Growth hormone co-treatment in IVF/ICSI cycles in poor responders

Abstract

To estimate the efficacy of growth hormone (GH) co-treatment within an antagonist protocol in IVF/ICSI cycles in poor responders. A prospective observational study involving 50 patients underwent a standard antagonist protocol with or without GH co-treatment. GH was administered by a daily subcutaneous injection of 1,33 mg (equivalent to 4 IU) starting from day 1 of ovarian stimulation until the day of 10,000 human chorionic gonadotropin (hCG) triggering . Concentrations of GH, insulin-like growth factor I (IGF-I) and IGF binding protein-3 (IGFBP-3) in serum and follicular fluid were the subject matter of analysis. The GH co-treatment significantly lowered the effective dose of gonadotropins, duration of stimulation, IGFBP-3 level in serum and follicular fluid on the day of oocyte retrieval. The total number of oocytes as well as the number of metaphase II stage (MII) oocytes, two pronucleus (2 pn) zygotes, good-quality transferred embryos was significantly higher in the GH þ group. Pregnancy was achieved in patients GH þ group only. Positive correlation was found between IGF-I level in follicular fluid, dynamics of IGFBP-3 level changes during stimulation protocol and the number of good-quality transferred embryos in the GH þ group. GH administration in IVF/ICSI cycles for poor responders raises ovarian sensitivity to the gonadotropin exogenous influence, increasing number of high-quality embryos and the probability of pregnancy. ARTICLE HISTORY

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

“…Nonetheless, the report demonstrated that GH patients reached oocyte retrieval faster than non-GH patients, as also shown in other studies [9], which may indicate that GH has an effect on folliculogenesis; however, this possibility was not supported by differences in embryo quality [8]. Nonetheless, the links between GH and folliculogenesis, oocyte quality and responsiveness to gonadotrophins is still unclear [2,9,11]. The authors also indicated that while there was no difference in the number of oocytes retrieved or transferred, the low recruitment numbers may mask any perceived improvements [8].…”

“…In accordance with this previous work on fresh transfers [12,13], the current findings indicated that the use of GH as an adjuvant cotreatment during IVF stimulation had a positive outcome on fresh ET and in addition, in subsequent FET cycles. As GH was not administered during the FET cycles, this suggested that the potential beneficial effects of GH may extend to embryo quality as presented previously [5,9,16], rather than involving an effect on endometrium receptivity [15,17]. However, in our previous studies on embryos generated under GH action, we failed to demonstrate that the adjuvant altered embryo quality to a measurable extent, as the proportion of highquality embryos on morphological assessment was the same with or without GH [12,13].…”

“…Cui et al [15] also performed in vitro experiments and showed that GH upregulated insulin-like growth factor 1, along with the proangiogenic factor vascular endothelial growth factor in an endometrial carcinoma cell line, which may modify endometrial receptivity [41] and aid decidualization. The potential effect of GH on endometrial receptivity is intriguing, but requires further research, as the more traditional hypothesis has centered around improved embryo quality [9].…”

“…However, this prospective randomized controlled trial (RCT)-known as the Live birth, In vitro fertilisation and Growth Hormone Treatment (LIGHT) study-failed to reach its enrolment target, as patients categorized as poor-prognosis resisted inclusion and only 34.9% of the required sample size was recruited [8,10]. Nonetheless, the report demonstrated that GH patients reached oocyte retrieval faster than non-GH patients, as also shown in other studies [9], which may indicate that GH has an effect on folliculogenesis; however, this possibility was not supported by differences in embryo quality [8]. Nonetheless, the links between GH and folliculogenesis, oocyte quality and responsiveness to gonadotrophins is still unclear [2,9,11].…”

“…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.…”