What is the recommended dose of Human Chorionic Gonadotropin (HCG) for fertility treatments?

HCG Dosing for Fertility Treatment

For ovulation induction in assisted reproductive technology, administer 5,000-10,000 IU hCG intramuscularly or subcutaneously when at least three follicles reach >17 mm diameter with appropriately rising estradiol levels, followed by oocyte retrieval 36-38 hours later. 1, 2, 3

Female Fertility Treatment Dosing

Standard Ovulation Induction Protocol

• The American Society for Reproductive Medicine and European Society of Human Reproduction and Embryology endorse 5,000-10,000 IU hCG when follicular maturation criteria are met (≥3 follicles >17 mm with appropriately rising estradiol) 1, 2
• The FDA-approved dosing for anovulatory infertile women appropriately pretreated with menotropins is 5,000-10,000 IU one day following the last menotropin dose, with 10,000 IU specifically recommended in menotropin labeling 3
• Both intramuscular and subcutaneous routes are equally effective, with subcutaneous administration achieving comparable or higher serum beta-hCG concentrations and offering better patient tolerance 4

Timing Considerations for IUI

• When using hCG trigger for intrauterine insemination with ovarian stimulation, perform single IUI any time between 24-40 hours post-injection without compromising pregnancy rates 1, 5
• The mean time to ovulation after intramuscular hCG is 40.4 hours 5

Critical Safety Thresholds

• Withhold hCG administration when >2 dominant follicles >15 mm OR >5 follicles >10 mm are present to prevent high-order multiple gestations 1
• This safety measure is essential to avoid ovarian hyperstimulation syndrome and multiple pregnancy complications 1

Male Hypogonadotropic Hypogonadism Dosing

Initial Therapy Protocol

• The Endocrine Society recommends 500-2,500 IU hCG administered 2-3 times weekly for male hypogonadotropic hypogonadism 1, 2
• The FDA label provides alternative regimens: 500-1,000 IU three times weekly for 3 weeks followed by the same dose twice weekly for 3 weeks, or 4,000 IU three times weekly for 6-9 months 3
• Monitor serum testosterone response before adding FSH analogues 1

Fertility Preservation During Testosterone Therapy

• For hypogonadal men desiring fertility preservation while on testosterone replacement, administer 500 IU hCG intramuscularly every other day concomitantly with testosterone 6
• This low-dose protocol maintains intratesticular testosterone and preserves spermatogenesis, preventing azoospermia that occurs in 40% of men on testosterone monotherapy 6
• Never prescribe testosterone monotherapy to males interested in current or future fertility, as it suppresses spermatogenesis 2, 5

Route of Administration Considerations

• Subcutaneous self-administration produces comparable serum and salivary testosterone levels to intramuscular injection and is preferred by patients 7
• Both routes administered twice weekly can induce normal physiological diurnal testosterone rhythm in some hypogonadotropic patients 7

Pediatric Cryptorchidism Dosing

The FDA label provides multiple regimens for prepubertal cryptorchidism (ages 4-9 years) not due to anatomical obstruction 3:

• 4,000 IU three times weekly for 3 weeks
• 5,000 IU every second day for 4 injections
• 500-1,000 IU over 6 weeks (15 injections)
• If unsuccessful, repeat with 1,000 IU per injection one month later 3

Reconstitution and Storage

• Use reconstituted solution completely after preparation 3
• Reconstituted solution remains stable for 60 days when refrigerated 3
• Inspect visually for particulate matter and discoloration before administration 3

Common Pitfalls to Avoid

• Do not use hCG in males currently on or planning exogenous testosterone monotherapy without concurrent hCG, as this suppresses gonadotropin secretion and negates fertility benefits 2
• Avoid administering hCG when excessive follicular development occurs (>2 follicles >15 mm or >5 follicles >10 mm) to prevent multiple gestations 1
• For post-varicocelectomy patients, adding hCG 5,000 IU weekly for 3 months significantly improves pregnancy rates (61.5% vs 22.7%) compared to surgery alone 8