hCG

Mechanism

Human chorionic gonadotropin, or hCG, acts at the same receptor as luteinizing hormone. In selected fertility treatment, it helps trigger final egg maturation and ovulation. In some male hormone disorders, it stimulates the testes to make testosterone.^331,332

Product	What the label describes
Pregnyl	Urine-derived hCG. Intramuscular route. Selected male and female indications.331
Novarel	Urine-derived hCG. Intramuscular route. Selected male and female indications.333
Ovidrel	Recombinant choriogonadotropin alfa. Subcutaneous prefilled syringe. Female fertility indications.332

Ovulation, pregnancy and live birth

One trial reported ovulation, pregnancy and live birth in the same group.

Ovulation		91.9%
Pregnancy		22.2%
Live birth		15.2%

Share of the Ovidrel treatment arm. Study 8209: 91 ovulations, 22 clinical pregnancies and 15 live births after ovarian stimulation and a single 250 microgram subcutaneous dose. Pregnancy and live-birth percentages are calculated from those counts. These are stages within one group, not three treatment groups.³³²

Read the denominator

The label also reports live births as 68.2% of clinical pregnancies: 15 of 22. That is the same 15 births, with a different denominator. Neither percentage predicts an individual person's chance of having a baby.³³²

When fertility treatment causes harm

Ovarian stimulation and the trigger treatment need to be considered together.

Ovarian hyperstimulation syndrome

OHSS can cause enlarged ovaries and fluid shifts. It may develop or worsen after the injection, especially if pregnancy occurs. Severe cases can involve blood clots, breathing problems and kidney problems.^332,334

3 of 99 women

The US label reports OHSS in 3 of 99 women in the 250 microgram ovulation-induction arm. Separate assisted-reproduction trials reported 4 of 236 women at that dose. These are different treatment settings, not a pooled personal risk estimate.³³²

Tests and storage

Pregnancy-test timing and storage rules are product-specific.

Up to 10 days

Ovitrelle can interfere with urine or blood pregnancy tests for up to 10 days after administration. A positive test during that time can reflect the treatment. Testing schedules are product- and clinic-specific.³³⁴

Product and country	Label limit
Pregnyl, US	After reconstitution: 60 days refrigerated.331
Novarel, US	After reconstitution: 30 days refrigerated.333
Ovidrel syringe, US	Up to 30 days at 25°C or below before use.332
Ovidrel pen, New Zealand	Up to 28 days below 25°C before use.335

Product-specific instructions

These limits concern different products and handling conditions. A label from another country, device or brand is not a substitute for the leaflet supplied with the medicine.^{331,333,332,335}

Male indications

Male treatment studies measure testosterone, sperm and pregnancy as distinct outcomes.

US urinary-hCG labels

Pregnyl and Novarel include selected cases of hypogonadotropic hypogonadism, a disorder involving insufficient hormone signals to the testes. That indication does not establish that adding hCG to any testosterone regimen will preserve fertility.^331,333

A legacy indication needs context

The labels also include selected nonobstructive cases of undescended testes before puberty. A listed indication alone does not establish the preferred treatment in current clinical guidelines.^331,333

Male safety and sport

The labels describe breast enlargement, fluid retention and, in children, early puberty. WADA prohibits chorionic gonadotrophin at all times in males under its 2026 list. Prescription status does not remove anti-doping requirements.^331,333,336

Does recombinant mean better?

Recombinant and urinary products were compared on fertility and safety outcomes.

Cochrane review

The 2016 review included 18 trials with 2,952 participants; 15 compared recombinant and urinary hCG, and three compared recombinant LH with urinary hCG. In the hCG comparison, seven trials with 1,136 participants found no conclusive difference in ongoing pregnancy or live birth.³⁴⁰

How much confidence to place in it

The review found no clear difference in OHSS either, but estimates were imprecise. Nine of the 18 trials were funded by pharmaceutical companies, and five did not clearly report funding.³⁴⁰

Intrauterine add-on

Giving hCG inside the uterus before embryo transfer is a separate IVF add-on. It should not be confused with an injection used to trigger final egg maturation.³⁴¹

Intrauterine IVF add-on

A 2026 analysis separated trials that met its trustworthiness checks from those that did not.

No live-birth benefit

Seven trials provided individual participant data for 2,244 people undergoing IVF. Giving hCG inside the uterus before embryo transfer did not improve live-birth or clinical-pregnancy rates compared with placebo or no add-on.³⁴¹

Why earlier reviews looked more positive

The researchers found 28 trials in total. All seven that provided individual data met their trustworthiness criteria. None of the trials without those data met the criteria, and that group reported more positive pregnancy results. This is a reason to examine study quality before relying on a pooled headline.³⁴¹

Does it preserve fertility on TRT?

