Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Peking University Third Hospital, Beijing, China.
National Clinical Research Center for Obstetrics and Gynecology, Beijing, China.
Front Endocrinol (Lausanne). 2020 Jan 23;11:1. doi: 10.3389/fendo.2020.00001. eCollection 2020.
Growth hormone (GH) was used for many years to increase ovarian response in poor ovarian responders (PORs). Although meta-analysis suggested that GH therapy improve early clinical outcomes, the benefit of GH usage on chance of live birth was still widely debated. This study was to determine whether or not GH supplementation influences the live birth rate (LBR). A total of 3,080 expected PORs receiving and not receiving (control) GH adjuvant therapy at Peking University Third Hospital from January 2017 to March 2018 were retrospectively analyzed. The basal characteristics of patients were compared using analysis of variance (continuous variables) and categorical variables were evaluated with a chi-square test. Logistic regression analyses were used to evaluate potential associations of LBR with GH treatment while adjusting other confounding factors. No statistically significant differences existed in miscarriage rate (5.3 vs. 12.5%; = 0.076) and LBR (37.7 vs. 34.5%; = 0.426) in young expected PORs (< 35 years of age). Moreover, no significant differences existed in the miscarriage rate (25.6 vs. 23.3%; = 0.681), and LBR (17.8 vs. 17.9%; = 0.977) in the old expected PORs (≥35 years of age). Logistic regression suggested that GH adjuvant therapy did not improve the LBR in young (OR, 1.27; 95% CI, 0.88-1.85; = 0.203) and elderly expected PORs (OR, 1.20; 95% CI, 0.82-1.76; = 0.342), while GH was not associated with risk of miscarriage in young (OR, 0.37; 95% CI, 0.11-1.24; = 0.108) and elderly expected PORs (OR, 0.91; 95% CI, 0.43-1.93; = 0.813). In subgroup analysis, GH treatment significantly increased the day 3 embryos available rate in the subgroup of young PORs with the long down-regulation (63.11 vs. 49.35%; = 0.004), while significantly reduced the risk of miscarriage in the subgroup of young PORs with GnRH antagonist protocol (0.00 vs. 12. %; = 0.023). There was no significant difference for LBR in PORs with GnRH antagonist (<35 years [35.19 vs. 28.45%; = 0.183]; ≥35 years [12.96 vs. 14.03%; = 0.707]), GnRH-a long (<35 years [33.33 vs. 36.99%; = 0.597]; ≥35 years [17.44 vs. 20.28%; = 0.574]) and long down-regulation (<35 years [58.82 vs. 41.90%; = 0.193]; ≥35 years [43.33 vs. 25.30%; = 0.065]). Growth hormone treatment may not improve live birth rate in expected poor responders.
生长激素 (GH) 多年来一直被用于增加卵巢反应不良者 (PORs) 的卵巢反应。尽管荟萃分析表明 GH 治疗可改善早期临床结局，但 GH 治疗对活产率的获益仍存在广泛争议。本研究旨在确定 GH 补充是否会影响活产率 (LBR)。
回顾性分析了 2017 年 1 月至 2018 年 3 月期间在北京大学生第三医院接受和未接受 (对照组) GH 辅助治疗的 3080 名预期 PORs 的基本特征。使用方差分析比较患者的基础特征 (连续变量)，并使用卡方检验评估分类变量。使用 logistic 回归分析评估 LBR 与 GH 治疗的潜在关联，同时调整其他混杂因素。
在年轻的预期 PORs (<35 岁) 中，流产率 (5.3%比 12.5%； = 0.076) 和活产率 (37.7%比 34.5%； = 0.426) 无统计学差异。此外，在年龄较大的预期 PORs (≥35 岁) 中，流产率 (25.6%比 23.3%； = 0.681) 和活产率 (17.8%比 17.9%； = 0.977) 也无统计学差异。logistic 回归表明，GH 辅助治疗并未改善年轻 (OR，1.27；95%CI，0.88-1.85； = 0.203) 和老年 (OR，1.20；95%CI，0.82-1.76； = 0.342) 预期 PORs 的活产率，而 GH 与年轻 (OR，0.37；95%CI，0.11-1.24； = 0.108) 和老年 (OR，0.91；95%CI，0.43-1.93； = 0.813) 预期 PORs 的流产风险无关。亚组分析表明，GH 治疗可显著增加年轻 PORs 中长降调节组的第 3 天胚胎可用率 (63.11%比 49.35%； = 0.004)，同时显著降低年轻 PORs 中 GnRH 拮抗剂方案组的流产风险 (0.00%比 12.0%； = 0.023)。在 GnRH 拮抗剂治疗的 PORs 中，活产率无显著差异 (年龄<35 岁 [35.19%比 28.45%； = 0.183]；年龄≥35 岁 [12.96%比 14.03%； = 0.707])、GnRH-a 长降调节 (年龄<35 岁 [33.33%比 36.99%； = 0.597]；年龄≥35 岁 [17.44%比 20.28%； = 0.574])和长降调节 (年龄<35 岁 [58.82%比 41.90%； = 0.193]；年龄≥35 岁 [43.33%比 25.30%； = 0.065])。
生长激素治疗可能不会提高预期 PORs 的活产率。
