Li Xue-Li, Wang Li, Lv Fang, Huang Xia-Man, Wang Li-Ping, Pan Yu, Zhang Xiao-Mei
Reproductive Medicine Center, Department of Obstetrics and Gynecology, Clinical Medical College, Yangzhou University, Northern Jiangsu Province Hospital, Yangzhou, China Department of Anesthesiology & Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Holcombe Boulevard, TX Department of Biobank, Clinical Medical School of Yangzhou University, Northern Jiangsu Province Hospital, Yangzhou, China.
Medicine (Baltimore). 2017 Mar;96(12):e6443. doi: 10.1097/MD.0000000000006443.
Growth hormone (GH) is used as an adjuvant therapy in in vitro fertilization and embryo transfer (IVF-ET) for poor ovarian responders, but findings for its effects on outcomes of IVF have been conflicting. The aim of the study was to compare IVF-ET outcomes among women with poor ovarian responders, and find which subgroup can benefit from the GH addition.
We searched the databases, using the terms "growth hormone," "GH," "IVF," "in vitro fertilization." Randomized controlled trials (RCT) were included if they assessed pregnancy rate, live birth rate, collected oocytes, fertilization rate, and implantation rate. Extracted the data from the corresponding articles, Mantel-Haenszel random-effects model, or fixed-effects model was used. Eleven studies were included.
Clinical pregnancy rate (RR 1.65, 95% CI 1.23-2.22), live birth rate (RR1.73, 1.25-2.40), collected oocytes number (SMD 1.09, 95% CI 0.54-1.64), MII oocytes number (SMD 1.48, 0.84-2.13), and E2 on human chorionic gonadotropin (HCG) day (SMD 1.03, 0.18-1.89) were significantly increased in the GH group. The cancelled cycles rate (RR 0.65, 0.45-0.94) and the dose of gonadotropin (Gn) (SMD -0.83, -1.47, -0.19) were significantly lower in patients who received GH. Subgroup analysis indicated that the GH addition with Gn significantly increased the clinical pregnancy rate (RR 1.76, 1.25-2.48) and the live birth rate (RR 1.91, 1.29-2.83).
The GH addition can significantly improve the clinical pregnancy rate and live birth rate. Furthermore, the GH addition time and collocation of medications may affect the pregnancy outcome.
生长激素（GH）被用作卵巢反应不良患者体外受精和胚胎移植（IVF-ET）的辅助治疗，但关于其对IVF结局影响的研究结果一直存在争议。本研究的目的是比较卵巢反应不良女性的IVF-ET结局，并找出哪个亚组能从添加GH中获益。
我们使用“生长激素”“GH”“IVF”“体外受精”等术语检索数据库。纳入评估妊娠率、活产率、收集的卵母细胞数、受精率和着床率的随机对照试验（RCT）。从相应文章中提取数据，使用Mantel-Haenszel随机效应模型或固定效应模型。共纳入11项研究。
GH组的临床妊娠率（RR 1.65，95%CI 1.23 - 2.22）、活产率（RR1.73，1.25 - 2.40）、收集的卵母细胞数（SMD 1.09，95%CI 0.54 - 1.64）、MII期卵母细胞数（SMD 1.48，0.84 - 2.13）以及人绒毛膜促性腺激素（HCG）日的雌二醇（E2）（SMD 1.03，0.18 - 1.89）均显著增加。接受GH治疗的患者取消周期率（RR 0.65，0.45 - 0.94）和促性腺激素（Gn）剂量（SMD -0.83，-1.47，-0.19）显著降低。亚组分析表明，添加GH联合Gn可显著提高临床妊娠率（RR 1.76，1.25 - 2.48）和活产率（RR 1.91，1.29 - 2.83）。
添加GH可显著提高临床妊娠率和活产率。此外，GH的添加时间和药物搭配可能会影响妊娠结局。
