From the Guidelines
Elevated human chorionic gonadotropin (hCG) levels are not typically a direct cause of male infertility, but rather hCG is used as a treatment for certain conditions that affect male fertility, such as hypogonadotropic hypogonadism (IHH) 1. The use of hCG in the treatment of IHH is aimed at stimulating testosterone production and spermatogenesis, with the degree of response correlating with the size of the testis prior to treatment 1. In the context of male infertility, the focus is on treating the underlying condition, and hCG therapy is a common approach for restoring testosterone production and spermatogenesis in patients with IHH 1. Key points to consider in the management of male infertility include:
- The potential negative effects of exogenous testosterone therapy on spermatogenesis, which can impair fertility 1
- The importance of counseling patients about the effects of testosterone therapy on fertility, especially those interested in pursuing family building in the near future 1
- The role of hCG and other medications, such as FSH injections, in the treatment of IHH and the restoration of spermatogenesis 1
- The consideration of referral for intrauterine insemination (IUI) or assisted reproductive technology (ART) if medical therapy fails to result in a pregnancy, but some sperm are found in the ejaculate 1.
From the Research
Relationship between elevated hCG and male infertility
- Elevated hCG levels have been found to be associated with impaired spermatogenesis in men with testicular cancer 2, 3, 4.
- Studies have shown that men with testicular cancer and elevated hCG levels have lower sperm concentration, total sperm count, and motility compared to those with normal hCG levels 2, 4.
- The presence of elevated hCG has been linked to suppressed gonadotropin response to Gn-RH, resulting in inhibition of LH and FSH secretion, which can further impair spermatogenesis 3.
- Additionally, elevated hCG has been associated with increased levels of testosterone, estradiol, and prolactin, which can also negatively impact semen quality 2, 3, 4.
Mechanisms underlying the relationship between hCG and male infertility
- The exact mechanisms by which elevated hCG affects male fertility are not fully understood, but it is thought that hCG may exert LH-like effects on the Leydig cells, leading to increased testosterone and estrogen production 2.
- Elevated hCG may also suppress the gonadotropin response to Gn-RH, resulting in decreased LH and FSH secretion, which can impair spermatogenesis 3.
- Other factors derived from the tumor, such as suppressive effects on the hypothalamic-pituitary-testicular axis, may also contribute to the impaired semen quality observed in men with testicular cancer 3.
Clinical implications
- The findings of these studies suggest that elevated hCG levels may be a marker of impaired spermatogenesis in men with testicular cancer, and that these patients may benefit from fertility preservation strategies such as sperm banking 2, 4.
- Further research is needed to fully understand the relationship between hCG and male infertility, and to develop effective treatments for men with testicular cancer and impaired fertility 5, 6.