HCG or Human chorionic gonadotropin is a hormone derived from the urine of pregnant females and purified to produce the hormone - luteinizing hormone. It is administered as an intramuscular injection for the treatment of the following conditions:

• Hypogonadotropic hypogonadism is secondary to a pituitary deficiency in males.
• Therapy of prepubertal undescended testis, not caused by anatomic obstruction.
• Induction of ovulation and pregnancy in the anovulatory and infertile woman who have a secondary cause of anovulation (not due to primary ovarian failure). Patients must be appropriately pretreated with human menotropins.

In adults, HCG is used (off-label) for the induction of spermatogenesis in patients with Hypogonadotropic hypogonadism

Chronic Gonadotropin Dose in Adults

HCG For Ovulation induction in females:

• 5,000 to 10,000 units 1 day following last dose of menotropins intramuscular.

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Hypogonadotropic hypogonadism:

• Various regimens have been used:
  • 500 to 1,000 units thrice weekly for 3 weeks, followed by the same dose twice weekly for 3 weeks.
  • 4,000 units thrice weekly for 6 to 9 months, then reduce dosage to 2,000 units 3 times a week for an additional 3 months

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Off-label use for induction of Spermatogenesis:

• • 1,000 to 2,000 units twice or three times per week until serum testosterone levels are normal.
  • Two to three months may be needed for HCG therapy.
  • After testosterone levels return to normal, human menopausal gonadotropin may be given to promote spermatogenesis.
  • HCG at the required dose should be continued to maintain serum testosterone levels.

Chronic Gonadotropin Dose in Children

Human Chronic Gonadotropin (HCG) Dose in Puberty induction:

• Children more than 12 years of age and Adolescents:
  • 500 to 3,000 units administered intramuscularly twice or thrice weekly
  • The dose must be adjusted based on serum testosterone levels, every 3 to 6 months.

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Prepubertal cryptorchidism:

• Children older than 4 years and Adolescents:
  • Various regimens between the ages of 4 and 9 years have been used:
    • 4,000 units every three days for three weeks
    • 500 units three times per week for 4 to 6 weeks, 5,000 units on alternate days for 4 injections.
    • Patients who are unsuccessful may try a second course of 1,000 units/dose one month later.
    • 15 injections between 500 and 1,000 units given over a period of six weeks

Pregnancy Risk Factor X

• HCG during pregnancy has been linked to intrauterine deaths and severe fetal adverse outcomes, including congenital malformations.
• The use of HCG is associated with increased miscarriages and ectopic pregnancy rates.
• As soon as the pregnancy is confirmed, it is important to stop using therapy.

Chorionic gonadotropin use during breastfeeding

• t is unknown whether breast milk contains human chorionic Gonadotropin. 
• Breastfeeding women who are receiving HCG treatment should exercise caution.

Chronic Gonadotropin Dose in Kidney Disease:

The manufacturer has not provided any dose adjustment in patients with renal disease. Use with caution in such patients.

Chronic Gonadotropin Dose in Liver Disease:

The manufacturer has not provided any dose adjustment in patients with renal disease. Use with caution in such patients.

Common Side Effects of HCG:

• Cardiovascular:
  • Arterial thrombosis
  • edema
• Central nervous system:
  • Depression
  • fatigue
  • headache
  • irritability
  • restlessness
• Endocrine & metabolic:
  • Gynecomastia
  • ovarian hyperstimulation syndrome
• Genitourinary:
  • Precocious puberty
  • Rupture of ovarian cyst
• Local:
  • Pain at the injection site

Contraindications to Chorionic gonadotropin include:

• Allergy to chorionic Gonadotropin or any other component of the formulation
• Precocious puberty
• Androgen-dependent tumors such as breast, uterine, and ovary carcinomas in females and breast cancer males
• Incompatible with pregnancy: Malformations of the reproductive organs
• Prostatic carcinoma and other androgen-dependent neoplasms
• Prepubertal males who have signs of an anatomical obstruction
• Fibroid tumors in the uterus are incompatible with pregnancy

Warnings and Precautions

• Thromboembolism, both arterial and venous, may occur especially in patients with a personal or a family history of thrombosis, obesity, and thrombophilia.
• Asthma
• Cardiovascular disease
• Cryptorchidism
• Migraine
• Renal impairment
• Seizure disorders
• Obesity
• Induction of ovulation

OHSS (Ovarian hyperstimulation syndrome):

• Symptoms of mild or moderate ovarian stimulation syndrome (OHSS), may include abdominal distention, diarrhea, nausea, vomiting, and abdominal discomfort.

Symptoms of Severe OHSS symptoms may include:

• Extreme abdominal pain
• anuria/ oliguria,
• ascites,
• severe dyspnea,
• Hypotension, or
• nausea & intractable vomiting.

You may also notice decreased creatinine clearance, hemoconcentration and hypoproteinemia.

Treatment

• It is primarily symptomatic, and includes fluid and electrolyte control, analgesics andPrevention of thromboembolic complications.
• The use of HCG may lead to multiple births. Before starting treatment, patients should be aware of the possibility of multiple births.

Monitoring Parameters:

Monitor the following parameters while on human chorionic gonadotrophin therapy.

• Males:
  • Serum testosterone levels & semen analysis 
• Females:
  • Ultrasound and estradiol levels to assess follicle development, the number, and size of the follicles
  • Assess ovulation by monitoring the basal body temperature, serum progestin level, menstrual record, and sonography.
• Ovarian hyperstimulation syndrome - a life-threatening condition
  • Monitoring of hospitalized patients should include the following parameters (on daily basis)
    • abdominal circumference
    • albumin
    • cardiorespiratory status
    • fluid balance
    • Hemoglobin & hematocrit
    • serum creatinine & electrolytes
    • urine output & urine specific gravity
    • vital signs
    • weight
  • Liver enzymes should be monitored weekly.

How to Administer Chronic Gonadotropin?

Human chorionic gonadotropin is only to be administered as intramuscular injection.

Mechanism of Action of Chronic Gonadotropin:

• The human placenta produces human chorionic gonadotropin. It comes from the urine of pregnant woman. All available preparations contain purified luteinizing hormonal.
• HCG stimulates gonadal steroids hormone production in males. HCG stimulates androgen production in the testis, which influences secondary sexual characteristics.
• HCG is a hormone that stimulates ovulation in females. It acts as a replacement for luteinizinghormone (LH) in the body.

The duration of action after an Intramuscular injection is 36 hours.

It is Distributed mainly into the testes in males and into the ovaries in females

It has a biphasic half-life. The initial and terminal half-lives are 6 to 11 hours & 23 to 37 hours respectively.

The time to peak plasma concentration after intramuscular injection is within 6 hours.

Excretion is mainly via Urine.

International Brands of Chronic Gonadotropin:

• Choragon
• Corion
• Gonacor
• Hucog-5000 HP
• Pregnyl w/diluent
• Primogonyl
• Profasi
• Profasi HP

Chronic Gonadotropin Brands in Pakistan: