Abstract
Following 5 recent studies at PIVET several female factors were defined which enabled the clear categorization for a poor prognosis in IVF, namely advanced female age ≥42 years, very low antral follicle count (AFC <5), very low serum anti-Mullerian hormone level (AMH<5pmol/L), serum Insulin growth factor-1 (IGF-1 level) in the lowest quartile, repetitive failed IVF cycles (≥3) and the failure of residual embryos to undergo cryopreservation. Following an Assessment Cycle (AC) to define the first 4 factors in IVF-naïve women, women were offered recombinant growth hormone (rGH) as an adjuvant at 1.0 IU daily for 6 weeks in the lead-up to the oocyte pick-up of their first IVF treatment cycle. Of 1173 women who proceeded directly into IVF after completing an AC, 252 women (21.5%) utilized rGH initiating 426 IVF cycles. Very low AFC and AMH levels were defined in 51 of the women who proceeded through 90 IVF treatment cycles utilizing rGH. Clinical outcomes included cancellation rates (reduced among rGH users, p<0.01), oocytes retrieved (no significant benefit from rGH), oocyte utilization (apparent benefit for rGH in older women with several factors), significant improvement in embryo utilization rates for older women with several factors (incremental cycles ≥3; p<0.002) or failure to achieve cryopreserved embryos (p<0.02). However, these benefits failed to translate into an improved pregnancy or live birth productivity rate nor a reduction in miscarriage rates; partly due to the low numbers of women with several poor prognosis factors. Furthermore, a note of caution emerged from this study as younger women who did not receive rGH had significantly better live birth outcomes (p<0.0001 from initiated cycles), regardless of the number of poor prognosis factors identified. Nonetheless, we encourage prospective studies to continue, focusing only on older women ≥40 years with low ovarian reserve and additional poor prognosis factors.
Highlights
From a slow beginning in the 1970’s, the generation of children from infertility settings applying Assisted Reproductive Technologies (ART) has likely passed 10 million
Given the negative results for recombinant growth hormone (rGH) shown in the overall group, the main study conducted here focused on the women categorized as having a poor prognosis, summarized in Table 3 and presented for detail and clarity in 11 Figures
This study failed to meet our expectations for proof that women facing poor prognosis in In vitro fertilization (IVF) would universally benefit from rGH adjuvant treatment
Summary
From a slow beginning in the 1970’s, the generation of children from infertility settings applying Assisted Reproductive Technologies (ART) has likely passed 10 million. Whilst this is hailed as a wonderful achievement, the reality is that the success rate per initiated treatment cycle is excellent for women under 35 years, but only mediocre for those aged between 35-40 years. The ANZARD report of 2020 shows that 91% of embryo transfers were conducted as a single embryo transfer (SET) and 57.2% were thaw cycles (where the vast majority involved blastocysts vitrified at the blastocyst stage). Of the Corresponding author: John L Yovich PIVET Medical Centre Perth, Western Australia Australia 6007
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