What it is
HMG stands for Human Menopausal Gonadotropin. It is a hormone medicine that contains two signals the body normally sends to the testes: FSH and LH, in roughly equal amounts. It is extracted from the urine of women after menopause, because their bodies produce high levels of both hormones.
HMG matters because it fills a gap that HCG leaves open. HCG copies only the LH signal. That tells the testes to make testosterone, but it does nothing for the FSH signal, which is what drives sperm production. Men on testosterone therapy or recovering from steroid use have both signals switched off. HCG turns testosterone back on. If sperm counts still do not recover, the missing piece is FSH, and that is what HMG provides.
HMG has been used in fertility medicine since 1961, so it has more than 60 years of clinical history. Brand names include Menopur, Repronex and Merional. Newer lab-made FSH products such as Gonal-F have replaced it in many clinics, but HMG remains a practical and cheaper option, especially for men who need both hormone activities.
HMG is not normally used on its own. It is added to an existing HCG protocol when the goal is fertility and HCG alone has not done enough.
Human Menopausal Gonadotropin is a urinary-derived gonadotropin preparation providing follicle-stimulating hormone and luteinising hormone activity in approximately a 1:1 ratio. It is extracted from the urine of postmenopausal women, whose elevated endogenous gonadotropin output provides a concentrated source of both hormones.
HMG addresses a limitation of HCG. HCG acts as an LH mimetic at the Leydig cell LH receptor and stimulates intratesticular testosterone, but it carries no FSH activity. FSH acts on Sertoli cells and is the primary driver of spermatogenesis. In men on TRT or recovering from anabolic steroid use, both LH and FSH are suppressed by negative feedback. HCG restores the testosterone axis; when spermatogenesis fails to recover, FSH deficiency is the remaining bottleneck, and HMG supplies it.
HMG entered clinical use in 1961 and has been a cornerstone of fertility medicine for over 60 years. Brand names include Menopur, Repronex and Merional. Recombinant FSH products such as Gonal-F have largely displaced HMG in many fertility clinics, but HMG remains a cost-effective option where both gonadotropin activities are wanted, particularly in male fertility protocols.
HMG is not a standalone compound in men. It is layered onto an established HCG protocol when fertility is the goal and HCG alone has not produced adequate sperm recovery.
How it works
The testes do two separate jobs, handled by two types of cell.
Leydig cells respond to LH and make testosterone. Sertoli cells respond to FSH and build the environment that developing sperm need to mature. Sperm production needs both. The Sertoli cells need the FSH signal to do their work, and they also need a high local supply of testosterone from the Leydig cells next to them. If either is missing, sperm production stalls.
When a man takes testosterone from outside the body, the brain stops sending both LH and FSH. HCG can replace the LH signal and get testosterone production going again, but it gives no FSH at all. For some men, the testosterone HCG restores is enough to support basic sperm production. For others, the lack of FSH is what holds them back.
HMG delivers both FSH and LH in one injection. The FSH part works on the Sertoli cells to support sperm production directly. The LH part works on the Leydig cells to make testosterone. Because men using HMG are usually also on HCG, the real gain from HMG comes from the FSH side.
The standard approach is simple. Start HCG first to bring testosterone back. If after 4 to 6 months sperm count has not recovered enough, add HMG (or a lab-made FSH) to supply the missing signal.
Testicular function is split between two cell populations. Leydig cells, located in the interstitium between the seminiferous tubules, respond to LH by producing testosterone. Sertoli cells, lining the seminiferous tubules, respond to FSH by maintaining the tubular environment and supporting germ cell maturation.
Spermatogenesis requires both systems. Sertoli cells need FSH stimulation to maintain the seminiferous tubules and nurture developing sperm through maturation, and they need high intratesticular testosterone concentrations supplied by adjacent Leydig cells. Without adequate FSH, Sertoli function fails; without adequate intratesticular testosterone, the tubular environment cannot support sperm development.
