From the Guidelines
Low luteinizing hormone (LH) in men should be treated with human chorionic gonadotropin (hCG) injections or clomiphene citrate to boost testosterone production, as recommended by the most recent guidelines 1.
Treatment Options
- For men with hypogonadotropic hypogonadism (HH), treatment with exogenous gonadotropins or pulsatile GnRH can initiate and maintain spermatogenesis, with hCG injections typically initiated to normalize serum testosterone levels, followed by the addition of FSH or FSH analogues to optimize sperm production 1.
- Men with low LH may benefit from hCG injections (1,000-2,000 IU 2-3 times weekly) or clomiphene citrate (25-50mg daily) to boost testosterone production, as these treatments can help improve sperm concentration, pregnancy rate, and live birth rate 1.
- Lifestyle modifications, including maintaining a healthy weight, reducing stress, avoiding excessive exercise, and limiting alcohol, can also help normalize hormone levels and improve fertility outcomes 1.
Important Considerations
- Regular monitoring with blood tests is essential during treatment to ensure hormone levels reach appropriate targets without overstimulation 1.
- The use of supplements, such as antioxidants and vitamins, has limited benefits and questionable clinical utility in treating male infertility, and their use should be approached with caution 1.
- Men with low LH should be evaluated for underlying causes, such as hyperprolactinemia, and treated accordingly, with referral to an endocrinologist or male reproductive specialist encouraged in complex cases 1.
From the Research
Low Luteinizing Hormone
- Low luteinizing hormone (LH) levels can impact fertility treatment outcomes, particularly in assisted reproductive technology (ART) cycles 2.
- The use of gonadotropin-releasing hormone (GnRH)-agonist triggering has been introduced as an alternative to human chorionic gonadotropin (hCG) triggering, which may allow for a more physiologic surge of both LH and follicle-stimulating hormone (FSH) 2.
- Studies have shown that LH supplementation in GnRH antagonist cycles can have a positive impact on the number of retrieved oocytes and good-quality embryos, particularly in aged women (40 years old and over) 3.
- However, other studies have found that early increases in LH levels during the GnRH-A protocol may affect the number of oocytes retrieved, but not the clinical outcomes 4.
- In cases where patients experience a premature rise in LH during a GnRH antagonist cycle, clinical and ongoing pregnancy rates per embryo transfer (ET) have been found to be equivalent to those who do not have an early surge 5.
- The effect of letrozole overlapped with gonadotropin on IVF outcomes in women with diminished ovarian reserve (DOR) or advanced age has also been studied, with results showing that the modified letrozole protocol (mLP) may be effective in improving embryo quality, clinical pregnancy rate, and live birth rate 6.