Paper Title
THE USE OF HCG OR HCG-COMBINED TREATMENTS FOR MALE INFERTILITY: A SYSTEMATIC REVIEW

Abstract
Abstract - Background: There exists a lack of consensus on the value of human chorionic gonadotropin (HCG) or HCG-combined therapies for the treatment of male infertility. Objectives: To evaluate the efficacy and safety of HCG or HCG-combined interventions in the treatment of male infertility, including men with oligospermia, men with varicocele, men with severe testiculopathy, and men with hypogonadotropic hypogonadism. Search Strategy: We searched the databases Embase, MEDLINE and the Cochrane Central Register of Controlled Trials (CENTRAL), from inception to December 2019. Selection Criteria: Randomised controlled trials evaluating the use of HCG or HCG-combined interventions for the treatment of male infertility. Data Collection and Analysis: We included seven trials, reporting data from 926 men. Study characteristics and methodological assessment were reported for each trial. Estimates of summaries were reported as odds ratios with random-effects methods used for calculation. When statistical analyses could not be performed, results were reported narratively. Main Results: HCG showed statistically significant differences in sperm morphology and pregnancy rate (odds ratio [OR] 34.49; 95% confidence interval [CI] 1.88 - 632.45; P=0.02) in men with varicocele who were treated for three months following varicocelectomy. The use of HCG-combined therapy for three months was associated with increased pregnancy rates in men with oligospermia (OR 2.91; 95% CI 1.57 - 5.38; P=0.0007) but no statistically significant differences were observed in men with severe testiculopathy (OR 5.13; 95% CI 0.27 - 98.56; P=0.28). There was no reporting of pregnancy rate for men with hypogonadotropic hypogonadism. There was absent or limited reporting of secondary outcomes, including live births, birth weight, gestational age at delivery and adverse events. Conclusion: There is limited evidence to support the use of human chorionic gonadotropin and a lack of compelling evidence to suggest HCG combined interventions for the treatment of male infertility. There is need for more research to be carried out. Keywords - HCG, Human Chorionic Gonadotropin, Male Infertility, Meta-Analysis, Randomised Controlled Trial, And Systematic Review.