Growth hormone and ovulation: is there an indication for treatment of infertile women with growth hormone?

We have explored the use of growth hormone (GH) for ovulation induction and ovarian stimulation for in vitro fertilization and embryo transfer (IVF-ET). We first compared the effects of co-treatment with GH and placebo on the dose of gonadotrophins required to induce ovulation. The patients were gonadotrophin deficient and, for the main part, hypopituitary. We found a significant reduction in the dose of gonadotrophins and the duration of treatment needed to induce ovulation. The dose of GH used in these studies was substantial, and we await the results of a multi-centre trial attempting to establish a dose-response relationship. We then explored the role of GH in patients undergoing IVF-ET. The end-point measured was an increase in the number of follicles developing during standard treatment with gonadotrophins. In the first randomized controlled clinical trial we found a suggestion only of an enhanced ovarian response to co-treatment with GH. Specifically selected patients with ultrasound-diagnosed polycystic ovaries were then treated. All were receiving treatment with luteinizing hormone-releasing hormone analogue as part of their ovarian stimulation protocol. The results showed clearly that in this group of patients, co-treatment with GH augmented the ovarian response to treatment with gonadotrophins. We also found an increase in serum and follicular-fluid insulin-like growth factor I (IGF-I) concentrations, but since the serum concentrations always exceeded those in follicular fluid, the results were consistent with the notion that follicular-fluid growth factor was predominantly derived from serum IGF-I rather than being synthesized locally.