Abstract
PurposeGrowth hormone (GH) supplementation in association with in vitro fertilization (IVF) is worldwide again increasing, even though study outcomes have been discrepant. Since GH acts via insulin-like growth factor-1 (IGF-1), its utilization in IVF would only seem to make sense with low IGF-1. We, therefore, determined whether IGF-I levels affect IVF outcomes.MethodsRetrospectively, 302 consecutive first fresh, non-donor IVF cycles were studied, excluding patients on GH supplementation. Patients were divided into 3 subgroups: IGF-1 in lower 25th percentile (group A, < 132 ng/mL, n = 64); 25th–75th percentile (B, 133–202 ng/mL, n = 164), and upper 25th percentile (C, > 202 ng/mL, n = 74). IGF-1 was tested immunochemiluminometric with normal range at 78–270 ng/mL. Because of the study patients’ adverse selection and low pregnancy chances, the main outcome measure for the study was cycle cancellation. Secondary outcomes were oocyte numbers, embryos transferred, pregnancies, and live births.ResultsGroup A was significantly older than B and C (P = 0.019). IGF-1 decreased with increasing age per year by 2.2 ± 0.65 ng/mL (P = 0.0007). FSH was best in group B and worst in A (trend, P = 0.085); AMH was best in B and worst in A (N.S.). Cycle cancellations were lowest in C (11.6%) and highest in A (25.0%; P = 0.042). This significance further improved with age adjustment (P = 0.021). Oocytes, embryo numbers, pregnancies, and live birth rates did not differ, though oocyte numbers trended highest in B.ConclusionsHere presented results support the hypothesis that IGF-1 levels affect IVF outcomes. GH treatments, therefore, may be effective only with low IGF-1.
Highlights
As add-on to ovulation induction for intrauterine inseminations [1] and in vitro fertilization (IVF) stimulation protocols [2], growth hormone (GH) supplementation was actively utilized for a little over a decade starting in the late 1980s
We report on 978 consecutive patients undergoing 815 IVF cycles at our center between 2018 and 2020 who as part of a diagnostic work-up had peripheral insulin-like growth factor-1 (IGF-1) level determinations at time of initial consultation
Patients in the lowest IGF-1 quartile were significantly older (43.0 ± 4.8 years) than those in mid-range and highest quartile group C (40.7 ± 5.6 years; P = 0.019). This is of importance because, as one would expect, IGF-1 levels were age dependent: A linear regression revealed that IGF-1 levels decreased with increasing age 2.2 ± 0.65 ng/mL per year (P = 0.0007; Fig. 1b)
Summary
As add-on to ovulation induction for intrauterine inseminations [1] and in vitro fertilization (IVF) stimulation protocols [2], growth hormone (GH) supplementation was actively utilized for a little over a decade starting in the late 1980s. After a relative hiatus of approximately two decades, GH supplementation has in the last 15 years again become more fashionable [3, 4], even though effectiveness of GH supplementation in improving IVF outcomes has remained controversial [5, 6]. Released in pulsatile fashion by GH-releasing hormone with peaks during sleep, it is inhibited by somatostatin, produced in the hypothalamus. Its levels are the highest during puberty and are affected by environmental factors, like sleep patterns, diet, exercise habits, and exposure to stress. The hormone’s principal organ target is the liver, where it induces synthesis of insulin-like growth factor (IGF-1) [7]. GH’s principal (though ) activity, is mediated
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