Exogenous testosterone suppresses both LH and FSH via negative feedback at the hypothalamus and pituitary. HCG substitutes for LH and restores intratesticular testosterone, but provides no FSH activity. In some men the intratesticular testosterone maintained by HCG suffices for basic spermatogenesis; in others FSH deficiency is the limiting factor.
HMG provides both FSH and LH activity in a single injection. The FSH component acts directly on Sertoli cells to support spermatogenesis; the LH component acts on Leydig cells to drive testosterone production. Since HMG is typically co-administered with HCG, its primary contribution is the FSH component.
The clinical sequence is HCG first to restore testosterone production, then, if sperm count has not adequately recovered after 4 to 6 months, addition of HMG (or recombinant FSH) to supply the missing FSH stimulation.
What it does
HMG restarts sperm production in men whose testes have been switched off by testosterone therapy, steroid use, or a pituitary problem. It does this by supplying the FSH signal that HCG lacks, alongside extra LH.
In practice, HMG combined with HCG restores fertility in most men. A meta-analysis found that 78% of men with a genuine gonadotropin deficiency had some sperm return with combined HCG and FSH treatment, and the median time to first sperm appearing was 9 months. In one published series, 56% of men who wanted children achieved a pregnancy with their partner during treatment.
For men whose pituitary never worked properly, HMG plus HCG can even bring on puberty and establish fertility for the first time. This takes 12 to 24 months.
HMG does the same job as lab-made FSH products. Comparison studies show similar sperm recovery rates between the two, with neither clearly better. HMG is often the cheaper choice.
HMG induces or restores spermatogenesis in men with suppressed gonadotropin output, whether from TRT, anabolic steroid use, or congenital or acquired hypogonadotropic hypogonadism. Its FSH component drives Sertoli cell function, while its LH component adds to Leydig cell stimulation already provided by HCG.
Combined with HCG, HMG restores fertility in the majority of cases. A 2024 meta-analysis by Muir et al. in Clinical Endocrinology reported that 78% of men with pathologic gonadotropin deficiency achieved some sperm recovery on combined HCG and FSH therapy, with a median time to first sperm appearance of 9 months. After a median of 18 months, mean sperm concentration reached 11.6 million per millilitre; recovery rates were greater than 1 million (55%), greater than 5 million (36%), greater than 10 million (24%) and greater than 20 million (15%). Combined HCG plus FSH appeared more effective than HCG alone, and baseline testicular volume was the key predictor of response. In one published series, 56% of men desiring children achieved pregnancy during treatment.
In prepubertal-onset hypogonadotropic hypogonadism, HMG plus HCG can induce puberty and establish fertility de novo over 12 to 24 months.
HMG is clinically equivalent to recombinant FSH for male fertility. A 2019 comparison in 112 men after varicocelectomy showed a 57% pregnancy rate with HMG versus 62.5% with recombinant FSH, a difference that was not statistically significant; both outperformed HCG alone.
Benefits
Evidence grades: what the labels mean
- Human trials Supported by randomised or placebo-controlled human trials.
- Limited human data Some human evidence, such as pilot studies, case reports or observational data, but no controlled trials.
- Animal or lab only Shown in animal or cell studies only; not yet tested in people.
- Anecdotal No published studies; based on user reports or theory.
Each grade reflects the strongest published support for that specific claim, not for the compound as a whole.
- Provides both FSH and LH signals, filling the gap HCG leaves openHuman trials
- Restores sperm production in most men whose testes were suppressed by TRT or steroid use (78% showed some recovery in a meta-analysis)Limited human data
- Treats pituitary-caused hypogonadism and can induce puberty and fertility for the first timeHuman trials
- Works as well as lab-made FSH products at a potentially lower costLimited human data
- Pairs directly with an existing HCG protocol rather than replacing itLimited human data
- Complete gonadotropin support: FSH and LH activity in approximately a 1:1 ratio, the most physiologically complete gonadotropin replacement for suppressed pituitary functionHuman trials
- Fertility restoration: 78% of men with pathologic gonadotropin deficiency achieved some sperm recovery with combined HCG and FSH therapy, median time to first sperm 9 months (Muir et al., 2024)Limited human data
- Hypogonadotropic hypogonadism treatment: with HCG, restores reproductive function and can induce puberty in prepubertal-onset cases over 12 to 24 monthsHuman trials
- Alternative to recombinant FSH: equivalent spermatogenesis recovery rates with no clear superiority of either agent, often at lower costLimited human data
- Adds the FSH component that HCG monotherapy cannot supply, targeting Sertoli cell function directlyLimited human data
What to expect
HMG is slow. Each round of sperm production takes about 70 to 74 days, and it takes several rounds before real improvement shows up. Expect to be patient.
