How to Improve Sperm Quality, LH, FSH and Testosterone in Infertile Men

[Rodger1]

Hi thanks for you input mate.
Well finally got semen analysis results back and despite my LH and fsh levels looking good, afraid not the same can be said for this.

28-Oct-2020	! Infertility studies - (SGB) - Abnormal - see patient task
	Semen sample volume	2.5	ml	>1.50ml
	Semen pH	8		>7.20
	! Total sperm count	<2.0	x10*6/ml	>15.00x10*6/ml
	! Progressively Motile	<4	%	>32.00%
	Non progressive	0	%
	Immotile	0	%
	! Sperm morphology	0	%	>4.00%
	Semen viscosity
	Liquefaction incomplete.
	White Cells
	>1x106/ml (Normal range <1*10*6/ml)
	This is an automated test, we cannot give accurate sperm
	concentration, motility or morphology results on low sperm
	concentrations. >2x10\S\6/ml
	Sample received more than two hours after production, please treat
	results with caution and consider repeat. Please ensure subsequent
	andrology specimens are delivered to the Histopathology Department,
	New Path Lab RLI within two hours of production Monday to Friday
	8.30-4.00

 

[Sides]

Hi thanks for you input mate.
Well finally got semen analysis results back and despite my LH and fsh levels looking good, afraid not the same can be said for this.

28-Oct-2020	! Infertility studies - (SGB) - Abnormal - see patient task
	Semen sample volume	2.5	ml	>1.50ml
	Semen pH	8		>7.20
	! Total sperm count	<2.0	x10*6/ml	>15.00x10*6/ml
	! Progressively Motile	<4	%	>32.00%
	Non progressive	0	%
	Immotile	0	%
	! Sperm morphology	0	%	>4.00%
	Semen viscosity
	Liquefaction incomplete.
	White Cells
	>1x106/ml (Normal range <1*10*6/ml)
	This is an automated test, we cannot give accurate sperm
	concentration, motility or morphology results on low sperm
	concentrations. >2x10\S\6/ml
	Sample received more than two hours after production, please treat
	results with caution and consider repeat. Please ensure subsequent
	andrology specimens are delivered to the Histopathology Department,
	New Path Lab RLI within two hours of production Monday to Friday
	8.30-4.00

What are you currently running? In your last post you said you had started back up with TRT along with 1000 HCG. Are you still taking the HMG or FSH? You can only do so much with TRT and HCG, although that would typically work well to maintain fertility and stimulate the Leydig cells of the testicles, which do 20% of the work in making sperm.

But you also need to stimulate the Sertoli cells, which do 80% of the job. If you are on TRT, the best way to do that is with HMG or FSH.

Also remember that a sperm cycle is approximately 2.5 months in the body, and it takes that long for the sperm to reach maturation. Whatever you were doing in October, you will only start seeing the results in late December or early January. I know it's hard (and expensive) to be patient and just keep working the protocol, but it will take time to make the testicles recover and see the results you are looking for.

After 28 years of using testosterone, test + HCG + HMG was what worked for me. My baby daughter has her first birthday coming up next week, and she is big (98th percentile in height and weight), happy and healthy, and driving me crazy toddling around the house getting into trouble. It took me eleven months of running my fertility protocol to get her, but it was all worth it every time she looks up into my eyes, or holds my hand when I take her to the playground. I hope you have the same joy in your life, but it will take time and effort and money to get there. Fertility is an expensive business, and insurance only covers so much.

 

[Rodger1]

What are you currently running? In your last post you said you had started back up with TRT along with 1000 HCG. Are you still taking the HMG or FSH? You can only do so much with TRT and HCG, although that would typically work well to maintain fertility and stimulate the Leydig cells of the testicles, which do 20% of the work in making sperm.

But you also need to stimulate the Sertoli cells, which do 80% of the job. If you are on TRT, the best way to do that is with HMG or FSH.

Also remember that a sperm cycle is approximately 2.5 months in the body, and it takes that long for the sperm to reach maturation. Whatever you were doing in October, you will only start seeing the results in late December or early January. I know it's hard (and expensive) to be patient and just keep working the protocol, but it will take time to make the testicles recover and see the results you are looking for.

After 28 years of using testosterone, test + HCG + HMG was what worked for me. My baby daughter has her first birthday coming up next week, and she is big (98th percentile in height and weight), happy and healthy, and driving me crazy toddling around the house getting into trouble. It took me eleven months of running my fertility protocol to get her, but it was all worth it every time she looks up into my eyes, or holds my hand when I take her to the playground. I hope you have the same joy in your life, but it will take time and effort and money to get there. Fertility is an expensive business, and insurance only covers so much.

