FSH and hCG dual therapy may result in the more rapid recovery of sperm to the ejaculate

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madman

Super Moderator
024 Dual Therapy with rFSH and HCG Results in a Significantly Shorter Time to Return of Spermatogenesis than Combination HCG and Clomiphene (2021)
K. Campbell, J. Sullivan, R. Valero Carrion, J. Kraus, B. Stocks, A. Lawrence, L. Lipshultz


Introduction: The use of testosterone replacement therapy (TRT) for hypogonadism continues to grow and more younger men are now receiving treatment. With the use of exogenous TRT, the hypothalamic-pituitary-gonadal axis becomes quiescent and endogenous testosterone production ceases. In addition, in most men, there is a halting of sperm production by the testis. In men who have previously taken TRT and now desire fertility, various pharmacological agents are employed to “reboot” endogenous T and restore spermatogenesis. It has previously been reported that human chorionic gonadotropin (hCG) in addition to selective estrogen receptor modulators (SERMs) such as clomiphene citrate has been shown to result in the return of sperm to the ejaculate in testosterone-induced azoospermia. Additionally, recombinant follicle-stimulating hormone (rFSH) has been used to potentiate Sertoli cell function recovery and sperm production. Studies have also shown the effectiveness of adding rFSH to HCG as a substitute for Clomiphene.

Objective: To assess the efficacy of using either FSH or clomiphene citrate in conjunction with hCG, in restoring sperm production in azoospermic men who have been treated with TRT for hypogonadism.

Methods: The study population consisted of men presenting to a single tertiary referral men’s health clinic with the following profiles: 1) desire to “reboot” and recover natural spermatogenesis, 2) previous exogenous TRT, and 3) evidence of azoospermia on initial presenting semen analysis. A retrospective chart review was performed of 40 patients prescribed high-dose hCG and clomiphene and 40 patients using hCG and FSH. Patients were identified by the type of reboot protocol used, initial total motile sperm count, and time to recovery of spermatogenesis. Demographic characteristics, relevant medical comorbidities, previous reboot cycle, and serum hormonal profiles were included. Exclusion criteria included lack of initial semen parameters and/or hormonal panel, non-testosterone-induced hypogonadism, and concomitant therapy.

Results: Once exclusion criteria had been applied, azoospermic patients undergoing reboot protocol with FSH (5) were noted to have a faster return of sperm to the ejaculate than those on clomiphene (5). The results were 5.5 months and 14.8 months, respectively. Additionally, a review of all patients who previously had failed reboot on clomiphene and underwent a second reboot on FSH revealed a 100% pregnancy rate (5/5).

Conclusions: Our results reiterate that FSH in combination with hCG may be considered as an alternative to combination hCG and clomiphene in the treatment of testosterone-induced azoospermia. FSH and hCG dual therapy may result in the more rapid recovery of sperm to the ejaculate being three times faster in the FSH group. Additionally, patients who have failed dual therapy with hCG and clomiphene should be considered for subsequent FSH.
 
Defy Medical TRT clinic doctor

Nelson Vergel

Founder, ExcelMale.com
Too bad FSH is so expensive.




 

madman

Super Moderator
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Simbarn

Active Member
Too bad FSH is so expensive.




Indeed!
 
@madman Would you say coming off testosterone would still be best in terms of regaining fertility? Or would fertility times be similar without test as they would be with 100mg weekly trt?
 

madman

Super Moderator
@madman Would you say coming off testosterone would still be best in terms of regaining fertility? Or would fertility times be similar without test as they would be with 100mg weekly trt?

Have you ever had a standard SA done?

Your best bet is to seek out a fertility specialist.

Many men can still maintain fertility while on TRT combined with hCG.

T + hCG + rFSH would be even better in most cases.

Even then depending on the individual, some may do better coming off testosterone.

If you have already tried both protocols while using exogenous T and are still struggling then I would seek out a fertility specialist!





*In their current iterations, home-based semen analysis devices cannot be regarded as a complete replacement for the standard semen analysis conducted in a laboratory setting, and certainly not a substitute for consultation with a fertility specialist. While the at-home semen assay kits we reviewed displayed a high level of accuracy at an affordable price, they only tested sperm concentration or motility. Sperm morphology and other important parameters impacting potential fertility are not tested. Thus, at-home assays should not be recommended as the sole test for male factor infertility in couples seeking pregnancy. However, these kits can still be effectively used to detect possible seminal defects early on instead of spending extensive time waiting for natural pregnancy to occur [32]. In this regard, home-based semen analysis kits can serve the role of an indicator to pursue additional evaluation or fertility assistance for patients who do present with suboptimal sperm concentration or motility according to the home test. It should also be emphasized to consumers of these products the potential for false-negative results and that additional testing in a clinic may still be necessary. Home-based semen analysis may have the greatest benefit for post-vasectomy patients where sperm count is of the most importance, through the option to test at home increasing compliance because of its convenience [14].






 
Have you ever had a standard SA done?