In the first month, do not expect any change in your semen results. The FSH signal is starting to act, but the effect on sperm output takes time.
By months 3 to 6, the first signs of sperm returning may appear. In published studies, the median time to first sperm was 9 months. Some men respond faster, some slower. Men with larger testes before treatment tend to respond sooner.
By months 6 to 12, sperm counts keep climbing. Published data shows counts above 5 million per millilitre after a median of 13 months, and above 10 million per millilitre after 18 months.
By months 12 to 24, sperm production usually peaks. Some men reach levels that allow natural pregnancy; others may still need fertility treatment. In one series, 56% of men who wanted children achieved a pregnancy during treatment.
Users report the timeline is the hardest part. Many expect results within weeks and feel discouraged at 2 to 3 months. Those who stick with it for 6 to 12 months generally report the best outcomes. Most men find HMG well tolerated, with injection site soreness the most common complaint.
HMG works on the timescale of spermatogenesis, which runs approximately 70 to 74 days per cycle. Multiple cycles are required before meaningful changes in semen parameters appear.
Month 1: no significant change in sperm parameters is expected. FSH stimulation of Sertoli cells has begun, but downstream effects on sperm output lag.
Months 3 to 6: first signs of sperm recovery may appear. Published median time to first sperm appearance is 9 months of gonadotropin treatment, with wide individual variation. Baseline testicular volume is the strongest predictor of response time; larger pre-treatment testes respond faster.
Months 6 to 12: sperm concentrations continue rising. Published data shows concentrations above 5 million per millilitre after a median of 13 months and above 10 million per millilitre after 18 months.
Months 12 to 24: maximum sperm production is typically reached. Some men achieve pregnancy-compatible parameters; others require assisted reproductive technology. In one published series, 56% of men who desired children achieved pregnancy during treatment.
In practice, the timeline is the most common source of frustration. Men who discontinue at 2 to 3 months because counts remain low miss the window; those who persist through 6 to 12 months report the best outcomes. HMG is generally well tolerated, with injection site discomfort the most frequent complaint and occasional mild mood changes or fatigue. Oestrogen-related effects are uncommon with HMG alone but can emerge alongside high-dose HCG.
Reconstitution and dosing
HMG is measured in IU, not milligrams. Each vial contains 75 IU of FSH activity and 75 IU of LH activity. Mix it with the diluent supplied or with bacteriostatic water, inject under the skin or into muscle, and use it promptly after mixing. The 150 IU step needs two 75 IU vials per injection.
HMG is added to HCG, not used alone. The usual sequence is:
Step 1: Start HCG alone at 1,500 to 2,000 IU weekly, split into 3 injections.
Step 2: Check testosterone and semen analysis for 4 to 6 months.
Step 3: If sperm count is still inadequate, add HMG at 75 IU three times weekly.
Step 4: If there is no response after another 4 to 6 months, increase to 150 IU three times weekly. Doses above 225 IU three times weekly are rarely needed.
Plan for 12 to 24 months in total to reach maximum sperm production. For men with a pituitary cause of low hormones, the pattern is the same: HCG 1,500 to 2,000 IU three times weekly for 4 to 6 months, then add HMG at 75 to 150 IU three times weekly, for 12 to 24 months.
Get a semen analysis every 3 months, and have testosterone and oestradiol checked. Oestrogen can rise, especially with high-dose HCG, so watch for breast tenderness or water retention.
