Addition of growth hormone to the microflare stimulation protocol among women with poor ovarian response

Bayoumi, Yasser; Dakhly, Dina M.R.; Bassiouny, Yasmin A.; Hashish, Nawara M.

doi:10.1016/j.ijgo.2015.05.034

Cited by 38 publications

(34 citation statements)

References 26 publications

(36 reference statements)

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“…3A). Six [15,16,18,20–22] studies showed an increase of pregnancy rate among women who received GH, whereas the difference did not reach to statistical significance. A pooled result using fixed-effects model showed that clinical pregnancy rate (RR 1.65, 95% CI 1.23–2.22; p < 0.001) was significantly increased in the GH group.…”

Section: Resultsmentioning

confidence: 99%

“…Seven of the 11 studies [15,20–24] reported the cancelled cycles rate in the meta-analysis (Fig. 3C).…”

Section: Resultsmentioning

confidence: 99%

“…Seven articles [15,16,18,19,20,22,23] were included in the GH addition with Gn group, clinical pregnancy rate (RR 1.76, 95% CI 1.25–2.48; P = 0.001) and live birth rate (RR 1.91, 95% CI 1.29–2.83; P = 0.001) was significantly increased in this group (Fig. 5A).…”

Section: Resultsmentioning

confidence: 99%

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The influence of different growth hormone addition protocols to poor ovarian responders on clinical outcomes in controlled ovary stimulation cycles

Wang

et al. 2017

Medicine

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Background:Growth hormone (GH) is used as an adjuvant therapy in in vitro fertilization and embryo transfer (IVF-ET) for poor ovarian responders, but findings for its effects on outcomes of IVF have been conflicting. The aim of the study was to compare IVF-ET outcomes among women with poor ovarian responders, and find which subgroup can benefit from the GH addition.Methods:We searched the databases, using the terms “growth hormone,” “GH,” “IVF,” “in vitro fertilization.” Randomized controlled trials (RCT) were included if they assessed pregnancy rate, live birth rate, collected oocytes, fertilization rate, and implantation rate. Extracted the data from the corresponding articles, Mantel–Haenszel random-effects model, or fixed-effects model was used. Eleven studies were included.Results:Clinical pregnancy rate (RR 1.65, 95% CI 1.23–2.22), live birth rate (RR1.73, 1.25–2.40), collected oocytes number (SMD 1.09, 95% CI 0.54–1.64), MII oocytes number (SMD 1.48, 0.84–2.13), and E2 on human chorionic gonadotropin (HCG) day (SMD 1.03, 0.18–1.89) were significantly increased in the GH group. The cancelled cycles rate (RR 0.65, 0.45–0.94) and the dose of gonadotropin (Gn) (SMD –0.83, –1.47, –0.19) were significantly lower in patients who received GH. Subgroup analysis indicated that the GH addition with Gn significantly increased the clinical pregnancy rate (RR 1.76, 1.25–2.48) and the live birth rate (RR 1.91, 1.29–2.83).Conclusion:The GH addition can significantly improve the clinical pregnancy rate and live birth rate. Furthermore, the GH addition time and collocation of medications may affect the pregnancy outcome.

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Section: Resultsmentioning

confidence: 99%

“…Seven of the 11 studies [15,20–24] reported the cancelled cycles rate in the meta-analysis (Fig. 3C).…”

Section: Resultsmentioning

confidence: 99%

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The influence of different growth hormone addition protocols to poor ovarian responders on clinical outcomes in controlled ovary stimulation cycles

Wang

et al. 2017

Medicine

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“…The biological and biochemical mechanisms by which growth hormone (GH) can lead to better clinical outcomes in assisted reproductive technology (ART) remain unclear, but are believed to be related to oocyte development and/or subsequent embryo quality, along with potential effects in the endometrium. Several clinical studies over the past decade have focused on the use of GH for women classified as poor-prognosis in ART programs [1][2][3][4][5][6][7][8][9] as a desperate means to establish a pregnancy in severely infertile patients. However, the data around any beneficial effect is perplexing, with many studies claiming positive effects and an almost equivalent number of other investigations reporting no significant effect.…”

Section: Introductionmentioning

confidence: 99%

Live birth outcomes of vitrified embryos generated under growth hormone stimulation are improved for women categorized as poor-prognosis

