Human Chorionic Gonadotropin (HCG)

Human Chorionic Gonadotropin Brand Names- Novarel | Ovidrel | Pregnyl

What is Human Chorionic Gonadotropin

Human chorionic gonadotropin (hCG) and a recombinant formulation, called choriogonadotropin alfa (r-hCG), is a gonad-stimulating polypeptide hormone normally secreted by the placenta during pregnancy.

The non-recombinant products are obtained from the urine of pregnant women.

Recombinant-hCG is produced via recombinant DNA techniques in Chinese Hamster Ovary (CHO) cells.

The pharmacological actions of hCG and of r-hCG are similar and resemble those of luteinizing hormone (LH); hCG is generally used as a substitute for LH.

HCG has been used to treat cryptorchidism or hypogonadotropic hypogonadism in males, sometimes in combination with menotropins or follitropin.

Interestingly, hCG was introduced for the treatment of cryptorchidism in 1931, and remained the only hormonal agent available to treat the condition until the 1970’s, when gonadotropin-releasing hormone (GnRH) analogs also became a treatment option.

Human chorionic gonadotropin (hCG) is used in controlled ovarian hyperstimulation protocols for infertility in females. Intralesional hCG has been utilized for the treatment of Kaposi’s sarcoma, but further clinical trials are required to prove efficacy.

Human chorionic gonadotropin is banned from use in competitive sport; some male athletes have used hCG to stimulate testosterone production or to prevent testicular atrophy resulting from the abuse of anabolic steroids and androgens.

Urine-derived hCG was first approved by the FDA in 1939, and received subsequent approval for additional indications in 1973.

Ovidrel®, the first recombinant hCG (r-hCG), received FDA approval for female infertility to induce final follicular maturation on September 20, 2000.

Ovidrel® pre-filled syringes received FDA approval in October 2003; manufacturing of Ovidrel® vials has ceased.

Indications

  1. cryptorchidism
  2. hypogonadism
  3. infertility
  4. Kaposi’s sarcoma
  5. oligospermia

For the treatment of male infants and children with prepubertal cryptorchidism not caused by anatomical obstruction

NOTE: HCG appears to be more effective at inducing testicular descent in those infants and children with palpable testes in the high scrotal, prescrotal, or inguinal regions.

Intra-abdominal testes are especially refractory to HCG treatment. While hormonal therapy is traditionally instituted after the age of 4 years, there are several studies that include male children of younger ages, and there is some evidence that treatment prior to age 2 years may be beneficial in terms of long-term outcomes.

Side Effects

  1. abdominal pain
  2. anaphylactic shock
  3. anaphylactoid reactions
  4. angioedema
  5. back pain
  6. breakthrough bleeding
  7. depression
  8. diarrhea
  9. dizziness
  10. dyspnea
  11. ectopic pregnancy
  12. edema
  13. elevated hepatic enzymes
  14. emotional lability
  15. erythema
  16. fatigue
  17. flatulence
  18. gynecomastia
  19. headache
  20. hot flashes
  21. injection site reaction
  22. insomnia
  23. irritability
  24. leukorrhea
  25. malaise
  26. mastalgia
  27. nausea
  28. ovarian enlargement
  29. ovarian hyperstimulation syndrome (OHSS)
  30. pelvic pain
  31. precocious puberty
  32. pruritus
  33. rash
  34. restlessness
  35. thromboembolism
  36. thrombosis
  37. urticaria
  38. vaginal bleeding
  39. vaginitis
  40. vomiting

Monitoring Parameters

  • pelvic exam
  • pelvic ultrasound
  • serum estradiol concentrations
  • serum gonadotropin concentrations
  • serum testosterone concentrations
  • sperm count
  • weight

Contraindications

  • adrenal insufficiency
  • ascites
  • asthma
  • benzyl alcohol hypersensitivity
  • breast-feeding
  • cardiac disease
  • children
  • dysfunctional uterine bleeding
  • endometrial cancer
  • endometriosis
  • geriatric
  • hamster protein hypersensitivity
  • hepatic disease
  • migraine
  • neonates
  • neoplastic disease
  • obesity
  • ovarian cancer
  • ovarian cyst
  • ovarian failure
  • pituitary adenoma
  • polycystic ovary syndrome
  • precocious puberty
  • pregnancy
  • prostate cancer
  • renal disease
  • renal impairment
  • seizure disorder
  • thromboembolic disease
  • thrombophlebitis
  • thyroid disease
  • tobacco smoking
  • uterine leiomyomata

Interactions

There are no drug interactions associated with Human Chorionic Gonadotropin HCG products

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