HMG is dosed in IU. Vials contain 75 IU of FSH activity and 75 IU of LH activity as lyophilised powder, reconstituted with the provided diluent or bacteriostatic water for subcutaneous or intramuscular injection. Use promptly after reconstitution. The 150 IU step needs two 75 IU vials per injection.
Published doses in men: 75 IU three times weekly as the standard starting dose, added to an existing HCG protocol; escalation to 150 IU three times weekly if no response at 4 to 6 months. Doses above 225 IU three times weekly are rarely needed. Lee and Ramasamy (2018) recommended adding HMG at 75 IU every other day if HCG alone has not restored sperm production after 4 to 6 months, with a typical range of 75 to 150 IU three times weekly.
Standard fertility protocol: HCG alone at 1,500 to 2,000 IU weekly (split 3x/week); monitor testosterone and semen analysis for 4 to 6 months; if sperm count is inadequate, add HMG 75 IU three times weekly; if no response after 4 to 6 further months, increase to 150 IU three times weekly. Total duration 12 to 24 months for maximum sperm production.
Hypogonadotropic hypogonadism: HCG 1,500 to 2,000 IU three times weekly for 4 to 6 months, then add HMG 75 to 150 IU three times weekly; 12 to 24 months for maximum effect.
Monitoring: semen analysis every 3 months, testosterone and oestradiol, and clinical assessment of testicular volume. Oestradiol elevation is possible, particularly with high-dose HCG, and may present as gynaecomastia, water retention or breast tenderness; adjust doses if symptoms appear. No published human research supports HMG monotherapy in men.
Standard (fertility, with HCG), 75 IU vial
Mix with 1 mL (100 units) of bacteriostatic water.
0.75 IU per unit
Cycle: 12 to 24 months total · Frequency: 3 times weekly
| When | Dose | Draw | How often |
|---|---|---|---|
| Starting | 75 IU (one vial) | 100 units | 3 times weekly, added to HCG after 4 to 6 months |
| Full | 150 IU (two 75 IU vials) | 200 units(over 100 units: split across 2 syringes) | 3 times weekly, if no response after a further 4 to 6 months |
Standard (hypogonadotropic hypogonadism, with HCG), 75 IU vial
Mix with 1 mL (100 units) of bacteriostatic water.
0.75 IU per unit
Cycle: 12 to 24 months · Frequency: 3 times weekly
| When | Dose | Draw | How often |
|---|---|---|---|
| Starting | 75 IU (one vial) | 100 units | 3 times weekly, added after 4 to 6 months of HCG |
| Full | 150 IU (two 75 IU vials) | 200 units(over 100 units: split across 2 syringes) | 3 times weekly |
The calculator works in milligrams; this compound is dosed in IU, use the table.
Who should avoid it
- Anyone with a hormone-sensitive cancer. HMG raises sex hormone activity and should not be used.
- Anyone who has had an allergic reaction to HMG or anything in the vial.
- Men with primary hypogonadism, meaning the testes themselves have failed. HMG sends a signal to the testes. If the testes cannot answer that signal, it will not help.
- Use extra care if you tend to run high oestrogen. Get estradiol checked and watch for breast tenderness or water retention.
- Use extra care if you have a heart, liver, or kidney condition.
- Use extra care if you have a thyroid problem that is not under control.
- Hormone-sensitive malignancies. Gonadotropin stimulation raises testicular steroid output and is contraindicated.
- Known hypersensitivity to HMG or any excipient in the formulation.
- Primary hypogonadism (testicular failure). HMG acts on Leydig and Sertoli cells via LH and FSH receptors; testes incapable of responding to gonadotropin stimulation will not recover function regardless of dose.
- Caution in men prone to elevated oestradiol. Leydig cell stimulation increases aromatisable substrate, particularly when HMG is layered on high-dose HCG. Monitor oestradiol.
- Caution with cardiac, hepatic, or renal disease.
- Caution with uncontrolled thyroid disorders.
- Recommended monitoring: semen analysis every 3 months, testosterone and oestradiol levels, and clinical assessment of testicular volume.
Side effects
- Sore or irritated injection site. This is the most common complaint.
- Headache.
- Tiredness.