Your best bet is to seek out a fertility specialist.

Many men can still maintain fertility while on TRT combined with hCG.

T + hCG + rFSH would be even better in most cases.

Even then depending on the individual, some may do better coming off testosterone.

If you have already tried both protocols while using exogenous T and are still struggling then I would seek out a fertility specialist!





*In their current iterations, home-based semen analysis devices cannot be regarded as a complete replacement for the standard semen analysis conducted in a laboratory setting, and certainly not a substitute for consultation with a fertility specialist. While the at-home semen assay kits we reviewed displayed a high level of accuracy at an affordable price, they only tested sperm concentration or motility. Sperm morphology and other important parameters impacting potential fertility are not tested. Thus, at-home assays should not be recommended as the sole test for male factor infertility in couples seeking pregnancy. However, these kits can still be effectively used to detect possible seminal defects early on instead of spending extensive time waiting for natural pregnancy to occur [32]. In this regard, home-based semen analysis kits can serve the role of an indicator to pursue additional evaluation or fertility assistance for patients who do present with suboptimal sperm concentration or motility according to the home test. It should also be emphasized to consumers of these products the potential for false-negative results and that additional testing in a clinic may still be necessary. Home-based semen analysis may have the greatest benefit for post-vasectomy patients where sperm count is of the most importance, through the option to test at home increasing compliance because of its convenience [14].






We achieved pregnancy a little over 2 years ago while staying on trt with hcg and FSH. It took every bit of 8+ months to achieve this. I’m currently on hmg and hcg trying for baby number 2.

I’ve done an at home test (yo) and I’m low and there is very little activity on the video. Been on hmg/hcg for a couple of months. I dropped trt two weeks ago in hopes it will speed up fertility


My question is…

Is it more beneficial to drop test even while on hmg to achieve fertility as soon as possible or is there little difference in staying on 100mg?
 

madman

Super Moderator
We achieved pregnancy a little over 2 years ago while staying on trt with hcg and FSH. It took every bit of 8+ months to achieve this. I’m currently on hmg and hcg trying for baby number 2.

I’ve done an at home test (yo) and I’m low and there is very little activity on the video. Been on hmg/hcg for a couple of months. I dropped trt two weeks ago in hopes it will speed up fertility


My question is…

Is it more beneficial to drop test even while on hmg to achieve fertility as soon as possible or is there little difference in staying on 100mg?

Most in the know would recommend coming off testosterone.


*For patients who desire a pregnancy within 6 months, TST should be discontinued immediately and therapy initiated with 3000 IU hCG every other day, with or without 25 mg daily clomiphene citrate, and a semen analysis obtained every 2 months. If semen parameters do not improve sufficiently and FSH remains suppressed, rhFSH at 75 IU every other day may be added with discontinuation of clomiphene citrate. If the patient and his partner anticipate desired pregnancy in 6–12 months, TST may be started or continued with 500 IU hCG given every other day with or without clomiphene citrate at the aforementioned dose. For those patients desiring pregnancy in greater than 1 year, we recommend the patient cycles off TST every 6 months with a 4-week treatment cycle of 3000 IU hCG every other day.




Also, something to keep in mind:

*In some countries, a range of FSH formulations is currently accessible. FSH has traditionally been given in the form of hMG, obtained from postmenopausal women’s urine. Although hMG has both FSH and LH activity, FSH activity predominates, and LH activity is so low that fertility requires a combination of hCG and hMG. More recently, highly pure urinary FSH preparations have been created, with higher specific activity than hMG. Recombinant human FSH formulations have greater purity and specific activity than any urinary preparation and no inherent LH activity.
 
Most in the know would recommend coming off testosterone.


*For patients who desire a pregnancy within 6 months, TST should be discontinued immediately and therapy initiated with 3000 IU hCG every other day, with or without 25 mg daily clomiphene citrate, and a semen analysis obtained every 2 months. If semen parameters do not improve sufficiently and FSH remains suppressed, rhFSH at 75 IU every other day may be added with discontinuation of clomiphene citrate. If the patient and his partner anticipate desired pregnancy in 6–12 months, TST may be started or continued with 500 IU hCG given every other day with or without clomiphene citrate at the aforementioned dose. For those patients desiring pregnancy in greater than 1 year, we recommend the patient cycles off TST every 6 months with a 4-week treatment cycle of 3000 IU hCG every other day.




Also, something to keep in mind:

*In some countries, a range of FSH formulations is currently accessible. FSH has traditionally been given in the form of hMG, obtained from postmenopausal women’s urine. Although hMG has both FSH and LH activity, FSH activity predominates, and LH activity is so low that fertility requires a combination of hCG and hMG. More recently, highly pure urinary FSH preparations have been created, with higher specific activity than hMG. Recombinant human FSH formulations have greater purity and specific activity than any urinary preparation and no inherent LH activity.
Thank you for that info. So I can assume that FSH or hmg along with hcg would be a better route than clomid and hcg assuming hmg was in the budget?
 
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