Sperm result after 3 months of HCG. What would you do?

[rrodin]

Been on test since 2018.

My girl and I are planning to get pregnant.

First result showed very low sperm.

Added HCG at 1500 IU EOD.

After aprox 3 months these are the results.

Where would you go from here?

Is this good enough for IUI or is IVF prefered? Albeit IVF is very expensive and im sure - for her - an energy consuming process.

Should i add some hmg?

What is the best route of action here?

Thankyou

.

 

[rrodin]

Anyone?

 

[Systemlord]

What is your vitamin D level?

 

[rrodin]

Not sure never looked mage. Is that relaterade to fertility?

 

[Vince]

Stop TRT for now.

If I was in your shoes I would definitely first try clomid. I believe it will be the best bet for you to become fertile again. It appears that most do better with low dose clomid, 12.5mg everyday or every other day or sometimes twice a week.

You can buy it in Mexico or reliable RX plus there's a number of other places. You can receive it from at low cost.

 

[madman]

Been on test since 2018.

My girl and I are planning to get pregnant.

First result showed very low sperm.

Added HCG at 1500 IU EOD.

After aprox 3 months these are the results.

Where would you go from here?

Is this good enough for IUI or is IVF prefered? Albeit IVF is very expensive and im sure - for her - an energy consuming process.

Should i add some hmg?

What is the best route of action here?

Thankyou

View attachment 52068
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View attachment 52069

Did you have a fertility evaluation/ SA done prior to starting T-therapy?

Look into throwing in rFSH/hMG!

When fertility markers are still subpar 3 months after starting hCG then your best bet would be adding in FSH.

Thread 'Restoring Spermatogenesis: The Efficacy of Gonadotropin Treatment in Male Gonadotropin Deficiency'

May 22, 2025

* Gonadotropin treatment has dual roles, including hCG effects on Leydig cell luteinizing hormone (LH) receptors to increase testosterone production and FSH causes proliferative effects on Sertoli cells to support spermatogenesis within the seminiferous tubules [5].


* Treatment‐related increases in testosterone and testicular volume (TV) were not different between hCG and combined hCG/FSH treated patients, although increases in TV were lower in men with CHH compared with those with hypopituitarism.


* Despite similar effects on serum...

• madman
• hypogonadism; fertility/sperm; lh/fsh; pregnancy
• Replies: 6
• Forum: hCG, Clomid & Others for Fertility, PCT or Low T

Post in thread 'HCG restart attempt.'

Dec 16, 2021

@Cataceous

You’ve posted that study demonstrating that 1000iu EOD of HCG is the most effective for T production (a great study despite its small sample size so a big thank you for that).

Do you know of any studies that analyze the most effective HCG dosing protocol for sperm production

The combination of hCG + hMG or FSH may be more effective for improving sperm quantity/quality, and testicular volume.

hCG 500 IU 2-3 times/week or EOD.

Some men may need higher doses of hCG.

hMG or rhFSH at a dose of 75–150 IU 3 times/week or EOD.


* HCG can...

• madman

• 

 

[Systemlord]

Not sure never looked mage. Is that relaterade to fertility?

Yes, vitamin D has a big impact on sperm parameters. Vitamin D deficient men have significantly lower total mobility, sperm quality, motility and progressive sperm motility.

Vitamin D deficiency is associated with male infertility.

 

[rrodin]

Did you have a fertility evaluation/ SA done prior to starting T-therapy?

Look into throwing in rFSH/hMG!

When fertility markers are still subpar 3 months after starting hCG then your best bet would be adding in FSH.

Thread 'Restoring Spermatogenesis: The Efficacy of Gonadotropin Treatment in Male Gonadotropin Deficiency'

May 22, 2025

* Gonadotropin treatment has dual roles, including hCG effects on Leydig cell luteinizing hormone (LH) receptors to increase testosterone production and FSH causes proliferative effects on Sertoli cells to support spermatogenesis within the seminiferous tubules [5].


