Division of Obstetrics and Gynaecology, University of Western Australia, Perth, Western Australia, Australia; Fertility Specialists of Western Australia, Bethesda Hospital, Claremont, Western Australia, Australia.
Fertil Steril. 2022 Apr;117(4):669-674. doi: 10.1016/j.fertnstert.2022.01.027. Epub 2022 Mar 4.
Growth hormone, letrozole, and clomiphene citrate do not have US Food and Drug Administration approval for their use in in vitro fertilization (IVF) cycles. However, despite this fact, they often are used to augment the IVF cycle in women considered "low responders." Unfortunately, because of the problems inherent to recruiting women who have undergone several unsuccessful IVF treatment cycles, and their inevitable low live birth rate, studies involving adjuvants for women considered low responders to ovarian stimulation often are underpowered. This is compounded further by the difficulty in recruiting vulnerable women to a study with a placebo arm. Consequently, the evidence base for their use as adjuncts to IVF treatment may be limited, and consequently their use may be empirical rather than evidence based. This short narrative review describes the evidence for these "add-ons" for a patient with a low response to ovarian stimulation. It suggests that a woman with a low ovarian response will derive benefit from using growth hormone; with a reduction in the ovarian stimulation required for oocyte retrieval, collection of a greater number of oocytes, and improvement in the clinical pregnancy rate. Although there currently is insufficient evidence to state categorically that it leads to an increased chance of a live birth. In the same situation, clomiphene citrate and letrozole lead to a reduced requirement for gonadotropins before oocyte retrieval, but with no improvement in live birth rate for their use.
生长激素、来曲唑和枸橼酸氯米酚未经美国食品和药物管理局批准用于体外受精 (IVF) 周期。然而，尽管如此，它们经常被用于增加被认为是“低反应者”的女性的 IVF 周期。不幸的是，由于招募经历多次不成功的 IVF 治疗周期的女性存在固有问题，以及她们不可避免的低活产率，涉及卵巢刺激低反应者辅助剂的研究通常效力不足。由于在安慰剂臂的研究中招募易受伤害的女性存在困难，这一问题进一步加剧。因此，它们作为 IVF 治疗辅助剂的使用证据可能有限，因此其使用可能是经验性的，而不是基于证据的。这篇简短的叙述性评论描述了这些“附加物”对卵巢刺激反应低的患者的证据。它表明，卵巢反应低的女性使用生长激素将受益；减少取卵所需的卵巢刺激，收集更多的卵子，并提高临床妊娠率。尽管目前没有足够的证据可以断言它会增加活产的机会。在同样的情况下，枸橼酸氯米酚和来曲唑可减少取卵前促性腺激素的需求，但使用它们并不能提高活产率。
