Those patients who still have some residual pain after the first injection should receive a second and third injection and patients who did not get any benefit from the first injection should not receive another one. Patient selection is very important in deciding on the type of injections patients should receive. Transforaminal injections (different approach to the epidural space) may produce longer pain relief and may also predict whether a patient might benefit from surgery or not (for details, see review McLain et al, Spine Journal 2005). For patients with the diagnosis of lumbar canal stenosis, improvement after such injections may be longer lasting than it was initially thought (Kapural et al., 2005).
As of this writing, there is only one published study on the use of hMG together with hCG anabolic steroid-induced azoospermia (no sperm count) that was persistent 1 year after cessation from steroid use. This case report was a married couple with primary subfertility secondary to azoospermia and male hypogonadotropic hypogonadism. The husband was a bodybuilder who admitted to have used the anabolic steroids testosterone cypionate, methandrostenolone, oxandrolone, testosterone propionate, oxymetholone, nandrolone decanoate, and methenolone enanthate. He was given twice-weekly injections of 10,000 IU of hCG (Profasi; Serono) and daily injections of 75 IU of hMG (Humegon; Organon) for 3 months. Results showed that semen parameters returned to normal after 3 months of treatment and the couple conceived spontaneously 7 months later. It was concluded that anabolic steroid-induced azoospermia that is persistent after cessation of steroid use may be treated successfully with hCG and hMG.