Does growth hormone-releasing factor assist follicular development in poor responder patients undergoing ovarian stimulation for in-vitro fertilization?

Abstract

Treatment with growth hormone-releasing factor (GRF) has been reported to improve the ovarian response to gonadotrophins in women who respond poorly to ovarian stimulation during in-vitro fertilization (IVF). The efficacy and tolerability of GRF were studied in a randomized, double-blind, placebo-controlled trial involving 196 patients. Following down-regulation with a gonadotrophin-releasing hormone agonist (GnRHa), patients were randomized to receive GRF (500 microg twice daily; n = 96) or placebo (n = 100) in addition to follicle stimulating hormone (FSH); treatment was continued until human chorionic gonadotrophin was given, or for a maximum of 14 days. GRF had no significant effect on the mean number of follicles with a diameter of >/=16 mm (GRF: 3.26 +/- 2.29; placebo: 3.27 +/- 2.30; P = 0.95), the number of FSH ampoules required to achieve ovarian stimulation (GRF: 55.2 +/- 16. 4; placebo: 54.9 +/- 17.2; P = 0.50), or on secondary measures of ovarian response and treatment outcome. There were, however, significant increases in circulating growth hormone (GH) and insulin-like growth factor (IGF)-1 concentrations. GRF was well tolerated. It is concluded that, despite producing significant increases in GH and IGF-1, concomitant treatment with GRF does not improve the ovarian response to FSH in poorly responsive women undergoing IVF.

DHEA supplementation positively affects spontaneous pregnancies in women with diminished ovarian function

“…It has been shown that IGF-1 has synergistic effects with FSH on follicular development, it increases the effect of FSH on E2 and progesterone secretion and the expression of LH receptors; moreover, it is an important factor for the maturation of oocytes. These effects appear to be due to the stimulation of IGF-1 production by GH, although the use of GH to improve the follicular response to gonadotrophins shows conflicting results [25].…”

Biological versus chronological ovarian age: implications for assisted reproductive technology

“…Although there are substantial in vitro data showing the critical importance of the IGF-IGFBP family (IGF-I, IGF-II and their binding proteins) to follicular development [133,134], subsequent studies failed to demonstrate a therapeutic advantage [135-141]. …”

GnRH Antagonist Protocol: Is It Effective for Expected Poor Ovarian Responders with Tubal Factor Undergoing IVF?

“…However, there are several disadvantages for the application of the GnRH-agonist long protocol in low responders, including increased Gn doses, the longer duration of Gn administration [14], the higher cycle cancellation rate, and the increased treatment costs [15]. Numerous strategies have been attempted to improve the outcome of POR, including: 1) increasing the doses of Gn [16]; 2) application of other protocols [17]; 3) addition of growth hormone (GH), and 4) addition of growth hormone-releasing factor (GHRF) [18].…”