An Evaluation of Ovarian Response and Pregnancy Rates with the Use of Growth Hormone as an Adjunct to IVF in Women who are Poor Responders to Standard IVF Stimulation Protocols

Background: Women who fail to respond adequately to standard ovarian stimulation protocols pose a significant treatment challenge. Research has been conducted in order to identify risk factors and causes of poor ovarian response and has attempted to identify new strategies which may improve the response to ovarian stimulation with standard IVF protocols. Growth hormone (GH) supplementation is one of these strategies proposed as a management option for poor IVF responders. GH is needed for growth and development but is also involved in the modulation of both male and female fertility through both gonadotrophin-dependent and gonadotrophin-independent actions. Some studies have shown that the supplementation of GH as an adjunct to ovarian stimulation for poor ovarian responders improves oocyte quality and increases pregnancy rates; while other studies has shown it to have no significant effect.

Objectives: To evaluate the effects of GH as an adjunct to IVF on ovarian response, oocyte quality and embryo grade as well as its effects on the achievement of pregnancy.

Methods: A retrospective cohort study of a subgroup of women attending a Fertility Centre in Johannesburg, who had responded poorly to stimulation protocols in previous IVF cycles. Those that had GH supplementation in addition to routine ovarian stimulation comprised the study group and those that did not were the controls.

Results: There were 98 women in the control and 103 in the study group. The mean age of the study group was older (38 vs 36 years) and the control group had higher AMH levels, especially amongst the respondents under the age of 40. Both groups were statistically significantly different with regards to AMH levels and age, p-values 0.000 and 0.007 respectively. The two groups produced on average equal numbers of oocytes, embryos and embryos for ET.

The study group exhibited more pregnancies than the control group (35 vs 30) although this was not statistically significant (p-value >0.05). The control group had on average, women of slightly younger age falling pregnant (35 vs 38 years). The study group had more respondents over the age of 40 years achieving pregnancy (14 vs 6). AMH levels were higher amongst women who achieved pregnancy in the control group (3.61 vs 2.78) but were only negligibly different for positive responders in the study group (1.57 vs 1.32). There was no statistically significant difference noted for the quality and quantity of the embryos for ET between the two groups.

Conclusion: This study suggests that GH is a useful adjunct in the treatment of women who are poor ovarian responders. It demonstrated that despite the fact that the study group had both on average an older age and lower AMH levels, they had significantly more pregnancies than expected for those under the age of 35 and relatively, although not statistically significantly more pregnancies than expected for those over the age of 35 (28% vs 25%).

Keywords: Growth hormone; IVF stimulation protocol; Ovarian response; Pregnancy