Hi mate,

Aww that's awesome takes me back 7 years to when our little girl was 1. Certainly a handful... I guess getting older has affected my fertility. Trt helped me and libido but maybe not run things long enough.

My wife thinks we are just not ever going to have a little brother or sister for her.

With being in the UK, all this I'm buying out of my own pocket. Hmg would never be prescribed by a Doctor, here.

21st Oct I stopped the clomid after being on it 8 weeks. Prior to that the last hcg+hmg was 7th August, then clomid started.

Currently on 125mg trt pw and 750iu hcg eod. Hoping this would be enough to maintain the LH and fsh number from the bloods done 3 weeks ago

I've currently only got enough hmg for 5 weeks, so I'm in a quandary whether to start it now or wait until I can get some more.

So what your saying is I may actually not need to worry as come early-mid Dec there could be a higher sperm reading?

Is it best to use all the hmg now?

God I'm so confused!

 

[gaz7718]

Personally I went straight to hcg and hmg for 3 months because the evidence I found on this site was the strongest for these two substances, albeit fsh seems equally suitable to hmg

I bought hmg from China. I did as much research as I could and just went with what appeared to be a reputable supplier through Alibaba.com. The prices were much more affordable. From memory 3 months of hmg was under £400 delivered.

it worked and our daughter is 3 weeks old and I’m a proud dad.

 

[Jay Ara]

Im in the a similar journey, I hope I will recover fertiliy after years of Nebido, I started to see some results of FSH injections.

I will start with the combination of HCG + FSH + Clomid to try to speed up the process and get quality life as well.

I hope I can report the good news sometime next year.

Fingers crossed!

Cheers
Jay

 

[gaz7718]

Good luck.

make sure your dosages are correct and in line with the successful research published on the matter.

For example, there’s no point taking a maintenance dose of hcg such as 500iu if you are trying to kick start your body to become fertile.

it can look like quite an expensive programme on paper but if your serious having having more children it’s a drop in the ocean compared to the costs you will incur once they are born

 

[DS3]

Good luck.

make sure your dosages are correct and in line with the successful research published on the matter.

For example, there’s no point taking a maintenance dose of hcg such as 500iu if you are trying to kick start your body to become fertile.

it can look like quite an expensive programme on paper but if your serious having having more children it’s a drop in the ocean compared to the costs you will incur once they are born

DR. Lipshultz has seen patients stay on exogenous T and maintain fertility by using 500 units EOD. There is very little research pertaining to HCG use in men. Additionally, there is no clinical evidence that demonstrates a minimal effective dosages for restoring fertility in men. 500 units EOD or ED may very well be enough to not only maintain but to restore fertility. Higher dosages such as 3000 units EOD have been used to restore fertility, but create a supraphyiological level of ITT and can lead to a desensitization of the Leydig cells (speculative).

You would do well to avoid using definitive language such as “there’s no point in...”. Scientific research scarcely demonstrates such definitive causation. In the case of HCG, much is left to be discovered.

 

[gonzo]

Personally I went straight to hcg and hmg for 3 months because the evidence I found on this site was the strongest for these two substances, albeit fsh seems equally suitable to hmg

I bought hmg from China. I did as much research as I could and just went with what appeared to be a reputable supplier through Alibaba.com. The prices were much more affordable. From memory 3 months of hmg was under £400 delivered.

it worked and our daughter is 3 weeks old and I’m a proud dad.

Just an update on my protocol. In month 2 of taking hcg EOD 500iu with hmg 75iu my wife has become pregnant. Previously without the hmg we had been trying for 1 year.

gaz 7718,

where you on HCG prior to taking HMG? If you were, did you increase dose of HCG?

I am also planning starting something similar real soon.

 

[Rodger1]

Personally I went straight to hcg and hmg for 3 months because the evidence I found on this site was the strongest for these two substances, albeit fsh seems equally suitable to hmg

I bought hmg from China. I did as much research as I could and just went with what appeared to be a reputable supplier through Alibaba.com. The prices were much more affordable. From memory 3 months of hmg was under £400 delivered.

it worked and our daughter is 3 weeks old and I’m a proud dad.

Hi mate how long did it take to get from China? I ordered 3 week ago still not turned up lol

 

[Jay Ara]

Good luck.

make sure your dosages are correct and in line with the successful research published on the matter.

For example, there’s no point taking a maintenance dose of hcg such as 500iu if you are trying to kick start your body to become fertile.

it can look like quite an expensive programme on paper but if your serious having having more children it’s a drop in the ocean compared to the costs you will incur once they are born

I’m on 300iu of FSH (Gonal-F) EOD and 1500iu HCG EOD, I had blood work done and my FSH is right in the middle of the scale and my Testosterone as well. I’m feeling good overall.
I also taking Proviron ED 50mg.

