体外受精/胞浆内单精子注射中补充生长激素是否能提高前一周期胚胎发育不良女性的累积活产率？
Does growth hormone supplementation of in vitro fertilization/intracytoplasmic sperm injection improve cumulative live birth rates in women with poor embryonic development in the previous cycle?
机构信息
The Assisted Reproduction Center, Northwest Women's and Children's Hospital, No. 73 Houzai Gate, Shaanxi Province, PO Box 710003, Xincheng District, Xi'an CityXi'an, China.
Translational Medicine Center, Northwest Women's and Children's Hospital, Xi'an, China.
出版信息
Reprod Biol Endocrinol. 2024 May 7;22(1):53. doi: 10.1186/s12958-024-01223-9.
BACKGROUND
Growth hormone (GH) has been proposed as an adjunct in in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycles, especially in women with poor ovarian response. However, it is unclear whether GH supplementation is effective in women with poor embryonic development in the previous IVF cycle. The aim of this study was to evaluate the effectiveness of GH supplementation in IVF/ICSI cycles in women with poor embryonic development in the previous cycle.
METHODS
This is a retrospective cohort study from a public fertility center in China, in which we performed propensity score-matching (PSM) for female age and AFC in a ratio of 1:1. We compared the cumulative live birth rate per started cycle, as well as a series of secondary outcomes. We included 3,043 women with poor embryonic development in the previous IVF/ICSI cycle, of which 1,326 had GH as adjuvant therapy and 1,717 had not. After PSM, there were 694 women in each group.
RESULTS
After PSM, multivariate analyses showed the cumulative live birth rate to be significantly higher in the GH group than the control group [N = 694, 34.7% vs. N = 694, 27.5%, risk ratio (RR): 1.4 (95%CI: 1.1-1.8)]. Endometrial thickness, number of oocytes retrieved, number of embryos available, and number of good-quality embryos were significantly higher in the GH group compared to controls. Pregnancy outcomes in terms of birth weight, gestational age, fetal sex, preterm birth rate, and type of delivery were comparable. When we evaluated the impact of GH on different categories of female age, the observed benefit in the GH group did not appear to be significant. When we assessed the effect of GH in different AFC categories, the effect of GH was strongest in women with an AFC5-6 (32.2% versus 19.5%; RR 2.0; 95% CI 1.2-3.3).
CONCLUSIONS
Women with poor embryonic quality in the previous IVF/ICSI cycles have higher rates of cumulative live birth with GH supplementation.
背景
生长激素（GH）已被提议作为体外受精（IVF）/胞浆内精子注射（ICSI）周期的辅助手段，特别是在卵巢反应不良的女性中。然而，在之前的 IVF 周期中胚胎发育不良的女性中，GH 补充是否有效尚不清楚。本研究旨在评估 GH 补充在之前 IVF/ICSI 周期中胚胎发育不良的女性中的有效性。
方法
这是一项来自中国一家公立生育中心的回顾性队列研究，我们按女性年龄和 AFC 进行倾向评分匹配（PSM），比例为 1:1。我们比较了每个启动周期的累积活产率，以及一系列次要结局。我们纳入了 3043 名在前一个 IVF/ICSI 周期中胚胎发育不良的女性，其中 1326 名接受了 GH 作为辅助治疗，1717 名未接受。PSM 后，每组各有 694 名女性。
结果
PSM 后，多变量分析显示 GH 组的累积活产率明显高于对照组[N=694，34.7% vs. N=694，27.5%，风险比（RR）：1.4（95%CI：1.1-1.8）]。GH 组的子宫内膜厚度、获卵数、可利用胚胎数和优质胚胎数均明显高于对照组。在出生体重、胎龄、胎儿性别、早产率和分娩类型等妊娠结局方面，两组无差异。当我们评估 GH 对不同年龄段女性的影响时，GH 组的获益似乎并不显著。当我们评估 GH 在不同 AFC 类别中的作用时，GH 的作用在 AFC5-6 的女性中最强（32.2%对 19.5%；RR 2.0；95%CI 1.2-3.3）。
结论
在前一个 IVF/ICSI 周期中胚胎质量差的女性中，GH 补充可提高累积活产率。
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