Low-Dose hCG Protocol in Infertility Treatment

Standard Dosing Protocols

The American Society for Reproductive Medicine and European Society of Human Reproduction and Embryology endorse administering 5,000-10,000 IU hCG intramuscularly when follicular maturation criteria are met (at least three follicles >17 mm with appropriately rising estradiol levels) 1
Perform oocyte retrieval 36-38 hours after hCG administration 2
Initial therapy for male hypogonadotropic hypogonadism involves 500-2,500 IU hCG administered 2-3 times weekly, effectively normalizing testosterone levels in men with deficient LH and FSH secretion 1

Never prescribe testosterone monotherapy to males interested in current or future fertility, as hCG may suppress gonadotropin secretion and negate benefits 3
In males currently on or planning exogenous testosterone therapy, hCG may suppress gonadotropin secretion and negate benefits 1

For patients with antiphospholipid antibodies undergoing ART, prophylactic anticoagulation with LMWH (enoxaparin 40 mg daily) should be started at beginning of ovarian stimulation, withheld 24-36 hours before retrieval, and resumed after retrieval to address the life-threatening thrombosis risk from elevated estrogen during ovarian stimulation 4
Continue LMWH until estrogen levels return to near-physiologic levels if no pregnancy occurs in aPL-positive patients 4