Gonadotrophin therapy

What is gonadotrophin therapy?

Gonadotrophins are a class of injectable drugs which are based on reproductive hormones made in the pituitary gland. The pituitary gland sits at the bottom of your brain, and makes two hormones vital for fertility: luteinising hormone (LH) and follicle stimulating hormone (FSH). LH and FSH work by stimulating the testes to work - LH stimulates the Leydig cells in your testicles to make testosterone; and FSH stimulates the Sertoli cells in your testicles to support the growth of mature sperm (spermatogenesis).

Gonadotrophins come in many forms: some contain synthetic hormones and others contain urine derived hormones; some have predominantly LH like activity, and others are mainly FSH-like in activity. Sometimes confusingly for patients, the most commonly prescribed form of LH containing gonadotrophin is not LH at all - human chorionic gonadotrophin (hCG) is a placental derived hormone that has almost the same activity and structure to LH. So, when you hear people talk about hCG, they are talking about LH (something designed to stimulate testosterone production in your testes).

Why Imperial Reproductive Endocrinology?

We run one of the busiest UK clinics for gonadotrophin therapy with many years of experience in treating men with this condition. But we don't just treat men with the condition - we conduct cutting-edge research into the condition and help to inform understanding of it worldwide. Our Clinical Director Dr. Channa Jayasena has conducted several research studies at Imperial College London looking at the patterns of gonadotrophin hormone release from the pituitary gland when stimulated by the novel brain hormone called kisspeptin. You can read some of his publications here at the National Institute of Health and at the UK Research & Innovation .

Diagnosis and referral path

Men with hypogonadotrophic hypogonadism (HH) need gonadotrophin therapy to make sperm and therefore father children. It is impractical and too costly to give gonadotrophins to men throughout life. So men are given testosterone therapy, and switched over to gonadotrophins when they want to start a family.

What does treatment involve?

Typically, patients need to take twice-weekly injections of one or two different gonadotrophns (such as gonasi or menopur), over a 12 month period. A few patients need just 9 months, and a few patients need 18 months. You need to be seen every 3 months to check your response to treatment, and your doctor may need you to check your testosterone levels and/or sperm count beforehand.

What is the success rate?

80-90% of men with HH which started during adulthood (e.g. following pituitary surgery) successfully develop sperm. 60-70% of men with HH from birth/problems going through puberty successfully develop sperm. The reason why HH from birth is more difficult to treat, is that the seminiferous tubules in the testes, may not be fully developed. So, gonadotrophin therapy has an additional role to fully mature the testicles to making sperm.

How much does it cost?

A typical treatment plan costs £6,000 to £12,000 in total. The biggest and most variable cost is the purchase of the gonadotrophins themselves - some patients just need one injection twice-weekly, but some patients need twice weekly injections of two different hormones. Blood testing and semen analysis will costs about £1,000-£1,500 in total.

You should have 2-3 monthly consultations over a 12 month period (approx. £1000). Availability of gonadotrophins can change quickly, so your doctor is essential to ensure you get prescribed the most effective and cost-efficient choice of therapy.

How can I make an appointment?

If you’d like to make an appointment, you can now book online. Otherwise, for more information please email [email protected] or telephone 0203 962 2213 to speak to a member of our team.