Choe Seung-Ah, Kim Myung Joo, Lee Hee Jun, Kim Jayeon, Chang Eun Mi, Kim Ji Won, Park Han Moie, Lyu Sang Woo, Lee Woo Sik, Yoon Tae Ki, Kim You Shin
Department of Obstetrics and Gynecology, Fertility Center of CHA Gangnam Medical Center, CHA University, 566, Nonhyun-ro, Gangnam-gu, Seoul, South Korea.
CHA Fertility Center, Seoul Station, Seoul, South Korea.
Arch Gynecol Obstet. 2018 Mar;297(3):791-796. doi: 10.1007/s00404-017-4613-4. Epub 2017 Dec 20.
Supplementation of growth hormone (GH) during controlled ovarian stimulation (COS) has been suggested to improve ovarian response. Despite potential benefits in poor responders, multiple injections of GH during COS are inconvenient. We conducted a randomized controlled study to evaluate the efficacy and safety of sustained-release human GH in poor responders undergoing in vitro fertilization (IVF).
This was a single-center, randomized, open-label, parallel study. Infertile women who satisfied the Bologna criteria for poor responders were randomized into GH treatment and control groups. The treatment group received a sustained-release GH (Eutropin Plus 20 mg) three times before and during COS (mid-luteal, late luteal, and menstrual cycle day 2). The baseline characteristics and IVF outcomes were compared between the two groups.
A total of 127 patients were included in the analysis. The mean age was 39.6 years and mean anti-Müllerian hormone level was 0.6 ng/ml. There was no significant difference in the baseline characteristics between GH treatment and control groups. The number of follicles on the human chorionic gonadotropin triggering day (3.1 ± 2.3 vs. 2.4 ± 1.6, P = 0.043) and the proportion of metaphase II oocytes (67.5 vs. 52.3%, P = 0.030) were higher in the GH group than in controls. The percentage of clinical and ongoing pregnancy and miscarriage was not different between the two groups.
Supplementation of sustained-release GH before and during COS improved ovarian response, with an increase in mature oocytes in poor responders. Further studies are needed to ensure this benefit in general infertility patients.
有人提出在控制性卵巢刺激（COS）期间补充生长激素（GH）可改善卵巢反应。尽管对反应不良者可能有益，但在COS期间多次注射GH并不方便。我们进行了一项随机对照研究，以评估长效重组人生长激素对接受体外受精（IVF）的反应不良者的疗效和安全性。
这是一项单中心、随机、开放标签、平行研究。符合博洛尼亚反应不良者标准的不孕妇女被随机分为GH治疗组和对照组。治疗组在COS前及COS期间（黄体中期、黄体晚期和月经周期第2天）三次接受长效GH（优拓金20mg）。比较两组的基线特征和IVF结局。
共有127例患者纳入分析。平均年龄为39.6岁，平均抗苗勒管激素水平为0.6ng/ml。GH治疗组和对照组的基线特征无显著差异。GH组人绒毛膜促性腺激素触发日的卵泡数（3.1±2.3 vs.2.4±1.6，P=0.043）和中期II级卵母细胞比例（67.5% vs.52.3%，P=0.030）高于对照组。两组的临床妊娠率、持续妊娠率和流产率无差异。
在COS前及COS期间补充长效GH可改善卵巢反应，使反应不良者成熟卵母细胞数量增加。需要进一步研究以确定对一般不孕患者的益处。
