Abstract
PurposeThe aim of this meta-analysis was to evaluate the effect of growth hormone (GH) supplementation in poor responders undergoing in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI).MethodsPubMed, MEDLINE and Cochrane Library databases were searched for the identification of relevant randomized controlled trials. Outcome measures were live birth rate, clinical pregnancy rate, miscarriage rate, cycle cancelation rate, number of retrieved oocytes and total dose of gonadotropin.ResultsFifteen randomized controlled trails (RCTs) involving 1448 patients were eligible for the analysis. GH supplementation improved live birth rate (RR, 1.74; 95% CI, 1.19–2.54), clinical pregnancy rate (RR, 1.65; 95% CI, 1.31–2.08) and retrieved oocytes number (SMD, 0.72; 95% CI, 0.28–1.16), while reducing cancelled cycles rate (RR, 0.62; 95% CI, 0.44–0.85) and dose of Gonadotropin (SMD,-1.05 95% CI, − 1.62 - -0.49) for poor ovarian response patients. Besides, there was no significant difference in the miscarriage rate between GH group and control group.ConclusionsBased on the limited available evidence, growth hormone supplementation seems to improve IVF/ICSI outcomes for poor ovarian responders. Further randomized controlled trials with large sample sizes are required to clarify the effect of GH adjuvant therapy in the treatment of women with poor ovarian response.
Highlights
Poor ovarian response (POR) is a condition that in a group of in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) cycles, despite the appropriate ovarian stimulation, the number of oocytes collected is below the expected value [1].POR presents approximately in 5–18% in all assisted reproductive technology (ART) cycles, with a pregnancy rate as low as 2—4% [2]
All articles were intended to compare whether growth hormone could improve the IVF/ICSI outcomes of patients diagnosed with diminished ovarian reserve and/or poor ovarian response
The meta-analysis indicated no significant difference in the miscarriage rates between the growth hormone (GH) group and control group (RR, 1.02; 95% confidence intervals (CIs), 0.61–1.70; p = 0.94)
Summary
Poor ovarian response (POR) is a condition that in a group of IVF and ICSI cycles, despite the appropriate ovarian stimulation, the number of oocytes collected is below the expected value [1].POR presents approximately in 5–18% in all assisted reproductive technology (ART) cycles, with a pregnancy rate as low as 2—4% [2]. Poor ovarian response (POR) is a condition that in a group of IVF and ICSI cycles, despite the appropriate ovarian stimulation, the number of oocytes collected is below the expected value [1]. In 2011, the European Society of Human Reproduction and Embryology (ESHRE) published the BOLOGNA criteria as a standardized definition. According to these criteria, poor responders are diagnosed with at least two of the three following criteria:1) advanced maternal age (≥40 years) or any other risk factor for POR, 2) a previously characterized POR cycle (≤3 oocytes with a conventional stimulation protocol), 3) an abnormal ovarian reserve test (i.e. antral follicle count < 5–7 follicles or AMH < 0.5–1.1 ng/ mL) [4]. Various treatment including different stimulation protocols and adjuvant therapies have been applied to
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