* Treatment‐related increases in testosterone and testicular volume (TV) were not different between hCG and combined hCG/FSH treated patients, although increases in TV were lower in men with CHH compared with those with hypopituitarism.


* Despite similar effects on serum...

• madman
• hypogonadism; fertility/sperm; lh/fsh; pregnancy
• Replies: 6
• Forum: hCG, Clomid & Others for Fertility, PCT or Low T

Post in thread 'HCG restart attempt.'

Dec 16, 2021

@Cataceous

You’ve posted that study demonstrating that 1000iu EOD of HCG is the most effective for T production (a great study despite its small sample size so a big thank you for that).

Do you know of any studies that analyze the most effective HCG dosing protocol for sperm production

The combination of hCG + hMG or FSH may be more effective for improving sperm quantity/quality, and testicular volume.

hCG 500 IU 2-3 times/week or EOD.

Some men may need higher doses of hCG.

hMG or rhFSH at a dose of 75–150 IU 3 times/week or EOD.


* HCG can...

• madman

• 

Checked them before, was "very" fertile, that is 250+ millions or whatever it was.

Thankyou, im gonna look into that.


Also thankyou to systemlord, didnt know about the vitamin d

 

[rrodin]

systemlord how much vitamin d do u recommend as a supplement?

 

[Mastodont]

2000iu D per day is usually sufficient, +1 on the FSH, trying to revive sperm on HCG only is kind of outdated anyway, you only need a little bit of hcg to have some intratesticular testosterone with the FSH.

 

[rrodin]

so does "hmg" work for fsh or are they completely different?

 

[Systemlord]

2000iu D per day is usually sufficient

This was never meant to be a therapeutic dose, it was meant to prevent Ricketts. This is where the 2000 IU vitamin D per day comes from.

10,000 IU per day is a therapeutic dose. You can absorb 60,000 IU in just a couple of hours in the sunlight.

You may need some vitamin K.

 

[Mastodont]

This was never meant to be a therapeutic dose, it was meant to prevent Ricketts. This is where the 2000 IU vitamin D per day comes from.

10,000 IU per day is a therapeutic dose. You can absorb 60,000 IU in just a couple of hours in the sunlight.

You may need some vitamin K.

To each his own, after years of trial and error and bloodwork, i have come to the conclusion that 2000iu daily keeps me around 85nmol/l during winter months when no uvb radiation is available. Larger doses have always caused issues like anxiety and nausea. I despise people who never do or recommend bloodwork to track levels but give recommendations in 10-30k iu as a universal safe bet. I was doing 8000iu for a while, that jacked my levels to 185

 

[Mastodont]

so does "hmg" work for fsh or are they completely different?

HMG does work, it's human derived menotropin that in addition to FSH contain also LH, but the half life for the LH component is very short so hcg should also be kept on board.

 

[madman]

HMG does work, it's human derived menotropin that in addition to FSH contain also LH, but the half life for the LH component is very short so hcg should also be kept on board.

* Human menopausal gonadotropin contains both LH- and FSH-activity. However, a dose that provides adequate FSH activity does not maintain Leydig cell function because the LH-activity is low. Thus a combination with hCG is required to achieve fertility.

Post in thread 'Anabolic steroids and TRT decrease SHBG, DHEA, pregnenolone and progesterone in men.'

Jan 16, 2022

@Nelson Vergel
What about HMG instead of HCG?

My reply from another thread: HMG to HCG IU equivalency?

Most would never use hMG as a sole replacement to substitute LH.

hCG is used as it mimics LH which stimulates the Leydig cells in the testes to produce ITT (intra-testicular testosterone) and hMG or rhFSH would be added (@75-150 IU 3 X weekly) as the main reason would be to stimulate Sertoli/germ cells.

Could you imagine the dose/cost needed to use hMG as a sole replacement not to mention other issues it may cause!


*Human menopausal...