- Mood changes.
- Higher oestrogen, especially when used alongside a high dose of HCG. This can show up as breast tenderness, breast tissue growth, or water retention. If this happens, get estradiol checked and the doses reviewed.
- Ovarian hyperstimulation is a serious risk for women using HMG for fertility, but it does not apply to men.
- Injection site pain or irritation, the most frequently reported adverse effect.
- Headache, fatigue, and mood changes.
- Oestradiol elevation secondary to increased Leydig cell testosterone output and aromatisation, most pronounced when combined with high-dose HCG. Manifestations include gynaecomastia, water retention, and breast tenderness. Oestradiol monitoring and dose adjustment are indicated if symptoms emerge.
- Ovarian hyperstimulation syndrome is the principal serious adverse event in women but is not applicable to men; in men the primary serious concern is excessive oestrogen production under combined high-dose gonadotropin protocols.
- Overall, HMG is generally well tolerated in men at recommended doses across published studies.
What the evidence shows
HMG has been used in fertility medicine since 1961, so there is a long track record. Nearly all the evidence in men comes from studies where HMG or another FSH product was added to HCG. No published human research supports HMG on its own in men.
A 2024 meta-analysis (Muir et al., 2024) looked at men whose pituitary was not making enough of the fertility hormones. After a median of 18 months of gonadotropin treatment, the average sperm concentration reached 11.6 million per millilitre. 78% of men produced some sperm, 55% reached more than 1 million, 36% more than 5 million, 24% more than 10 million, and 15% more than 20 million. Adding FSH to HCG worked better than HCG alone. Men with larger testes at the start responded faster.
A 2019 study published in Medicine compared recombinant FSH, HCG, and HMG in 112 men after varicocele surgery. The HMG group saw better sperm movement and shape and a 57% pregnancy rate. The recombinant FSH group had a 62.5% pregnancy rate. Both beat HCG alone, and the difference between HMG and recombinant FSH was not statistically significant.
A 2018 review (Lee and Ramasamy, 2018) recommended adding HMG at 75 IU every other day if HCG alone has not restored sperm production after 4 to 6 months, with a usual range of 75 to 150 IU three times weekly.
A historical review (Lunenfeld, 2004) covers the development of HMG from the 1960s onward.
The bottom line: HMG works, but slowly, and only as part of a plan that includes HCG.
HMG has been in clinical use since 1961 (Lunenfeld, 2004). Every published dataset in men positions it as an FSH-providing adjunct to HCG in gonadotropin-deficient states; there is no published human evidence for HMG monotherapy in men.
The 2024 meta-analysis by Muir et al. in Clinical Endocrinology examined gonadotropin-induced spermatogenesis in men with pathologic gonadotropin deficiency. After a median of 18 months, mean sperm concentration reached 11.6 million per millilitre. Recovery thresholds: greater than 0 in 78%, greater than 1 million in 55%, greater than 5 million in 36%, greater than 10 million in 24%, and greater than 20 million in 15%. Combined HCG plus FSH outperformed HCG alone, and baseline testicular volume was the principal predictor of response. Median time to first sperm appearance was 9 months, with concentrations above 5 million per millilitre at a median of 13 months and above 10 million at 18 months.
A 2019 randomised comparison published in Medicine enrolled 112 men post-varicocelectomy across recombinant FSH, HCG, and HMG arms. HMG significantly improved motility and morphology with a 57% pregnancy rate; recombinant FSH improved all semen parameters with a 62.5% pregnancy rate. Both exceeded HCG alone, and the HMG versus recombinant FSH difference was not statistically significant.
Lee and Ramasamy (2018), Translational Andrology and Urology, recommend adding HMG at 75 IU every other day when HCG alone fails to restore spermatogenesis after 4 to 6 months, with a typical range of 75 to 150 IU three times weekly.
In one published series, 56% of men desiring children achieved partner pregnancy during treatment. Mechanistically, the FSH component acts on Sertoli cells to sustain the seminiferous tubule environment, while HCG-driven intratesticular testosterone from Leydig cells supplies the androgen milieu spermatogenesis requires.
