Evaluating the Combination of Human Chorionic Gonadotropin and Clomiphene Citrate in Treatment of Male Hypogonadotropic Hypogonadism: A Prospective Study

Abstract

Background In this study, we evaluated MHH patients who wished to preserve fertility, assessing the efficacy of a short course (12 months) of a combined hCG +clomiphene citrate. Materials and Methods The cross-sectional study included 19 patients with hypogonadotropic hypogonadism who were admitted to the Andrology and Fertility Hospital of Hanoi between March 2016 and March 2018. Using hCG every three days in combination with clomiphene citrate 25mg per day until normal testosterone levels are reached, maintain the dose until spermatozoa are present. Results The mean age was 30.2 ± 5.6. Differences in penis length between the time before and after treatment were significant (p=0.005). The average dose of hCG using in our study was 5579 ± 1773.7 IU. After treatment 6 months and 12 months, the changes in clinical features in all patients and the total hypogonadotropic hypogonadism group were statistically significant (p<0.001). In particular, the differences in testosterone hormone levels in the partial hypogonadotropic hypogonadism group were also statistically significant (p=0.03). No adverse event was observed in our study. The number of patients appearing sperm in the semen is 9 patients (47.4%) after 12 months, but most of the sperm were completely deformed (<1%), and the average motility in the progressive motility group was below 8%. Conclusion In conclusion, a combination of hCG and clomiphene citrate may be an option for MHH patients who desired fertility. After 12 months, 47.4% of patients have sperm in semen but almost all of them were deformity. Hormone profile and secondary sexual characteristics improved significantly. There was no adverse event in our study that considered it as safe therapy.

Treatment progress of cryptozoospermia with Western Medicine and traditional Chinese medicine: A literature review

“…Exogenous LH supplementation, which most commonly involves human chorionic gonadotropin ( HCG ), is the most common method for regulating spermatogenesis and addresses the needs of a large proportion of patients with hypergonadotropic hypogonadism. 30 However, with the application of HCG and an expanded observation sample, its efficacy has also been challenged. Especially for sports patients, HCG was listed as a banned substance for male athletes by the World Anti‐Doping Agency ( WADA ); therefore, it has the potential to become a focus of debate and the beginning of conflicts between doctors and patients.…”

“…LH acts directly on the interstitial cells and promotes testosterone secretion. Exogenous LH supplementation, which most commonly involves human chorionic gonadotropin ( HCG ), is the most common method for regulating spermatogenesis and addresses the needs of a large proportion of patients with hypergonadotropic hypogonadism 30 . However, with the application of HCG and an expanded observation sample, its efficacy has also been challenged.…”

Uso de citrato de clomifeno e hCG no tratamento de hipogonadismo secundário: uma revisão integrativa

“…O tratamento prescrito atualmente na forma secundária é o uso de testosterona exógena, que gera aumento do feedback negativo no eixo hipotálamo-hipófise-gônadas, Brazilian Journal of Development, Curitiba, v.9, n.5, p. 17432-17445, may., 2023 ocasionando redução da produção de hormônio folículo estimulante (FSH), atrofia testicular e infertilidade (HABOUS et al, 2018;TRINH et al, 2021).…”

“…Dessa forma, não haveria atrofia testicular, nem interferência na espermatogênese, fato que se mostra muito importante principalmente para tratamento de homens jovens que desejam manter sua fertilidade (RAMASAMY et al, 2014;SOARES et al, 2018). No entanto, apesar de ter se mostrado seguro para o manejo a longo prazo do hipogonadismo, não há evidências sobre seu impacto no risco cardiovascular e metabólico, e mais estudos sobre seu uso em homens devem ser realizados (SOARES et al, 2018;TRINH et al, 2021).…”

“…Diversos estudos já mostraram a eficácia do hCG na reversão do hipogonadismo secundário e da infertilidade masculina (FINK et al, 2020;HABOUS et al, 2018;LA VIGNERA et al, 2015;TRINH et al, 2021), sendo os resultados dose dependentes, com doses de 250 a 500 UI apresentando resultados satisfatórios na restauração dos níveis fisiológicos intratesticulares de testosterona (FINK et al, 2020). A gonadotrofina coriônica humana (hCG) é um hormônio glicoproteico que funciona como um análogo do LH nos homens (TRINH et al, 2021), sendo capaz de se ligar nos receptores de LH nas células de Leydig localizadas no espaço intersticial dos testículos, estimulando esses receptores a fazerem uma atividade semelhante ao estímulo do próprio LH, que consiste na produção de testosterona . A própria produção de testosterona intratesticular já é um fator importante para a espermatogênese, tornando assim o hCG um fármaco útil para a reversão de infertilidade e de hipogonadismo (FINK et al, 2020).…”