The evidence is promising in selected men, but it does not guarantee sperm production or a pregnancy.

Intratesticular hormone outcome

A three-week experiment in 29 healthy men found that hCG could maintain testosterone inside the testes during testosterone-induced hormone suppression. It did not establish sperm production, pregnancy, live birth or long-term safety.³⁴²

Small clinical series

A retrospective study followed 26 men using testosterone with hCG for an average of 6.2 months. None developed an absence of sperm in the semen, and nine partners became pregnant. There was no comparison group, so the study cannot show what would have happened without hCG.³⁴³

Continuing nonprescribed androgens

A 2025 clinic series followed 19 men who continued androgen use. Average sperm counts rose after three to six months of hCG treatment, but some men still had very low counts or no sperm. The study had no control group and did not establish the safety of continued androgen use.³⁴⁴

When hormone signals are missing

This specific disorder has treatment studies in selected men; their results do not represent every low-testosterone presentation.

Combination treatment

A review of 103 studies involving 5,328 males with hypogonadotropic hypogonadism found better sperm-production results with hCG plus FSH than with hCG alone. The studies varied greatly in patient age, treatment and follow-up, and many were not randomized.³⁴⁵

Sperm production and pregnancy outcomes

The review reported sperm production in 86% with hCG plus FSH and 40% with hCG alone. These pooled results are not a head-to-head trial or pregnancy rates. The median reported treatment or follow-up period was 18 months.³⁴⁵

Country records

The national pathway and postmarketing survey cover prescribing and surveillance.

France: selected male uses

In February 2026, France amended its compassionate prescribing framework for the Ovitrelle pen. It includes male infertility due to missing hormone signals, with FSH treatment, and selected diagnostic and developmental uses. This national pathway does not expand the central European product indication.³⁴⁷

Japan: surveillance after approval

A Japanese re-examination report dated October 2025 described 419 patients in an Ovidrel postmarketing survey. Seventeen had reported adverse drug reactions, including 13 cases of ovarian hyperstimulation syndrome. The survey had no randomized comparison group.³⁴⁸

Weight-loss and product claims

A hormone with legitimate medical uses can still be sold with unsupported promises.

The weight-loss claim

No. A review of eight controlled and 16 uncontrolled studies found no evidence that hCG improves weight loss, fat distribution, hunger or well-being. Most studies were methodologically weak. FDA has no approved hCG weight-loss product.^346,337

The US compounding rule changed

In March 2020, hCG moved into the biologic licensing framework. FDA states that these biologics are not eligible for the usual 503A or 503B compounding exemptions. Separate rules for mixing, diluting or repackaging do not amount to approval of a compounded hCG product.³³⁸

Common questions

Fertility, testosterone, pregnancy tests, product differences and side effects.

01 Does hCG preserve fertility while someone is on testosterone?

It may help, but it does not guarantee fertility. In 29 healthy men, hCG maintained testosterone inside the testes during three weeks of experimental hormone suppression, but the study did not measure sperm, pregnancy, or live birth. In a separate 26-man testosterone-plus-hCG series, semen measures stayed stable, no participant had a complete absence of sperm in semen, and nine partners became pregnant, but there was no comparison group.^342,343

02 Can hCG raise sperm counts or restore fertility, and who actually responds?

It can help some men whose brain or pituitary is not sending enough hormone signal to the testes; whether it applies depends on the cause of infertility. A review of 5,328 males reported sperm more often when FSH was added to hCG than with hCG alone, but the studies used different patients and treatments and many were not randomized. Results from combined treatments do not prove that hCG alone will work.^331,333,345

03 What is hCG, and what is it actually approved for?

hCG is a glycoprotein hormone that acts at the LH/hCG receptor, but its clinical products are not interchangeable. In the United States, Pregnyl and Novarel are urinary-derived products injected into muscle for selected female and male uses, while Ovidrel is a recombinant product injected under the skin for female fertility care. An hCG result on a blood or urine test is a measurement and does not show that someone received an hCG drug.^{331,333,332,349,350}

04 Are Pregnyl, Novarel, Ovidrel, and Ovitrelle the same product?

No: Pregnyl and Novarel are US urinary-derived products injected into muscle, while Ovidrel and Ovitrelle are recombinant products injected under the skin; the central EMA information covers female fertility care. France amended its separate compassionate prescribing framework for selected male uses of the Ovitrelle pen in 2026, which is not an expansion of the EMA indication. The products still have different routes, indications, devices, strengths, and storage rules.^{331,333,332,334,347}