 

[Johnny Test]

What are you currently running? In your last post you said you had started back up with TRT along with 1000 HCG. Are you still taking the HMG or FSH? You can only do so much with TRT and HCG, although that would typically work well to maintain fertility and stimulate the Leydig cells of the testicles, which do 20% of the work in making sperm.

But you also need to stimulate the Sertoli cells, which do 80% of the job. If you are on TRT, the best way to do that is with HMG or FSH.

Also remember that a sperm cycle is approximately 2.5 months in the body, and it takes that long for the sperm to reach maturation. Whatever you were doing in October, you will only start seeing the results in late December or early January. I know it's hard (and expensive) to be patient and just keep working the protocol, but it will take time to make the testicles recover and see the results you are looking for.

After 28 years of using testosterone, test + HCG + HMG was what worked for me. My baby daughter has her first birthday coming up next week, and she is big (98th percentile in height and weight), happy and healthy, and driving me crazy toddling around the house getting into trouble. It took me eleven months of running my fertility protocol to get her, but it was all worth it every time she looks up into my eyes, or holds my hand when I take her to the playground. I hope you have the same joy in your life, but it will take time and effort and money to get there. Fertility is an expensive business, and insurance only covers so much.

Can you share with me dosages you took over these 11 months. I’d like to stay on trt, add HCG & HMG. Should I take clomid throughout or an AI? Thanks in advance.

 

[Johnny Test]

Any help would be greatly appreciated

 

[Pipster]

Does anyone have any advice on 75iu of fsh 3x weekly vs 150iu fsh 3x weekly or say 75 iu fsh EOD? I just got mine and am currently taking 125mg T weekly (split into several doses) and 500iu HCG EOD. Trying to conceive.

Also, anyone notice any sides from FSH? Also, does anyone know how long the FSH took to make a difference in them?

Thanks as always.

 

[Nelson Vergel]

75 IU FSH should work. It’s expensive stuff.

Semen analysis results after adding FSH to TRT and hCG

So after 6 months of adding FSH to my TRT protocol I got a sperm analysis done. A quick background. My fertility was normal before TRT and went to zero when I started TRT without HCG. Adding HCG 500 IU 2x a week my sperm analysis results were: sperm count 2.1mm (normal >=20mm) total sperm 7.2mm...

www.excelmale.com

 

[Jay Ara]

Does anyone have any advice on 75iu of fsh 3x weekly vs 150iu fsh 3x weekly or say 75 iu fsh EOD? I just got mine and am currently taking 125mg T weekly (split into several doses) and 500iu HCG EOD. Trying to conceive.

Also, anyone notice any sides from FSH? Also, does anyone know how long the FSH took to make a difference in them?

Thanks as always.

I’m on 1500 EOD HCG and 300iu EOD for the last 4 months. My sperm count went from 0 to 1.5 million (what is still pretty low) but I hope to go further up. Trying IVF in April, I hope my levels are gonna be better by that.
I stopped with T
I feel ok, not as good as I was with Nebido but it is definitely better then just stop cold.

 

[DS3]

Does anyone have any advice on 75iu of fsh 3x weekly vs 150iu fsh 3x weekly or say 75 iu fsh EOD? I just got mine and am currently taking 125mg T weekly (split into several doses) and 500iu HCG EOD. Trying to conceive.

Also, anyone notice any sides from FSH? Also, does anyone know how long the FSH took to make a difference in them?

Thanks as always.

I felt some mental side effects from FSH. To be fair, I am sensitive to hormonal medications. My wife and I recently conceived. I have been on TRT for a decade. I dropped my T dosage from 200 mg weekly to 100 mg, and added 500 iu ED of HCG for 1 month. As soon as we started trying, we conceived within the following month.

As a side note, I’ve maintained HCG at 250 iu 2x per week (approximately) for the previous 4 years. I am assuming that minute amount helped to maintain fertility.

 

[madman]

Does anyone have any advice on 75iu of fsh 3x weekly vs 150iu fsh 3x weekly or say 75 iu fsh EOD? I just got mine and am currently taking 125mg T weekly (split into several doses) and 500iu HCG EOD. Trying to conceive.

Also, anyone notice any sides from FSH? Also, does anyone know how long the FSH took to make a difference in them?

Thanks as always.

