Difficult-to-treat women for controlled ovarian hyperstimulation: tips and tricks

Artini, Paolo Giovanni; Papini, Francesca; Ruggiero, María; Scaravelli, Giulia; Berardino, Olga Maria Di; Simi, Giovanna; Cela, Vito

doi:10.1586/eem.11.43

Cited by 2 publications

(2 citation statements)

References 110 publications

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“…In our NMA, no GH supplementation protocol has been proven effective in improving the clinical pregnancy rate and live birth rate of POR patients according to the overall pooled results. However, it is important to consider that the objective of COH is to recruit a sufficient number of follicles to compensate for the inefficiencies of embryo culture and selection for transfer 55 , and in assisted reproduction, the number of retrieved oocytes is regarded as a significant prognostic variable with a linear correlation to live birth rates 56 , so it is possible that, despite the lack of improvement in pregnancy rate and live birth rate within a single transfer cycle, the increased quantity Table 4. A comprehensive sorting table for the primary and secondary outcome measures.…”

Section: Discussionmentioning

confidence: 99%

Comparative efficacy of different growth hormone supplementation protocols in improving clinical outcomes in women with poor ovarian response undergoing assisted reproductive therapy: a network meta-analysis

Xu,

Tong,

Yang

et al. 2024

Sci Rep

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Growth hormone (GH) has a long-standing history of use as an adjunctive therapy in the treatment of poor ovarian response (POR), but the optimal dosage and timing remains unclear. The aim of this study was to evaluate and compare the efficacy of different GH supplementation protocols through a network meta-analysis (NMA) and determine the optimal treatment protocol. This study was reported based on the Preferred Reporting Items for Systematic Reviews for Network Meta-Analysis (PRISMA-NMA) statement. Databases including PubMed, Web of Science, Cochrane Library and Embase were searched until June 2023. A total of 524 records were retrieved in our search, and 23 clinical studies comprising 4889 cycles were involved. Seven different GH protocols were identified. Results showed that compared to the control group, daily administration of 4–8 IU of GH during the follicular phase of the stimulation cycle had the best comprehensive therapeutic effects on improving the number of retrieved oocytes, mature oocytes, endometrial thickness, and reducing gonadotropin requirements in POR patients undergoing assisted reproductive therapy, with a relatively brief treatment duration and a moderate total GH dose. Subgroup analysis demonstrated that this protocol could significantly improve the clinical pregnancy rate of POR patients in the randomized controlled trials (RCT) subgroup and the African subgroup. Therefore, its clinical application is suggested. Besides, the potential advantages of long-term GH supplementation protocol (using GH for at least 2 weeks before oocyte retrieval) has merit for further research. Rigorous and well-designed multi-arm RCTs are needed in the future to confirm the conclusions drawn from this study.

show abstract

Section: Discussionmentioning

confidence: 99%

Comparative efficacy of different growth hormone supplementation protocols in improving clinical outcomes in women with poor ovarian response undergoing assisted reproductive therapy: a network meta-analysis

Xu,

Tong,

Yang

et al. 2024

Sci Rep

View full text Add to dashboard Cite

show abstract

“…In our NMA, no GH supplementation protocol has been proven effective in improving the clinical pregnancy rate and live birth rate of POR patients according to the overall pooled results. However, it is important to consider that the objective of COH is to recruit a su cient number of follicles to compensate for the ine ciencies of embryo culture and selection for transfer 51 , and in assisted reproduction, the number of retrieved oocytes is regarded as a signi cant prognostic variable with a linear correlation to live birth rates 52 , so it is possible that, despite the lack of improvement in pregnancy rate and live birth rate within a single transfer cycle, the increased quantity and maturity of oocytes may contribute to a greater likelihood of cumulative pregnancies and live births due to more embryos available for transfer and cryopreservation. We look forward to conducting further research in the future to validate this hypothesis.…”

Section: Discussionmentioning

confidence: 99%

Comparative Efficacy of Different Growth Hormone Supplementation Protocols in Improving Clinical Outcomes in Women with Poor Ovarian Response Undergoing Assisted Reproductive Therapy: A Network Meta-analysis

Xu,

Tong,

Yang

et al. 2023

Preprint

View full text Add to dashboard Cite

Growth hormone(GH) is widely used in assisted reproduction for patients with poor ovarian response(POR), but the optimal dosage and timing remains unclear. The aim of this study was to evaluate and compare the efficacy of different GH supplementation protocols through a network meta-analysis (NMA) and determine the optimal treatment protocol. This study was reported based on the Preferred Reporting Items for Systematic Reviews for Network Meta‑Analysis (PRISMA‑NMA) statement. Databases including PubMed, Web of Science, Cochrane Library and Embase were searched until June 2023. A total of 524 records were retrieved in our search, and 23 clinical studies comprising 4889 cycles were involved. Seven different GH protocols were identified. Results showed that compared to the control group, daily administration of 4–8 IU of GH during the follicular phase of the stimulation cycle had the best comprehensive therapeutic effects on improving the number of retrieved oocytes, mature oocytes, endometrial thickness, and reducing gonadotropin requirements in POR patients undergoing assisted reproductive therapy, with a relatively brief treatment duration and a moderate total GH dose. Subgroup analysis demonstrated that this protocol could significantly improve the clinical pregnancy rate of POR patients in the randomized controlled trials (RCT) subgroup and the African subgroup. Therefore, its clinical application is suggested. Besides, the potential advantages of long-term GH supplementation protocol need to be explored. Further rigorous and well-designed multi-arm RCTs are needed to confirm the conclusions drawn from this study.

show abstract

Difficult-to-treat women for controlled ovarian hyperstimulation: tips and tricks

Cited by 2 publications

References 110 publications

Comparative efficacy of different growth hormone supplementation protocols in improving clinical outcomes in women with poor ovarian response undergoing assisted reproductive therapy: a network meta-analysis

Comparative efficacy of different growth hormone supplementation protocols in improving clinical outcomes in women with poor ovarian response undergoing assisted reproductive therapy: a network meta-analysis

Comparative Efficacy of Different Growth Hormone Supplementation Protocols in Improving Clinical Outcomes in Women with Poor Ovarian Response Undergoing Assisted Reproductive Therapy: A Network Meta-analysis

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