Abstract
This retrospective study examines the influence of recombinant growth hormone (rGH) and melatonin adjuvants on oocyte numbers, embryo utilization and live births arising from 3637 autologous IVF±ICSI treatment cycles undertaken on 2376 women across ten years (2011-2020) within a pioneer Australian facility. Despite using an FSH-dosing algorithm enabling maximal doses up to 450 IU for women with reduced ovarian reserve, younger women had significantly higher mean numbers of oocytes recovered than older women ranging from 11.1 for women <35 years to 9.4 for women aged 35-39 years reducing to 6.5 for women aged 40-44 years and 4.0 for those aged ≥45 years (p<0.0001). Overall, the embryo utilization rate was 48.5% and live birth productivity rate was 35.4 % across all ages and neither rGH nor melatonin showed any benefit on these rates, in fact, those women with nil adjuvants showed the highest live birth rate per initiated cycle (42.0% overall: p<0.0001, and 55.3% for the youngest group: p<0.001). Embryo utilization was increased marginally by rGH in those women aged 40-44 years who had high ovarian reserve (p<0.05), but this benefit did not translate into any improvement in the live birth rate. Similarly, other factors known to cause a poor prognosis, including low IGF-1 profile, recurrent implantation failure, and low oocyte numbers at OPU, showed no improvement in embryo utilization nor in live births from the adjuvants. The relevance of embryo quality was examined on 1135 women whose residual embryos after a single fresh-embryo transfer failed to develop to a suitable grade for cryopreservation. From 1727 cycles such women often displayed an improved embryo utilization rate with rGH, but not with melatonin. Even so, live birth rates were not improved by either of the adjuvants.
Highlights
Assisted reproductive technology (ART) has earnt a well-respected position in modern medicine with its current widespread application generating more than 10 million offspring since the first child born in 1978, in truth the technology has a poor prognosis for a large proportion of patients [1,2]
This retrospective study examines the influence of recombinant growth hormone and melatonin adjuvants on oocyte numbers, embryo utilization and live births arising from 3637 autologous IVF±ICSI treatment cycles undertaken on 2376 women across ten years (2011-2020) within a pioneer Australian facility
The key laboratory outcome is represented by the E Utn % and the key clinical outcome is represented by the Live birth pregnancy productivity rate per initiated IVF±ICSI treatment cycle (LBP % / In)
Summary
Assisted reproductive technology (ART) has earnt a well-respected position in modern medicine with its current widespread application generating more than 10 million offspring since the first child born in 1978, in truth the technology has a poor prognosis for a large proportion of patients [1,2]. From nearly 50 clinical reports on women with various poor prognosis factors, mostly involving retrospective studies, it appears that embryo utilization is increased in the vast majority [16] but improvement in live birth rates is reported in under 50% and those studies all display design weaknesses with problematic confounding variables [17,18] To minimise the latter, we present a 10-year study period from our pioneer Australian facility practising a stable protocol where blastocyst culture, single embryo transfers and an advanced cryopreservation program underlie a clinical regimen dictated by a validated Follicle stimulating hormone [FSH]-dosing algorithm which generated 10±2 oocytes for most of the women
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