Gonadotropin Treatment for the Male HH

Abstract: Hypogonadotropic hypogonadism (HH) is caused by a dysfunction in the hypothalamus and/or the pituitary gland and it can be congenital or acquired. This condition is biochemically characterized by low or inappropriately normal gonadotropin levels along with low total testosterone...

www.excelmale.com

3.7. Routes of Administration

Gonadotropins can be administered either subcutaneously or intramuscularly. The subcutaneous route of administration is as effective as the intramuscular one but significantly increases patient compliance. Some HH patients can restore sperm production and fertility even using hCG alone, with a standard dosage of 500 - 2500 IU injection 2 to 3 times weekly [23]. The dose of hCG can be reduced over time as the testicular size eventually increases. However, when sperm concentration in the ejaculate is lower than 10 million/ml or once there is a plateau in the response to hCG, which typically occurs at 6 months, FSH therapy (in one of the three forms described above) should be added at a dose of 75 IU on alternate days. If sperm production and testicular growth remain suboptimal, the dose of FSH can be gradually increased up to 150 IU daily. A number of evidences have shown that adding FSH (any forms) to hCG was associated with a significantly better outcome as compared with hCG alone [24] (Fig. 2).


Fig. (2). Induction of spermatogenesis in males with post-pubertal onset hypogonadotropic hypogonadism

The use of this combined therapy for a period of 12-24 months induces testicular growth in almost all patients, spermatogenesis in approximately 80%, and pregnancy rates in the range of 50% [24,41,32,45].

Furthermore, it has also been shown that induction of spermatogenesis achieved by FSH plus hCG treatment in HH can be maintained qualitatively, but not quantitatively in most of the patients with hCG alone [46]. Along this line, a sequential therapy with 3 months of treatment with FSH plus hCG alternated by hCG therapy alone for another 3 months has been proposed to reduce the relatively high costs of gonadotropin therapy [28]. However, it is still not known if this dosing regimen has the same high efficacy on the primary outcome i.e. clinical pregnancy rate.

The dose and injection interval of FSH might be adapted on an individual basis to achieve the best treatment outcome. As a whole, the testicular volume increase, the stimulation of spermatogenesis, the serum levels of FSH and testosterone achieved, and other factors can monitor the efficacy of the treatment. Unfortunately, large randomized comparative studies with different FSH preparations, different doses, and different injection intervals are still missing in HH men [47,36]. Interestingly enough, a retrospective study suggested that lower weekly FSH doses are sufficient to stimulate spermatogenesis and allow induction of the desired pregnancy in the female partner [36].

In terms of efficacy, a quite recent meta-analysis evaluating the available longitudinal studies dealing with the achievement of spermatogenesis after gonadotropin therapy in azoospermic HH individuals showed an overall successful outcome in 75% of patients, with a mean sperm concentration achieved of almost 6 million/mL [48]. Better results were obtained in patients with a postpubertal onset of HH and in those with lower endogenous LH and FSH levels before initiating therapy[48].In an Australian study of 75 men with HH treated with gonadotropins, the median time for sperm to appear in the ejaculate was 7.1 months and for conception, it was approximately 28 months [32]. Similar data were reported in a compilation of clinical trial data from Asian, European, Australian and American patients [45].

 

[madman]

Gonadotropin (GnRH, FSH, HCG & HMG) Treatment in Male Infertility

Male hypogonadism is often associated with impaired fertility. In special cases, treatment with gonadotropins can induce, maintain, or augment spermatogenesis. Patients responsive to such regimens are men with secondary hypogonadism, lacking gonadotropin secretion due to pituitary disorders or...

www.excelmale.com

 

[madman]

Pros and cons of using TRT vs HCG for treatment low-t symptoms

Human chorionic gonadotropin treatment: a viable option for management of secondary hypogonadism and male infertility (2020) Julius Fink, Brad J. Schoenfeld, Anthony C. Hackney, Takahiro Maekawa & Shigeo Horie Abstract Introduction: Low testosterone and its symptoms is a condition affecting...

www.excelmale.com

5.1 Effects on intratesticular testosterone

Exogenous testosterone administration suppresses intratesticular testosterone (ITT), which is crucial for the production of sperm [24]. In such patients, ITT has been shown to be suppressed by 94%. However, with every other day injections of HCG at dosages of 125IU, ITT was only 25% less than baseline, with 250IU 7% less, and with 500IU 26% greater than the baseline [25]. In another study, 37 normal men were treated with GnRH antagonist acyline and attributed to one of the following low dose HCG groups: 0, 15, 60, or 125 IU sc every other day or 7.5 g daily testosterone gel for 10 days. In order to measure ITT, testicular fluid was retrieved via percutaneous aspiration at baseline and after 10 days of treatment. The median baseline ITT was 2508 nmol/liter. ITT improved in a dose-dependent manner: 15 IU HCG group reached an ITT of 136 nmol, 60 IU HCG group reached an ITT of 319 nmol, 125 IU HCG group reached an ITT of 987 nmol/liter. Serum HCG significantly correlated with both ITT and serum testosterone [24,26]. These studies indicate that HCG can significantly increase ITT in a dose-dependent manner and that dosages between 250 and 500 IU might be optimal to restore physiological ITT levels.




