Elkalyoubi Mohamed, Schindler Larissa, Zaheer Hena
M Elkalyoubi, Dubai Fertility Center, Dubai Health Authority, Dubai, United Arab Emirates.
L Schindler, Bourn Hall Fertility Clinic (Mediclinic group) , Dubai, United Arab Emirates.
Reprod Fertil. 2023 Feb 1;4(1). doi: 10.1530/RAF-22-0107.
Treatment of sub-fertile women aged ≥ 40 years old (AMA) is challenging. Co-treatment with growth hormone (GH) is suggested to improve reproductive outcomes in poor responders. However, few studies, and with conflicting results, focused on women with AMA. A systematic review and meta-analysis of randomized controlled trials (RCTs) and comparative retrospective trials (CRTs) of GH cotreatment in AMA women undergoing in vitro fertilization or intracytoplasmic injection treatment using their autologous oocytes was performed. The search included studies published in English up to the end of 2021. The primary outcome was the clinical pregnancy rate per embryo transfer. Secondary outcomes were the number of mature and retrieved oocytes and the rate of live birth. 406 studies were found. The final analysis included three RCTs and four CRTs with 481 patients who used GH and 400 patients who did not. Clinical pregnancy and live birth rates were significantly higher in the GH cotreatment group compared to the placebo as well as the group without GH co-treatment, (OR 2.2; 95% CI 1.34 - 3.61 and OR 4.12; 95% CI 1.82 - 9.32, respectively). Intriguingly, the subgroup analysis showed that poor-responder patients did not benefit from co-treatment with GH. There were no statistically significant differences in the number of mature or retrieved oocytes. GH cotreatment in a subgroup of women with AMA improves clinical pregnancy and live birth per fresh embryo transfer. However, this conclusion must be taken with caution and further research is needed. The review is registered in PROSPERO database (CRD42021252618). www.crd.york.ac.uk/prospero/.
治疗年龄≥40岁的亚生育期妇女（高龄产妇）具有挑战性。建议联合使用生长激素（GH）以改善低反应者的生殖结局。然而，针对高龄产妇的研究较少，且结果相互矛盾。我们对接受体外受精或卵胞浆内单精子注射治疗且使用自身卵母细胞的高龄产妇联合使用GH的随机对照试验（RCT）和比较性回顾性试验（CRT）进行了系统评价和荟萃分析。检索范围包括截至2021年底以英文发表的研究。主要结局是每次胚胎移植的临床妊娠率。次要结局是成熟和获取的卵母细胞数量以及活产率。共检索到406项研究。最终分析纳入了3项RCT和4项CRT，其中使用GH的患者有481例，未使用GH的患者有400例。与安慰剂组以及未联合使用GH的组相比，联合使用GH组的临床妊娠率和活产率显著更高（分别为OR 2.2；95%CI 1.34 - 3.61和OR 4.12；95%CI 1.82 - 9.32）。有趣的是，亚组分析表明，低反应者患者并未从联合使用GH中获益。成熟或获取的卵母细胞数量在统计学上无显著差异。在部分高龄产妇亚组中，联合使用GH可提高新鲜胚胎移植后的临床妊娠率和活产率。然而，这一结论必须谨慎对待，还需要进一步研究。该综述已在PROSPERO数据库（CRD42021252618）注册。www.crd.york.ac.uk/prospero/