05 How do hCG, hMG or FSH, clomiphene, and gonadorelin differ?

They work at different points in the reproductive hormone pathway and are not interchangeable. For men with deficient pituitary hormone signals, hCG supplies an LH-like signal, while FSH or hMG adds FSH activity; clomiphene and gonadorelin are separate approaches with their own eligibility and evidence. A short hCG-versus-clomiphene study measured testosterone and symptoms rather than sperm, pregnancy, or live birth, and the broader studies used very different patients and treatment combinations.^345,351,331

06 How long can an hCG trigger make a pregnancy test look positive?

The EMA Ovitrelle information says the medicine can interfere with blood or urine hCG tests and cause a false-positive pregnancy result for up to 10 days after administration. That warning is specific to the product and does not give a universal testing timeline for every hCG product.³³⁴

07 Does the hCG diet work?

No. A review of eight controlled and 16 uncontrolled studies found no evidence that hCG improves weight loss, hunger, fat distribution, or well-being, and a double-blind 40-woman trial found no advantage over saline with the same restricted diet. FDA says no hCG product is approved for weight loss and warns that very-low-calorie diets can cause serious complications.^346,352,337

08 What side effects matter for men?

Urinary hCG labels describe breast enlargement, sodium and fluid retention, injection-site reactions, and allergic reactions; treatment in children can cause early puberty changes. The frequency and relevance depend on the product and population, and voluntary reports without a known number of exposed people cannot give a rate or prove that hCG caused an event. The labels distinguish a prior serious allergy to hCG from expected or postmarketing reactions.^331,333,353

09 Which male conditions are labeled uses, and why does the diagnosis matter?

Current US urinary hCG labels include selected cases where the pituitary is not sending enough hormone signal to the testes, plus undescended testes in children when there is no physical blockage. Those are not generic indications for primary testicular failure, every infertility cause, or every low-testosterone presentation. A review of seven undescended-testis trials found no clear advantage over placebo and judged the evidence low quality and imprecise, so a label indication does not prove that it is preferred current care.^331,333,354

10 Can hCG still be compounded, and why is availability product-specific?

Since March 23, 2020, FDA has treated hCG as a biological product, so the usual 503A and 503B drug-compounding exemptions do not apply. Pregnyl, Novarel, and Ovidrel have separate product records; availability varies by product and date. Enforcement records document selected contamination, potency, and labeling failures, not a defect rate for the whole market.^338,355,339

11 What does an hCG trigger prove about ovulation, pregnancy, and live birth?

In one Ovidrel ovulation-induction study, 99 participants received the product: 91 ovulated, 22 had a clinical pregnancy, and 15 had a live-birth outcome. The label's 68.2% live-birth figure means 15 out of the 22 pregnancies, while 15 out of all 99 treated participants is 15.2%. Triggering ovulation is not the same result as becoming pregnant or having a live birth.³³²

12 What is OHSS, and when can fertility-treatment symptoms be urgent?

Ovarian hyperstimulation syndrome, or OHSS, is a fertility-treatment complication involving enlarged ovaries and fluid shifts, with possible breathing, kidney, blood-clot, or ovarian-twisting complications. The labels warn that it can progress after treatment stops and may become more severe if pregnancy occurs. Severe pelvic or abdominal pain, rapid weight gain, vomiting, breathing difficulty, or low urine output needs prompt clinical assessment.^332,331,334

13 How do storage and handling rules differ by product?

Storage is not one rule for every hCG product. Current US labels say reconstituted Pregnyl may be refrigerated for up to 60 days and Novarel for up to 30 days; Ovidrel is a single-use prefilled product, and the New Zealand pen and US syringe have different room-temperature limits. Follow the instructions for the exact supplied product rather than a generic hCG mixing schedule.^{331,333,332,335}

14 How long does hCG last, and can route or formulation change that?

There is no single half-life for every hCG product, route, and population. The US Ovidrel label reports a mean terminal half-life of 29 plus or minus 6 hours after injection under the skin in healthy women; an 18-woman crossover of urinary Pregnyl found 32 to 33 hours after historical injections into muscle and under the skin, but the peak level and timing were not proven equivalent. Those studies do not provide a universal duration or schedule in men.^332,356

15 Is hCG banned in sport?

Yes, for males covered by the World Anti-Doping Code. The current 2026 WADA list prohibits chorionic gonadotrophin at all times, and a prescription does not automatically satisfy sport rules because therapeutic-use exemptions are separate. The published 2027 list keeps the same entry but is not yet the current list.^336,357,358