Using growth hormone as an adjuvant in IVF: Live birth outcomes from various poor prognosis scenarios
1 PIVET Medical Centre Perth, Western Australia Australia 6007.
2 Department of Pharmacy and Biomedical Sciences Curtin University Perth, Western Australia Australia 6845.
Research Article
GSC Biological and Pharmaceutical Sciences, 2021, 15(01), 063–080.
Article DOI: 10.30574/gscbps.2021.15.1.0083
Publication history:
Received on 13 February 2021; revised on 16 March 2021; accepted on 18 March 2021
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.
Keywords:
Growth Hormone (GH); Insulin growth factor-1 (IGF-1); In vitro fertilization (IVF); Assisted Reproductive Technology (ART); Pregnancy Productivity Rate; Live Birth Productivity Rate; Poor prognosis Fertility Factors.
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Copyright © 2021 Author(s) retain the copyright of this article. This article is published under the terms of the Creative Commons Attribution Liscense 4.0
