Short answer: Both are daily injections under the skin that stimulate the ovaries.12 Follistim AQ Cartridge (follitropin beta) is recombinant FSH given with a pen, approved for ovulation induction, IVF or ICSI, and sperm production in some men. Menopur (menotropins) has FSH and LH activity, is mixed from powder, and is approved for multiple follicle growth in IVF and other assisted reproduction. Neither label reports a trial against the other.
| Follistim AQ Cartridge | Menopur | |
|---|---|---|
| Drug | Follitropin beta, recombinant FSH1 | Menotropins, 75 IU FSH and 75 IU LH activity per vial2 |
| Approved for | Ovulation induction; IVF or ICSI in ovulatory women; sperm production in men with hypogonadotropic hypogonadism1 | Multiple follicle development and pregnancy in ovulatory women in an assisted reproduction cycle2 |
| Form | Ready-to-use cartridge, 300, 600 or 900 IU, used only with the Follistim Pen1 | Powder mixed with saline, injected under the skin of the abdomen2 |
| IVF starting dose | 200 IU daily for at least the first 7 days1 | 225 IU daily from cycle day 2 or 3, after GnRH agonist suppression2 |
| IVF limits | Up to 500 IU a day; usually 7 to 12 days1 | Up to 450 IU a day; no more than 20 days; changes no more than every 2 days and by 150 IU at most2 |
| OHSS in label IVF trials | 6.4% of 751 women1 | 6.2% of 434 women; 7.2% of 373 in the approval trial2 |
| Other common side effects | Pelvic discomfort 8.3%, headache 7.3%, pelvic pain 5.5%1 | Abdominal pain 6.7%, headache 6.2%, injection site pain and reaction 3.9%2 |
| Missed dose | Do not double the next dose; call the provider1 | Do not double the next dose; call the provider2 |
| Boxed warning | None1 | None2 |
The Follistim AQ label says the cartridge with the Follistim Pen delivers on average 18% more follitropin beta than reconstituted Follistim by syringe, so it gives a conversion table: for example, 150 IU by syringe becomes 125 IU by pen, and 225 IU becomes 175 IU. It says switching from other brands, types or methods of giving FSH may need a dose adjustment.1 The Menopur label allows Menopur to be mixed with Bravelle (urofollitropin) in the same syringe, with a total starting dose no higher than 225 IU.2
Both labels warn about abnormal ovarian enlargement, OHSS (which peaks about 7 to 10 days after treatment and is watched for at least two weeks after hCG), lung and blood vessel complications, ovarian torsion, multiple births, ectopic pregnancy and miscarriage. Both say hCG is withheld if the ovaries are abnormally enlarged at the end of stimulation.12 These numbers come from separate trials with different people, lengths and methods, so they are not a head-to-head comparison.
Which, if either, fits is for your prescriber. More detail: Follistim AQ side effects, Menopur side effects, the Follistim AQ and Menopur dosing schedules, the Menopur missed-dose page, Follistim AQ vs Gonal-f: how do the two FSH injections differ? and Menopur vs Gonal-f: what is the difference for IVF?.