Keane

Hinchliffe

et al. 2019

Clin Exp Reprod Med

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Objective: To determine the clinical pregnancy (CP) and live birth (LB) rates arising from frozen embryo transfers (FETs) that had been generated under the influence of in vitro fertilization (IVF) adjuvants given to women categorized as poor-prognosis. Methods: A registered, single-center, retrospective study. A total of 1,119 patients with first FETs cycle include 310 patients with poor prognosis (109 treated with growth hormone [GH], (+)GH group vs. 201 treated with dehydroepiandrosterone, (-)GH group) and 809 patients with good prognosis (as control, (-)Adj (Good) group). Results: The poor-prognosis women were significantly older, with a lower ovarian reserve than the (-)Adj (Good) group, and demonstrated lower chances of CP (p< 0.005) and LB (p< 0.005). After adjusting for confounders, the chances of both CP and LB in the (+)GH group were not significantly different from those in the (-)Adj (Good) group, indicating that the poor-prognosis patients given GH had similar outcomes to those with a good prognosis. Furthermore, the likelihood of LB was significantly higher for poor-prognosis women given GH than for those who did not receive GH (p< 0.028). This was further confirmed in age-matched analyses. Conclusion: The embryos cryopreserved from fresh IVF cycles in which adjuvant GH had been administered to women classified as poor-prognosis showed a significant 2.7-fold higher LB rate in subsequent FET cycles than a matched poor-prognosis group. The women with a poor prognosis who were treated with GH had LB outcomes equivalent to those with a good prognosis. We therefore postulate that GH improves some aspect of oocyte quality that confers improved competency for implantation.

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“…GH has been applied as an adjuvant option in the field of in vitro fertilization (IVF) treatment since the 1990s, but there is still controversy regarding its efficacy in improving the IVF cycle outcome . A retrospective, matched case–control study reported that the administration of GH during the luteal phase before a microdose gonadotropin‐releasing hormone (GnRH) agonist flare protocol for IVF did not improve the outcomes of patients with poor ovarian responder (POR), whereas a recent meta‐analysis showed that the addition of GH could significantly improve the clinical pregnancy rate and live birth rate .…”

Section: Introductionmentioning

confidence: 99%

Six‐week pretreatment with growth hormone improves clinical outcomes of poor ovarian responders undergoing in vitro fertilization treatment: A self‐controlled clinical study

Cai

Liang

et al. 2018

J of Obstet and Gynaecol

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Aim:The purpose was to explore whether the 6 weeks of growth hormone (GH) pretreatment could increase the live birth rate of poor ovarian responders (POR). Methods: This self-controlled, retrospective study was performed among 380 POR who had GH adjuvant (GH+) at a university-affiliated hospital in Guangzhou, China, from October 2010 to April 2016. Growth hormone was injected daily beginning with the previous menstruation and maintained until ovum pickup, for approximately 6 weeks. Clinical variables between the GH+ cycle and the other GH-free (GH-) cycle of each patient were compared. Both cycles were conducted with a similar conventional control ovarian hyperstimulation protocol for in vitro fertilization treatment. One to one case-control matching was performed to adjust essential confounding factors between GH+ cycles and GH-cycles. Results: GH pretreatment improved embryo quality (1.14 AE 1.50 vs 0.11 AE 0.48, P < 0.05) and decreased miscarriage (18.8% vs 80.0%, P < 0.05) significantly, resulting in an increase in the live birth rate (23.5% vs 3.9%, P < 0.05). The oocyte utilization rate in GH+ cycles was remarkably improved, even with older patients and more failed previous attempts. Significant improvement in embryo quality was shown by an increased number of good-quality embryos and improved oocyte utilization rate after matching. Conclusions: The longer term use of low-dose GH administration for 6 weeks could be beneficial for the utilization of oocytes and for finally increasing the live birth rates of POR.

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Addition of growth hormone to the microflare stimulation protocol among women with poor ovarian response

Abstract: Addition of GH to the microflare stimulation protocol provided some potential benefits to women with poor ovarian response. However, further studies are required before it could be recommended for routine clinical use. ClinicalTrials.gov:NCT02185326.

Cited by 38 publications

References 26 publications

The influence of different growth hormone addition protocols to poor ovarian responders on clinical outcomes in controlled ovary stimulation cycles

The influence of different growth hormone addition protocols to poor ovarian responders on clinical outcomes in controlled ovary stimulation cycles

Live birth outcomes of vitrified embryos generated under growth hormone stimulation are improved for women categorized as poor-prognosis

Six‐week pretreatment with growth hormone improves clinical outcomes of poor ovarian responders undergoing in vitro fertilization treatment: A self‐controlled clinical study

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