Chorionic gonadotropin is a glycoprotein hormone

Chorionic gonadotropin is a glycoprotein hormone produced by the placenta, which is extracted from the urine of pregnant women. It can stimulate gonadal activity, for women, it can promote follicle maturation and ovulation, for men, it can promote the function of seminiferous tubules and the activity of testicular stromal cells to increase androgen production, promote testicular decline and promote sperm production. It is commonly used for sexual dysfunction, habitual abortion, severe uterine bleeding, amenorrhea, infertility, cryptorchidism, etc., but it is not effective for cryptorchidism caused by anatomical lesions. Chorionic gonadotropin has the same alpha subunit structure as luteinizing hormone (LH). It has the biological and immune activity similar to LH. It needs large-dose injection when used to stimulate follicle maturation to simulate the LH peak before ovulation, thereby accelerating follicular maturation and inducing ovulation. Intramuscular injection of 10,000 U is commonly used, and most cases ovulate 36 to 48 hours after injection. If conditions permit, use B-ultrasound to monitor follicular development. If artificial insemination or triggering ovulation to guide sexual intercourse, it should be carried out on the day of chorionic gonadotropin (HCG) injection and (or) the second day, and the B-ultrasound should be checked again after 48 hours to understand whether ovulation has occurred. If you still have not ovulated, you need to repeat HCG injections and repeat instructions for timely intercourse to increase pregnancy rate.

Pharmacological action

Chorionic gonadotropin is a gonadotropin secreted by placental trophoblast cells. Similar to Luteinizing Hormone (LH), but Follicle Stimulating Hormone (FSH) has little effect. For females, it promotes the maturation and ovulation of the follicles, and transforms the ruptured follicles into the corpus luteum, prompting them to secrete progesterone. For males, it has the effect of Interstitial Cell Stimulating Hormone (ICSH), which can promote the function of the seminiferous tubules, especially the activity of the interstitial cells of the testis, so that it produces androgens, promotes the development and maturity of sexual organs and side characteristics, and promotes the testis Decrease and promote sperm production.

Pharmacokinetics

Chorionic gonadotropin can be destroyed by the gastrointestinal tract, so it is only for injection. The half-life is biphasic, 11h and 23h respectively. Ovulation occurred within 32 to 36 hours of administration. Within 24 hours, 10% to 12% are excreted in urine through the kidneys in their original form. The peak blood drug can be reached 6h after intramuscular injection. Mainly distributed in the gonads. When the elimination is in a two-phase manner, t1/2 are 6-11h and 23-38h, respectively. 10% to 12% of the intramuscular injection dosage is excreted in the urine within 24 hours.

Indications

(1) Diagnosis and treatment of cryptorchidism in adolescence.

(2) Male infertility caused by hypopituitarism can be combined with urogonadotropin. Long-term hypogonadotropin function should also be supplemented with testosterone therapy.

(3) Female anovulatory infertility caused by insufficient pituitary gonadotropin, often after clomiphene treatment is ineffective, the combination of this product and postmenopausal gonadotropin is used to promote ovulation.

(4) For in vitro fertilization to obtain multiple oocytes, it needs to be combined with postmenopausal gonadotropins.

(5) Insufficient corpus luteum function, functional uterine bleeding, threatened abortion in early pregnancy, habitual abortion.

Contraindications

1. Pituitary hyperplasia or tumor.


2. Precocious puberty.


3. Unknown diagnosis of vaginal bleeding, uterine fibroids, ovarian cysts or ovarian enlargement.


4. Thrombophlebitis.


5. Male prostate cancer or other androgen-dependent tumors.


6. Patients with inflammation of the reproductive system, hormonal active adenocarcinoma, and asexual glands (congenital or after surgery).


7. Diseases with low or absent ovarian function, such as Turner’s syndrome, simple gonadal dysplasia, and premature ovarian failure. People who are allergic to chorionic gonadotropin are prohibited.

Dosage

1. (1) Single use of chorionic gonadotropin: for patients with mild hypopituitary and ovarian dysfunction, intramuscular injection of 3000-5000U on the 12th to 14th day of the menstrual cycle, 2 times a day, 2 times in total, sexual intercourse that night; (2) ) Combination with chlorphenamine: about 7 days after stopping chlorphenamine, add 2000-5000U chorionic gonadotropin, each intramuscular injection, sexual intercourse that night; (3) Combination with HMG: during menstruation From the 6th day, two HMGs were injected intramuscularly every day for 7 to 14 consecutive days. Observe cervical mucus every day. For example, 7 days after the injection of HMG, when the amount of cervical mucus is increased, thinner, and the degree of stringiness is good, HMG is stopped, and 5000-10000 U of chorionic gonadotropin is injected intramuscularly, and each injection is used for intercourse that night. If possible, from the 7th day of HMG application, 24h urine estrogen levels will be measured every day or every other day. When the estrogen output is 100-200μg per day, HMG is stopped and 5000-10000U chorionic gonadotropin is injected. If 24h urine estrogen exceeds 200μg, chorionic gonadotropin should not be injected to avoid excessive stimulation.


2. Insufficient corpus luteum function: Intramuscular injection of 500-2000U on the 14th to 16th day of menstruation (1 to 3 days when basal body temperature rises), once a day, 5-6 times in total, stop the drug after reduction.


3. Threatened abortion or habitual abortion due to insufficient corpus luteum function: intramuscular injection of 3000-5000 U every day or every other day, a total of 5-10 times, stop the drug after reduction.


4. Dysfunctional uterine bleeding: intramuscular injection of 500 to 1500 U per day for 3 to 5 days.


5. Cryptorchidism: under 10 years old, 500-1000 U per intramuscular injection, 10-14 years old, 1500 U per intramuscular injection, 2 to 3 times a week for 4 to 8 weeks.


6. Male sexual dysfunction: 4000U intramuscular injection each time, 3 times a week.

Adverse reactions

(1) When used to promote ovulation, it is more common to induce ovarian cysts or mild to moderate ovarian enlargement, accompanied by mild gastric bloating, stomach pain, and pelvic pain, which generally subside within 2 to 3 weeks, but rare Severe ovarian hyperstimulation syndrome. The rapid accumulation of body fluids in the thoracic cavity, abdominal cavity and pericardial cavity due to the significant increase in vascular permeability causes a variety of complications, such as decreased blood volume, electrolyte flocculation, blood concentration, and abdominal hemorrhage , Thrombosis, etc. The clinical manifestations are severe pain in the abdomen or pelvis, indigestion, edema, decreased urine output, nausea, vomiting or diarrhea, shortness of breath, swelling of the lower limbs, etc. It often occurs 7 to 10 days after ovulation or after treatment is over, the reaction is serious and can be life-threatening. (2) When used for the treatment of cryptorchidism, precocious puberty occasionally occurs in males, which is manifested as acne, enlarged penis and testicles, increased pubic hair growth, and excessive height growth.

(3) Less common adverse reactions include breast enlargement, headache, irritability, depression, and fatigue.

(4) Occasionally, local pain and allergic rash after injection.

(5) Using this product to promote ovulation can increase the rate of multiple births, immature newborns, and premature births.

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