• madman

• 

 

[Swilsondc]

I was in the same boat several years back. Trt for years zero sperm count to start. I had my sperm frozen prior to trt therapy so I’m not sure what parameters for IVF/IUI but mine were normal and viable for IVF later. Yes it is expensive and emotional process After it did not work I wanted to see if I could get my count back up. Stopped trt went to clomid 3 months felt awful did not even want to have sex, T total dropped to sub 100ng/dl. Stopped that went to only HCG for couple months then decided to start back Test with it. 500iu 3x/wk HCG with whatever dose T I was on at the time. Sperm count went back up to pre Trt levels but I didn’t see these numbers til close to 9 months on this regimen. BTW I take 5000iu vit D daily just for overall health.

 

[Nelson Vergel]

HMG is very expensive and hard to get.

I would increase hCG to 3000 IU every other day plus TRT, or bring in clomiphene or enclomiphene at 25 mg/day plus hcg 1500 UI every other day. I may even get off TRT for a while.

Also keep in mind these supplements:

Antioxidant supplements and semen parameters: An evidence based review - PMC

Many studies have focused on male infertility. There is limited evidence about the influence of nutrition on quality of semen. Approximately, 30-80% of infertility cases are caused by oxidative stress and decreased level of seminal total antioxidant ...

pmc.ncbi.nlm.nih.gov

The Role of Antioxidant Supplements in Male Infertility​

Date: October 26, 2023

Source: Excerpts from "Antioxidant supplements and semen parameters: An evidence based review - PMC" (2016) by Ahmadi et al.

Key Theme: This review comprehensively examines the impact of various oral antioxidant supplements on improving semen parameters and fertility rates in men experiencing infertility, a condition significantly linked to oxidative stress.

Main Points:​

1. Oxidative Stress as a Major Contributor to Male Infertility:

• Approximately "30-80% of infertility cases are caused by oxidative stress and decreased level of seminal total antioxidant capacity."
• Oxidative stress occurs when "the production of reactive oxygen species (ROS) exceeds the body’s natural antioxidant defenses."
• Sperm are particularly vulnerable to ROS due to their plasma membrane's high levels of polyunsaturated fatty acids. This vulnerability can lead to "Lipid peroxidation cascade [that] can seriously compromise the functional integrity of membrane cells, decrease sperm motility, and subsequently reduce fertility." ROS also "pathologically results in high levels of DNA damage."
• Environmental factors such as "high temperature, electromagnetic waves, air pollution, insecticides, alcohol consumption, obesity and poor nutrition" can increase ROS levels.
• Infertile men often exhibit "lower antioxidant capacity of semen... that explain the reduced semen antioxidants and high levels of ROS compared to fertile men."

