Low dose growth hormone for ovarian stimulation – are there improved outcomes in poor responders?

This study investigated the effectiveness of low dose (LD) growth hormone (GH) for controlled ovarian stimulation (COS) in poor responder (PR) patients. 

They found that LD-GH may improve fertility outcomes in these patients.

Controlled ovarian stimulation (COS) is used to help women ovulate. A combination of drugs stimulates eggs to mature. After COS women usually undergo assisted reproduction (AR). There are several drug regimens for COS. They are categorized based on the length of the protocol. Each can have different fertility outcomes. Some women are poor responders (PR) to COS drugs. This means the number of eggs released is lower than normal. 

Low dose growth hormone (LD-GH) is one option used in COS. Some studies show that LD-GH improves oocyte (egg) quality and number. However, other studies suggest that there is no improvement in clinical pregnancy (CPR) or live birth rates (LBR). Many of these studies used different COS protocols. It is unclear if LD-GH with an ultra-long protocol (ULP) improves fertility outcomes in PR women. 

This study had 2 parts. The first part included 184 women with a poor ovarian response. Women were randomly assigned to ULP and LD-GH or ULP alone. After COS, oocytes were fertilized using intracytoplasmic sperm injection (ICSI). The second part of the study analyzed data from medical records. This involved 163 PR patients and 157 normal responder (NR) patients who were undergoing in vitro fertilization (IVF). PR patients were treated with GH along with the IVF protocol. NR patients received the normal IVF protocol without GH.  

In the first study ovarian response and oocyte number were higher with LD-GH. The CPR was significantly higher in the GH group (31.9%) compared to the non-GH group (16.7%). The ongoing pregnancy rate was also significantly higher in LD-GH patients (26.6%) compared to the non-LD-GH group (14.4%). This translates to a 2.34-fold higher chance of pregnancy in LD-GH patients.

In the second study, there were similar implantation rates and CPRs for PRs with GH compared to NR without GH.

The authors concluded that LD-GH may improve fertility outcomes in poor responders.

The number of patients in the first part of the study was low. The second part used medical records which may have contained incomplete information. The live birth rate was not assessed in this study. 

If you have any concerns regarding infertility please consult with your physician.