T Nation

Need Advice for Fertility

Please help! I’m new here but have been reading the past few days. My husband has been on trt for 3+ years. We decided to have another baby a year ago. Of course he had zero sperm on a SA at that time. He came off T for 2 weeks and took clomid 25mg eod and hcg 1500iu 2x week. He then went back on T and continued the hcg at 500iu 2x week. His counts came up and we did IVF. I had some issues at the time which is why we did IVF. I have since had surgery to correct those.

He did not stay on the hcg after the IVF we were convinced I would get pregnant but after both transfers I was not pregnant. After I had surgery he started the same protocol as before and now 4 months later he has zero sperm still. He does not want to go off T long term! His Dr is willing to work with us but she doesn’t really know much about the fertility aspect of trt. From what I’ve read I’m thinking of asking her to let us try some fsh. Just wondering what your thoughts are of this… Stay on T, continue hcg 500iu 2x week, add 75iu of fsh 3x week. Should the addition of fsh stimulate spermatogenesis since hcg alone isn’t working thus far? Also how long should he plan on being on fsh? Until I get pregnant? Oh and he is also on anastozole .5mg week.

This is what you need: https://en.wikipedia.org/wiki/Menotropin

When on clomid, you could have tested LH/FSH to see how the hypothalamus and pituitary were responding.

High doses of SERM or hCG are not a good idea as LH can be too high and LH receptors could get desensitized and E2 might get out of control.

hCG preserves physical structure of the testes and has a weak FSH effect, but FSH is needed to make swimmers.
You need to stay on TRT so he is interested.

He should have been on T and anastrozole and hCG [T+AI+hCG] keeping near E2=22pg/ml. Most docs get this all wrong and Rx T only.

After the testes are shutdown on T without hCG, introduction of hCG will restore some of the size of the testes and these physical changes take time.

Some guys have made babies with T+hCG or added hCG later on to do that. But 3 years is a long time.

Meanwhile make sure that you are getting iodine from iodized salt and thyroid function is OK and if an egg sticks, you can get more iodine in prenatal vitamins.


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Got it! Thank you! My fertility Dr noticed my t4 and t3 were in range but not optimal so I’ve been on synthroid and t3 for over a year. My pcp now monitors it and uses the fertility Dr’s ranges. Its all good now and wow I didn’t notice how bad I felt before. We do use ionized salt always have. He gets his labs done every 2-3 months. He’s been on test cyp. and anastozole the whole time. He keeps his T in the 800’s and his e2 in the low 20’s. His Dr likes these ranges and through trial and error he has noticed this is where he feels the best also. We thought we were done having babies so we said no to the hcg (I kick myself daily for that) the dr did offer it. Since he’s been on the hcg he says he has noticed a definite increase in size and placement (slightly lower) of his testicle. So I’m thinking that is a good sign. Is there anyway to get the menotropins if the dr isn’t willing to prescribe. She’s been good so far but she’s also said she’s never tried to regain fertility before and she’s not very knowledgeable about the meds used for this. She’s a little afraid to go outside her wheelhouse but she said she would research what we found out. I just would like to have a plan B. Thank you for all your help and knowledge!

menotropin is really LH and FSH and nothing harmful at all, there are normal human hormones, not drugs. This is really what one hopes a SERM does. Testing LH/FSH on SERM makes a lot of sense as menotropin is probably a lot of $$$, test and know if you need it.

If thyroid meds are good, then you should wake up at 97.7F or better and be hitting 98.6F mid afternoon.

Through all my searching I saw a lot of people asking questions about hmg and testosterone but no one ever came back and told how well it worked or if it worked so here’s an update.
We acquired fsh (straight not hmg) from an online pharmacy 2 weeks ago. My husband stated injecting 75iu fsh and 500iu hcg on Monday, Wednesday, and Friday. I mixed these into 1 injection. He has taken 6 doses so far. I got a microscope online so we could monitor progress. As of tonight he DOES have motile sperm swimming in a straight line!!! This is huge for us, from zero to probably 30 in a drop on a slide. Now that’s not a lot but… It’s a great start. He has continued his testosterone and anastozole at the same dosage and frequency that he has always taken. To say the least we are extremely pleased. I’ll try to remember to post another update for anyone searching for options in the future further into his treatment. We’re planning on continuing this plan and getting a semen analysis at the 3 month mark.

How did this all turn out?