2. Specific Antioxidants and Their Reported Effects on Semen Parameters:

• Vitamin C and Vitamin E:
• Vitamin C is a water-soluble antioxidant found in high concentrations in seminal plasma, which "prohibits DNA damage."
• Vitamin E is fat-soluble, "neutralizes free radicals and protects cellular membrane against O2 free radicals," and "inhibits the production of ROS in infertile male."
• Combined use of Vitamin E (1g/d) and Vitamin C (1g/d) for two months "reduced the level of DNA damage" and "improved ICSI success rate in patients with sperm DNA damage," though one study found "no significant relationship... between vitamin E and C intake and major semen parameters such as motility and concentration."
• A combination of selenium (200 μg) and vitamin E (400 IU) for at least 100 days resulted in "52.6% total improvement in sperm motility, morphology, or both, and 10.8% spontaneous pregnancy" in men with idiopathic asthenoteratospermia.
• Carnitine (L-carnitine (LC) and L-acetyl carnitine (LAC)):
• LC is a natural compound crucial for bioenergetic processes, with its highest concentrations in the epididymis.
• Multiple studies indicate a "positive relationship between LC and LAC and sperm motility in infertile men," especially for those with lower baseline motility.
• Some studies showed that LC and LAC supplementation "increased sperm motility and TOSC (total oxygen radical scavenging capacity)." One trial reported "Nine pregnancies occurred in carnitine-treated patients during therapy and five of them were achieved after combined LC plus LAC administration."
• However, one study "found no significant positive relationship between LC and LAC therapy and sperm motility and sperm concentrations."
• Coenzyme Q10 (CoQ10 / Ubiquinone):
• CoQ10 is an antioxidant that plays a role in energy generation within cells.
• Studies showed that CoQ10 supplementation "increased in the semen of patients who received CoQ10, and the sperm motility was improved in these individuals," leading to "Twelve spontaneous pregnancies."
• Ubiquinone treatment (28 weeks) improved "sperm density, sperm motility and sperm morphology."
• While some studies showed "non-significant changes in semen parameters such as density, motility or morphology" with CoQ10 alone, it "increased seminal catalase and superoxide dismutase (SOD) with a significant positive correlation between CoQ10 concentration and normal sperm morphology, catalase, and SOD."
• A meta-analysis indicated that CoQ10 supplementation "does not increase live birth or pregnancy rates, but there is a global improvement in sperm parameters such as sperm concentration and motility and CoQ10 concentration in semen."
• Zinc:
• Zinc is vital for "testicular development and sperm maturation," and its deficiency is linked to "male hypogonadism and incomplete development of sex characteristics."
• "Decreased levels of zinc in the semen were associated with reduced sperm fertilization capacity."
• Studies on zinc supplementation (e.g., 5 mg folic acid + 66 mg zinc, or 220 mg zinc sulfate bid) showed improvements in "sperm concentration," "semen volume, progressive sperm motility percentage and total normal sperm count."
• Zinc supplementation also "restored to normal values" peroxynitrite levels, arginase activity, and NO synthase activity in seminal plasma of infertile men.
• However, one study found "No significant improvements in sperm concentration, motility and morphology after supplementation with folic acid, zinc, and combination of them."
• Selenium and N-acetyl-cysteine (NAC):
• Selenium is an essential trace element for sperm formation and testosterone biosynthesis. Selenoproteins "help maintain normal sperm structure integrity."
• NAC is a precursor to glutathione peroxidase.
• Combined selenium and NAC therapy "significantly improved" all semen parameters including sperm counts, concentration, motility, and morphology. Administering both together "resulted in further beneficial effects."

3. Multi-Antioxidant Supplementation:

• "Currently, multi-antioxidant supplementations are considered as an effective therapy for male infertility." The "synergetic effect" is a key interest.
• Combination therapies containing various antioxidants (e.g., LC, vitamin C, CoQ10, vitamin E, zinc, folic acid, selenium, vitamin B12) showed "significant increase in concentration, motility, vitality and morphology of sperm," and "a significant improvement of DNA integrity."
• Such therapies can "improve sperm quality not only in terms of key seminal parameters and basal DNA damage, but also helps to maintain DNA integrity."
• A randomized controlled trial using a multi-antioxidant supplement (Lycopene, vitamin E, vitamin C, zinc, selenium, folate, garlic) prior to IVF/ICSI cycles "recorded a statistically significant improvement in viable pregnancy rates (38.5%) compared to the control group (16%)."

Conclusion and Future Research Needs:​

• The review concludes that "majority of reviewed studies showed significant association between antioxidant supplementations and one or two semen parameters."
• Specific supplements like L-carnitine, selenium, vitamin C, and vitamin E "may lead to improving sperm concentration, motility and morphology, and sometimes DNA integrity."
• The study emphasizes the need for "further research... to determine the appropriate antioxidant compounds as well as certain dose of antioxidants in clinical practices."
• Crucially, future studies "should concern the pregnancy rate as a primary outcome in their designs," as current evidence on live birth or pregnancy rates from antioxidant supplementation alone remains limited despite improvements in semen parameters.

 

[Mastodont]

HMG is very expensive and hard to get.

While recombinant FSH is not, at least in most parts of the world, if one can't afford a short run of it, i would question if having a baby is something one can afford. Also freezing sperm for 10 years will probably be more expensive. Not nearly all guys end up with good sperm on HCG only, and huge doses rack up the bill as well.