVF plan often starts with a box marked HMG 150, and many couples want to know what is inside it and why it is needed every day. In this video, in Hindi, our consultant opens an HMG 150 pack, shows the powder and the liquid used to mix it, and explains where the injection fits in an IVF cycle, from the first scan to the trigger. This guide covers the same ground in English. It is general information only: the medicine, the dose and the dates are always decided by your own doctor.

Pai Hospital is registered as a Level 2 ART clinic under the Assisted Reproductive Technology (Regulation) Act, 2021 (Reg. No. GA/AC/2022/12689/L2/South Goa/02, valid to 14 January 2030).

What is an HMG injection?

HMG stands for human menopausal gonadotropin. It is a purified hormone preparation that carries FSH (follicle stimulating hormone) activity and LH (luteinising hormone) activity, the same two hormones the brain sends to the ovaries each month. Its generic name is menotropin. In a natural cycle, the brain releases just enough FSH to grow one egg. A daily HMG injection raises that signal, so that several follicles (the small fluid sacs that each hold an egg) grow at the same time.

HMG is one of a family of injections called gonadotropins. The others include urinary FSH and recombinant FSH, which carry FSH alone. Which one is used, alone or in combination, is a choice the doctor makes for each woman; read IVF injections explained one by one for the whole group.

HMG injection uses

• IVF and ICSI. This is the main use. Several mature eggs are needed, because not every egg collected will be mature, fertilise and grow into an embryo.
• IUI cycles. A smaller dose may be used to grow one or two follicles, timed with the IUI.
• Ovulation induction. For women who do not ovulate with tablets, a low, carefully stepped dose can help one follicle grow.
• Egg freezing. The same injections are used to grow the eggs that are then frozen.

In the video, our consultant explains that HMG can be used in women in their early twenties and also in women over forty, as long as the ovaries can still respond. Age and the egg reserve, measured with an AMH blood test and a scan, help the doctor choose the dose.

The HMG 150 injection pack: what is inside

HMG is supplied in packs of different strengths. The strength is written in IU, international units, the way the strength of the hormone is measured, and the number on the box, such as the 150 of an HMG 150 pack, is the strength of one vial. In the video, the box holds two things: a small vial of white powder, which is the medicine, and an ampoule of liquid called the diluent. The powder is not injected as it is. It is first mixed with the diluent, and only then is it ready.

Some women are prescribed more than one vial a day. In the video, our consultant explains that when two vials are needed on the same day, they can be mixed together and given as a single injection, so that there is one needle prick instead of two. Never change the number of vials yourself: follow the plan written for you.

How the HMG injection is mixed and given

1. Wash your hands and check the name, the strength and the expiry date on the box.
2. Draw the diluent into the syringe.
3. Add it to the powder vial and swirl gently until the powder has fully dissolved. Do not shake it hard.
4. Draw the whole dose back into the syringe.
5. Inject it under the skin of the tummy or the thigh, or into the muscle, exactly as your nurse has shown you.
6. Change the injection site from day to day.

HMG can be given into the muscle with a standard syringe, or under the skin with a fine insulin syringe; the doctor or nurse tells you which. Many women find the fine needle easier to manage. The first injection is usually given at the hospital, where the nurse shows you or your husband how to prepare the next ones.

When HMG starts and how long it runs

In the video, our consultant uses a simple chart of the cycle days to show the usual pattern:

• Day 1 or 2 of the period: a baseline scan checks the ovaries. If all is well, HMG starts.
• The first five days: one injection every day.
• Around day 7: a scan shows how the follicles have responded. Often the larger follicles are about 10 mm by then.
• After that: a scan every one or two days, and the dose is adjusted to the response.
• When the lead follicle reaches about 14 mm: a second daily injection is added to stop the eggs being released too early. Read about the cetrorelix injection.
• After about 10 to 12 days in all: when the lead follicle reaches about 18 mm, the trigger injection is given, and the eggs are collected about 35 to 36 hours later.

The scans that guide each step are explained in the follicular study. Every woman responds differently, so these numbers are a typical pattern, not a fixed timetable.

HMG vs highly purified HMG

A prescription may say HMG or HMG HP. Both are made from the same source and carry FSH and LH activity. The highly purified form goes through extra purification steps, so it carries fewer of the other proteins found in the plain form. Knowing the difference helps you understand what is written on your prescription. Both are used in IVF and in IUI, and which one suits your cycle is decided by the treating doctor. Brand names vary from one pharmacy to another; the generic name and the strength on the box are what matter.

Side effects, and when to call

Most women notice only mild effects: some bloating, a feeling of fullness low in the tummy, tender breasts, mood changes, or redness where the injection was given. Because several follicles are growing, the ovaries become larger for a while. A small number of women, especially those with PCOS or many follicles, can over-respond. This is called ovarian hyperstimulation syndrome (OHSS), and the scans and dose changes are there to keep that risk low.

Call the hospital at once if you have severe tummy pain, a quickly swelling tummy, vomiting, breathlessness, or you are passing very little urine.

About this guide

This guide is by the Pai Hospital Team. Pai Hospital is at Vaddem, Vasco-da-Gama, Goa, with its own operating theatre and IVF laboratory. Consultations are held in Panjim, Margao, Mapusa and Vasco; the scans, the egg collection and the embryo transfer are done at the hospital at Vaddem, Vasco-da-Gama. The fees for IVF and the other fertility treatments are on our IVF cost in Goa page.

This article is for education only and is not personal medical advice; please speak to your own doctor about your situation.

Your questions

Or call +91 95185 02773

This page is for general education and is not personal medical advice. Treatment depends on your own examination and reports, so please speak to a doctor about your situation. We do not carry out or offer sex determination of any kind.