Abstract
In this fourth study examining the relevance of measuring the IGF profile (IGF-1, IGFBP-3 and the ratio of IGFBP-3/ IGF-1) in women presenting for assisted reproductive technologies (ART), we have examined the influence of recombinant growth hormone (rGH) prescribed as an adjuvant on the profile. Of 1633 ART-naïve women who completed an assessment cycle (AC) workup, and which included an IGF profile, 941 women proceeded to an in-vitro fertilization ± intracytoplasmic sperm injection (IVF±ICSI) treatment cycle during the period January 2011 to December 2019. Among those women, 90 were prescribed rGH because they were classified as likely poor-prognosis cases on the basis of advanced age or evidence of severely reduced ovarian reserve parameters. These women had their IVF±ICSI treatment within 3-months of their AC and consented to a second IGF profile measurement 4-6 weeks during their rGH treatment phase. Of the 90 women prescribed rGH adjuvant, 71 used the adjuvant and 19 deferred the treatment, but still completed the second IGF-profile. The data showed that rGH caused a significant elevation in IGF-1 (p<0.0001) as well as its main binding protein, IGFBP-3 (p<0.001), albeit to a lesser degree. Consequently, the IGF ratio, considered a more reliable marker of IGF-1 activity, was shown to be significantly reduced towards the normal range (p<0.0001). The data of clinical outcomes from these 90 women as well as the entire 941 women entering the IVF±ICSI treatment are presented for comparison, noting these data are not suitable for statistical evaluation as the groupings are disparate and unmatched. Further studies are intended to show the clinical relevance of increasing the IGF-1 levels in the analytical investigation of rGH as an adjuvant in ART.
Highlights
Assisted reproductive technology (ART) has contributed to an estimated more than 10 million women achieving live births worldwide over the past 42 years, the successes have occurred mainly in young women, leaving an unmet need among those women over 35 years
In this fourth study examining the relevance of measuring the insulin growth factor (IGF) profile (IGF-1, Insulin-Like Growth Factor Binding Protein-3 (IGFBP-3) and the ratio of IGFBP-3/ IGF1) in women presenting for assisted reproductive technologies (ART), we have examined the influence of recombinant growth hormone prescribed as an adjuvant on the profile
Most recently we have reported on the relevance of human growth hormone (hGH) testing on the same serum samples used for the IGF profile, noting that only 12% of measurements fall into the adult growth hormone deficiency (AGHD)-exclusion zone [9]
Summary
Assisted reproductive technology (ART) has contributed to an estimated more than 10 million women achieving live births worldwide over the past 42 years, the successes have occurred mainly in young women, leaving an unmet need among those women over 35 years. In order to apply a more definitive solution to the notion of AGHD as a cause of poor-prognosis we have been sequentially exploring the relevance of both human growth hormone (hGH) estimations in serum along with that of the insulin growth factor (IGF) profile; embracing IGF-1, its main binding protein IGFBP-3 and the IGF Ratio of IGFBP-3/IGF [9] These studies follow on the clinical standards for the diagnosis of growth hormone deficiency (GHD) in children [10] along with the recent acceptance by the Endocrine Society that AGHD is a legitimate endocrine disorder, distinct from the natural aging process [11]
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