Growth Hormone Supplementation in the Luteal Phase Before Microdose GnRH Agonist Flare Protocol for In Vitro Fertilization

Dunne, Caitlin; Seethram, Ken; Roberts, James W.

doi:10.1016/s1701-2163(15)30152-3

Cited by 20 publications

(19 citation statements)

References 15 publications

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“…[32] There was evidence that GH addition significantly lower cycle cancellations in POR with micro dose gonadotropin releasing hormone (GnRH) agonist protocol [33] which was consistent with the present meta-analysis. However, retrospective matched case-control study reported there was no difference between the groups in clinical pregnancy rate and cycle cancellation rate in POR patients, [34] which is different from our analysis. Result of Gregoraszczuk et al [35] demonstrated that the influence of exogenous GH on steroid secretion by granulose cells and theca cells recovered from different follicles, GH addition stimulated both estradiol and progesterone secretion from large preovulatory follicles.…”

Section: Discussioncontrasting

confidence: 99%

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: Discussioncontrasting

confidence: 99%

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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“…A retrospective matched case–control study including 42 patients explored for the first time the effect of GH as an adjuvant in a micro-dose GnRH agonist flare-up protocol. The study group was treated with 3.33 mg GH daily subcutaneously (SC) for 14 days before starting COS (39). The authors did not find differences in any of the reported outcomes, although the small sample size and the retrospective character of the study necessitated a future RCT to draw firm conclusions.…”

Section: The Search For the Most Optimal Stimulation Protocolmentioning

confidence: 99%

Growth Hormone and Reproduction: Lessons Learned From Animal Models and Clinical Trials

et al. 2019

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Growth Hormone (GH) has been considered as a therapeutic option to increase the number of growing follicles during Assisted Reproductive Technology (ART) for more than 30 years. In this review the biological rationale for therapeutic GH usage is explained through evidence in animal models, aiming to put this into a clinical context. First, we explain the GH—Insulin like Growth Factor (IGF)-1—gonadal axis and its role in reproduction. Evidence suggests that GH can stimulate the secretion of IGF1 not only in the liver but also in the peripheral target structures, including the ovary. Moreover, IGF-1 can be secreted locally under the influence of stimuli other than GH. In the case of the ovary, steroid hormones, gonadotropins or the combination of both seems to be involved. Even more interesting, the ovary itself can secret GH locally and exert a paracrine action modulating the intracellular signaling pathway of GH, i.e., not by the systemic pathway where GH binds to the extracellular domain of the GH receptor. Finally, these aspects from animal models are put into clinical perspective by discussing results and shortcomings of studies and meta-analyses in order to put forth the state-of-the-art rationale for therapeutic GH usage in modern ART.

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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 . Although there is no consensus on GH administration in terms of patient criteria, ovarian stimulation protocol, GH treatment duration or optimized dosage, there is a trend to prolong GH treatment prior to ovarian stimulation instead of concurrent exposure to Gonadotropin .…”

Section: Introductionmentioning

confidence: 99%

“…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 . Although there is no consensus on GH administration in terms of patient criteria, ovarian stimulation protocol, GH treatment duration or optimized dosage, there is a trend to prolong GH treatment prior to ovarian stimulation instead of concurrent exposure to Gonadotropin . The purpose of this self‐controlled, retrospective study was to analyze the effect of 6 weeks of GH administration prior to ovum pick up on the clinical outcome of patients classified as POR under IVF treatment.…”

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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Growth Hormone Supplementation in the Luteal Phase Before Microdose GnRH Agonist Flare Protocol for In Vitro Fertilization

Cited by 20 publications

References 15 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

Growth Hormone and Reproduction: Lessons Learned From Animal Models and Clinical Trials

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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