User reports
From public forums
The biggest thing users report is frustration with how long it takes. Many expect changes within weeks and lose heart when sperm counts are still low at 2 to 3 months. Those who stick with it for 6 to 12 months generally report the best results.
Most users say HMG is easy to tolerate. A sore injection site is the most common complaint. Some mention mild mood changes or tiredness. Oestrogen-type effects are less common with HMG alone but do happen when it is combined with high-dose HCG.
Cost comes up a lot. Brand-name HMG such as Menopur can cost $75 to $150 or more per vial, and a protocol may use three vials a week for 6 to 24 months. Plan for that before starting.
The dominant theme in user reports is timeline mismatch. Expectations of a response within weeks collide with the 70 to 74 day spermatogenic cycle, and discouragement at 2 to 3 months is common. Users who persist for 6 to 12 months consistently report the best outcomes.
Tolerability is generally described as good. Injection site discomfort is the most frequent complaint, with mild mood changes and fatigue reported by some. Oestrogen-related effects are less commonly attributed to HMG alone but are reported when it is layered on high-dose HCG.
Cost is a frequently cited barrier. Brand-name products such as Menopur run $75 to $150 or more per vial, and protocols may consume three vials weekly across 6 to 24 months of treatment. In practice, HMG is substantially more expensive than HCG, which shapes the decision between HMG and recombinant FSH in many settings.
User reports are individual experiences submitted by site visitors. They are not medical advice, are not verified for accuracy, and do not reflect Amino Reference's views. Read the evidence section above and talk to a clinician. Full disclaimer.
Stacking
This is the standard pairing and HMG is not used without it. HCG tells the testes to make testosterone. HMG adds the FSH signal that drives sperm production. Together they cover both jobs the testes need to do. HCG is started first at 1,500 to 2,000 IU weekly, and HMG is added only if sperm count has not recovered after 4 to 6 months.
The canonical male fertility combination. HCG supplies LH-receptor stimulation of Leydig cells and maintains intratesticular testosterone; HMG contributes the FSH activity required for Sertoli cell support of spermatogenesis. HCG at 1,500 to 2,000 IU weekly is initiated first; HMG at 75 IU three times weekly is added after 4 to 6 months of inadequate sperm recovery, escalating to 150 IU three times weekly if needed. Combined HCG plus FSH outperformed HCG alone in Muir et al. (2024).
- Testosterone (TRT)
Some fertility recovery plans keep a reduced dose of TRT running alongside HCG and HMG. The aim is to keep testosterone high enough to feel well while the testes are coaxed back into producing sperm. This needs close management and regular blood work.
In some fertility recovery protocols a reduced TRT dose is continued with HCG and HMG to preserve systemic androgen levels for wellbeing while gonadotropins maintain testicular function. Exogenous testosterone continues to suppress endogenous LH and FSH via hypothalamic-pituitary negative feedback, so the gonadotropins carry the entire testicular signal. Requires careful management and regular monitoring of testosterone, oestradiol, and semen parameters.
- Recombinant FSH (Gonal-F, Follistim)
This is an alternative rather than something to add on top. For a man already on HCG, the useful part of HMG is its FSH. Recombinant FSH gives pure FSH without the extra LH. Studies show both work about the same. HMG is often cheaper; recombinant FSH allows more exact dosing.
A substitute for HMG rather than a co-administered agent. For men already receiving HCG, the therapeutic contribution of HMG is its FSH component; recombinant FSH delivers pure FSH activity without additional LH. Published comparisons show no statistically significant difference in spermatogenesis outcomes. HMG may be more cost-effective in some settings, while recombinant FSH offers more precise dosing.
Common questions
When is HMG needed instead of HCG alone?
HCG on its own is enough for most men who just want to keep testicular size and basic function during TRT. HMG is added when having a child is the goal and HCG alone has not brought sperm count back after 4 to 6 months. The FSH in HMG is what pushes sperm production when HCG is not enough.
