What is the typical dose of human chorionic gonadotropin (hCG) for fertility treatments and hypogonadism?

Human Chorionic Gonadotropin (hCG) Dosing for Fertility and Hypogonadism

For fertility treatments, the standard dose of hCG is 5,000-10,000 IU administered intramuscularly as a single dose, while for hypogonadism in males, the typical dose is 500-2,500 IU administered 2-3 times weekly.

Dosing for Fertility Treatments

Ovulation Induction in Women

• Standard dose: 5,000-10,000 IU as a single intramuscular injection 1
• Typically administered one day following the last dose of menotropins/FSH in controlled ovarian stimulation protocols 2
• The 5,000 IU dose is generally sufficient to trigger ovulation, while 10,000 IU may be preferred for luteal phase support 3
• Administration timing: When at least three follicles >17mm are present with appropriately rising estradiol levels 2

Route of Administration

• Traditionally given intramuscularly, but subcutaneous administration is also effective:
  • Studies show similar serum hCG levels with both routes using 5,000 IU 4
  • Subcutaneous administration is well-tolerated and may be preferred for patient comfort
  • Caution: Subcutaneous administration may be less reliable in patients with BMI >30 4

Dosing for Male Hypogonadism

Hypogonadotropic Hypogonadism

• FDA-approved regimens: 1
  • 500-1,000 IU three times weekly for three weeks, followed by the same dose twice weekly for three weeks
  • 4,000 IU three times weekly for six to nine months, then reduced to 2,000 IU three times weekly for an additional three months

Clinical Practice Guidelines

• The AUA guideline recommends hCG injections of 500-2,500 IU administered 2-3 times weekly 2
• This regimen is particularly important for men wishing to maintain fertility, as exogenous testosterone therapy suppresses spermatogenesis 2
• Response to treatment correlates with testicular size prior to treatment 2

Treatment Outcomes

• Normalizes serum testosterone levels in most patients 5, 6
• Increases testicular volume in approximately 92% of patients 5
• Can initiate and maintain spermatogenesis in some patients even without FSH supplementation 5
• Comparable effectiveness to clomiphene citrate for testosterone restoration, with a 223% increase in testosterone levels after 3 months 6

Special Considerations

Cryptorchidism in Children

• Dosing options: 1
  • 4,000 IU three times weekly for three weeks
  • 5,000 IU every second day for four injections
  • 15 injections of 500-1,000 IU over six weeks
  • 500 IU three times weekly for four to six weeks

Prader-Willi Syndrome

• A therapeutic trial of hCG is indicated for treatment of undescended testes before surgery 2
• Benefits include increased scrotal size and partial normalization of phallus length 2

Important Clinical Pearls

1. Fertility preservation: hCG is preferred over exogenous testosterone for men with hypogonadism who wish to preserve fertility 2

2. Monitoring: Regular monitoring of testosterone levels is recommended to ensure adequate response

3. Combination therapy: For patients with inadequate response to hCG alone, addition of FSH (human menopausal gonadotropin or recombinant FSH) may be necessary 5

4. Prior testosterone use: Previous testosterone therapy does not appear to negatively impact response to hCG treatment 5

5. Storage: Use completely within 60 days after reconstitution and refrigerate after reconstitution 1