Single-centre retrospective analysis of growth hormone supplementation in IVF patients classified as poor-prognosis

Abstract

BackgroundPatients undergoing in vitro fertilisation (IVF) receive various adjuvant therapies in order to enhance success rates, but the true benefit is actively debated. Growth hormone (GH) supplementation was assessed in poor-prognosis women undergoing fresh IVF transfer cycles.MethodsData were retrospectively analysed from 400 IVF cycles, where 161 women received GH and 239 did not.ResultsClinical pregnancy, live birth rates and corresponding ORs and CIs were significantly greater with GH, despite patients being significantly older with lower ovarian reserve. Patient’s age, quality of transferred embryo and GH were the only significant independent predictors of clinical pregnancy (OR: 0.90, 5.00 and 2.49, p<0.002, respectively) and live birth chance (OR: 0.91, 3.90 and 4.75, p<0.014, respectively). GH increased clinical pregnancy chance by 3.42-fold (95% CI 1.82 to 6.44, p<0.0005) and live birth chance by 6.16-fold (95% CI 2.83 to 13.39, p<0.0005) after adjustment for maternal age, antral follicle count and transferred embryo quality.ConclusionThese data provided further evidence to indicate that GH may support more live births, particularly in younger women. It also appears that embryos generated under GH have a better implantation potential, but whether the biological mechanism is embryo-mediated or endometrium-mediated is unclear.

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

“…This may mean that alternative, weaker studies, such as retrospective cohort studies, may be required to advance the field provided they are stringently designed, conducted and analysed. Two recent retrospective studies by our group showed that CP and LB rates were significantly greater with GH (3.42-fold and 6.16-fold higher, respectively) following the transfer of fresh autologous embryos in stimulated cycles [12,13]. Age at embryo transfer (ET) and morphological quality of the transferred embryo were the only other significant independent predictors of the likelihood of CP and LB, but no significant differences were observed in the proportion of high-quality embryos generated in the GH arm, echoing the most recent prospective study [8].…”

“…Nonetheless, these classifications have not been able to define subsets of poor-prognosis patients who can benefit from various ART interventions including adjuvant co-treatment [31]. In our previous studies, we introduced the concept of reduced embryo quality as an additional diagnostic parameter for poor-prognosis patients, whereby those with > 50% of embryos with marked fragmentation are predicted to have poorer outcomes [1,12,13]. In the current study, we used the same criteria to define a poor prognosis, and it is these patients who are offered adjuvant therapies such as GH in order to enhance their primary ART outcomes.…”

“…In our practice, poor-prognosis women can receive GH or other IVF adjuvant (dehydroepiandrosterone [DHEA]) treatment in stimulation cycles if they have one of the following characteristics: age ≥ 40 years, generating ≤ 3 metaphase II oocytes despite high folliclestimulating hormone (FSH) stimulation doses ( ≥ 300 IU), > 50% poorquality embryos, repetitive implantation failure (RIF) in ≥ 3 ETs without achieving pregnancy, and a low ovarian reserve (antral follicle count [AFC] ≤ 8 or anti-Müllerian hormone [AMH] level ≤ 8 pmol/L), designated as AFC groups D and E in our published recombinant FSH dosing algorithms [19,20]. These criteria have been published previously for fresh ET cycles, with group B/C corresponding to 9-19 folli-cles inclusive and group A equating to 20 or more follicles [12,13]. In the current FET study, patients receiving or having a medical history of receiving IVF adjuvants (GH or DHEA) were considered to have a poor prognosis for the above reasons.…”

“…Age at embryo transfer (ET) and morphological quality of the transferred embryo were the only other significant independent predictors of the likelihood of CP and LB, but no significant differences were observed in the proportion of high-quality embryos generated in the GH arm, echoing the most recent prospective study [8]. While these examinations [12,13] were undertaken as retrospective, observational analyses and have significant limitations, they represent one of the largest current GH data-sets published. However, these reports focused on only fresh ET cycles and not subsequent frozen cycles, which are also lacking in the LIGHT study.…”

Effects Of Hormonal Supplements In Women with Poor Ovarian Response Undergoing Assisted Reproductive Technology

“…In a recent retrospective study including 400 women in which 161 had been treated with GH (average of 1.5 IU per day), Keane et al (16), reported that GH supplementation significantly increased clinical pregnancy rate by 3.42-fold (95% CI 1.82 to 6.44, p<0.0005) and live birth rate by 6.16-fold (95% CI 2.83 to 13.39 p<0.0005) (16). When the data were analyzed based on female age, the authors noticed that the effect of GH was mainly related to patient's age.…”