HCG monotherapy suffices for most men seeking to preserve testicular volume and function on TRT. HMG is indicated when active fertility is the objective and HCG has not produced adequate spermatogenic recovery after 4 to 6 months; its FSH activity addresses the Sertoli cell deficit that LH-receptor stimulation alone cannot.
How long does HMG take to work?
A long time. Sperm take 70 to 74 days to develop, and it takes several rounds for numbers to build. First sperm may appear at around 9 months. Full production can take 12 to 24 months. Expect nothing in the first month and stay consistent.
Spermatogenesis runs a 70 to 74 day cycle and multiple cycles are needed for measurable change. Median time to first sperm appearance in published data was 9 months, with concentrations above 5 million per millilitre at a median of 13 months and above 10 million at 18 months. Maximum output typically requires 12 to 24 months.
Can HMG be used without HCG?
No. There is no published research supporting HMG on its own in men. It is always used together with HCG.
No published human research supports HMG monotherapy in men. All evidence involves combination with HCG to provide adequate LH stimulation alongside the FSH component.
Is HMG the same as recombinant FSH?
Not quite. HMG has both FSH and LH activity and comes from a natural source. Recombinant FSH is pure FSH made in a lab. Both work about the same for fertility. The choice usually comes down to cost and what is available.
No. HMG is urinary-derived with approximately 1:1 FSH and LH activity; recombinant FSH is synthetically produced pure FSH. Comparative studies show similar spermatogenesis outcomes with no clear superiority, so selection typically hinges on cost, availability, and dosing precision.
What dose of HMG is used?
The usual starting dose for men is 75 IU three times a week, added to an existing HCG plan. If nothing has changed after 4 to 6 months, it can go up to 150 IU three times a week. Going above 225 IU three times a week is rarely needed.
Standard initiation is 75 IU three times weekly layered on an established HCG protocol. Absent response at 4 to 6 months, escalate to 150 IU three times weekly. Doses above 225 IU three times weekly are rarely required.
What should be monitored during treatment?
Semen analysis every 3 months, plus blood tests for testosterone and estradiol. Testicle size should also be checked, since men with larger testes at the start tend to respond faster.
Semen analysis every 3 months, serum testosterone and oestradiol, and clinical assessment of testicular volume. Baseline testicular volume is the strongest predictor of response in Muir et al. (2024).
Why is HMG so expensive?
Brand-name HMG such as Menopur can cost $75 to $150 or more per vial, and a protocol may use three vials a week. Over 6 to 24 months that adds up. It is significantly more expensive than HCG.
Brand-name products such as Menopur run $75 to $150 or more per vial with protocols consuming up to three vials weekly over 6 to 24 months. HMG is substantially more expensive than HCG, which is why it is reserved for cases where HCG alone has failed to restore spermatogenesis.
References
- Muir CA, et al. Efficacy of Gonadotropin Treatment for Induction of Spermatogenesis in Men With Pathologic Gonadotropin Deficiency: A Meta-Analysis. Clinical Endocrinology. 2024.
- Lee JA, Ramasamy R. Indications for the use of human chorionic gonadotropic hormone for the management of infertility in hypogonadal men. Translational Andrology and Urology. 2018;7(Suppl 3):S348-S352.
- Lunenfeld B. Historical perspectives in gonadotropin therapy. Human Reproduction Update. 2004;10(6):453-467.
- Ramazanzadeh F, et al. Comparison of recombinant human follicle stimulating hormone, human chorionic gonadotropin, and human menopausal gonadotropin on semen parameters after varicocelectomy: a randomized clinical trial. Iranian Journal of Reproductive Medicine. 2014;12(8):555-560.
- Nieschlag E, Behre HM, Nieschlag S. Andrology: Male Reproductive Health and Dysfunction. 3rd ed. Berlin: Springer; 2010.
- Coviello AD, et al. Low-dose human chorionic gonadotropin maintains intratesticular testosterone in normal men with testosterone-induced gonadotropin suppression. Journal of Clinical Endocrinology and Metabolism. 2005;90(5):2595-2602.
This entry was written from additional reference material. Units are recomputed from the stated protocol.