5.2 Effects on serum testosterone

A weekly dosage of 4500IU spread over 3 weekly injections has shown to lead to normal testosterone levels in isolated HH men [27]. Another study showed that single injections of 400IU, 2000IU, and 4000IU of HCG led to significant serum testosterone concentrations in hypogonadal as well as eugonadal males without differences among the groups after administration [28]. In hypogonadal men, 400IU, 2000IU, and 4000IU of HCG increased testosterone from about 200 to 400 ng/dl. In eugonadal men, 400IU, 2000IU, and 4000IU of HCG led to an increase from about 450 to 700 ng/dl in testosterone [28]. Interestingly, higher doses of HCG did not lead to greater testosterone level increases [28]. Another study showed similar results, with no differences in serum testosterone after single injections of 1500, 3000, or 4500IU of HCG, with testosterone increasing 24 hours post-injection and peaking 3-4 days later [29]. Serum testosterone peaked 3 days after injection [28].

From the above information, it can be suggested that low dose HCG (~500IU) injected 3 times per week can restore healthy serum and intratesticular testosterone levels in HH patients. The higher dosages used in infertility treatment to trigger sperm production might not be necessary if the goal is to increase serum testosterone levels. That is, combined treatment with HCG followed by rFSH might also be potent in order to induce fertility [21].

Indeed, HCG dosages used in the treatment of infertility can range from 3,000 to 10,000 IU 2-3 times per week [30]. One study showed that 3-6 months (1000 IU 3 times/week or 2000IU 2 times/week) of HCG treatment in 100 males with hypogonadotropic hypogonadism leads to normal serum testosterone concentrations despite the fact that 81 patients remained azoospermic [31]. These data show that low dose HCG treatment is very effective in restoring normal serum testosterone levels, however, spermatogenesis might require higher dosages of HCG. The exact mechanism by which HCG affects sperm production besides testosterone increase is not completely understood yet and needs further investigation. We summarized studies involving HCG treatment on testosterone and/or fertility parameters in Table 1.




10. Conclusion

HCG therapy is an effective treatment for patients suffering from infertility, often restoring healthy sperm production. However, HCG also increases serum and intratesticular testosterone levels, making it a prime candidate to treat patients with secondary hypogonadism. Even though the cost and injection frequency might be slightly higher as compared to TRT, HCG alone or used with TRT might be the best option for patients who desire to have children in the future. Depending on the response to HCG alone, concomitant TRT might be necessary to bring serum testosterone levels to the desired levels. Responses of serum testosterone levels seem to be independent of the dose of HCG and to peak 3 days post-injection. Therefore, low doses of ~400 IU HCG injected every 3 days intramuscularly or subcutaneously might lead to a significant increase of serum and intratesticular testosterone with few daily fluctuations in levels. Indeed, high dosages commonly seen in the treatment of male infertility going as high as 5000 IU several times per week might be unnecessary if the goal is not to increase sperm production but rather to increase testosterone only. In summary, HCG might be a safe, affordable, and effective method to restore healthy testosterone levels in males suffering from secondary hypogonadism. Nonetheless, further clinical trials should be carried out to demonstrate and elucidate the benefits of HCG therapy.




11. Expert opinion


*The HPG axis seems responsive HCG in a similar fashion as LH and self-regulates the testosterone production within the testes in an amount independent manner. Doses of HCG as low as 400 IU seem to significantly increase serum testosterone levels and even with dosages, 10 times that amount (4000 IU), the serum testosterone elevations seem similar to that of a 400 IU dosage (i.e., remaining within the physiological range). Rather than sensing the amount of HCG and accordingly producing testosterone, even small amounts of HCG seem to maximize the response for testosterone production within the testes probably due to receptor sensitivity.

 

[Rodger1]

We still haven't conceived yet. I'm 150mg T pw, on 500-1000iu and 75-112.5iu hmg every couple of days. Reason for the dose is trying to see. If I can make the hmg last as its so expensive and waited ages to get shipment from china.
Would It help chances. If I reduced the test to say 100mg? I was told by a good source that 150iu 3 times a week was best but just cannot afford to run that dosage for Many months