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. 2024 Sep 4;21(3):208-218.
doi: 10.4274/tjod.galenos.2024.59944.

The effects of growth hormone supplementation in poor ovarian responders undergoing In vitro fertilization or Intracytoplasmic sperm injection: A systematic review and meta-analysis of randomized controlled trials

Faezeh Zakerinasab  1 , Qumars Behfar  2 , Reza Parsaee  3 , Fariba Arbab Mojeni  4 , Arina Ansari  5 , Niloofar Deravi  6 , Reza Khademi  7
Affiliations

The effects of growth hormone supplementation in poor ovarian responders undergoing In vitro fertilization or Intracytoplasmic sperm injection: A systematic review and meta-analysis of randomized controlled trials

Faezeh Zakerinasab et al. Turk J Obstet Gynecol. .

Abstract
in English, Turkish

To evaluate the effect of growth hormone (GH) supplementation on outcomes of in vitro fertilization (IVF) or Intracytoplasmic sperm injection (ICSI) for women with poor ovarian response. Relevant randomized controlled trials (RCTs) were obtained through search in several databases including PubMed, Scopus, Clinicaltrials.gov, Google Scholar, and Cochrane Library. Outcome measures included live birth rate, clinical pregnancy rate, cycle cancelation rate, number of retrieved oocytes, number of transferred embryos, total dose of gonadotropin, duration of gonadotropin treatment, and peak estradiol level. Additionally, a meta-regression analysis was carried out to determine any potential linear relationships between these outcomes and IVF success. After analyzing 18 RCTs comprising of 1870 patients, the study found that GH supplementation improved the number of retrieved oocytes [standardized mean difference (SMD), 0.65; 95% confidence interval (CI), 0.29-1.00] and transferred embryos group (SMD, 0.80, 95% CI, 0.39, 1.21) as well as peak E2 level (SMD, 1.20; 95% CI, 0.59, 1.81). While reduced the total dose and duration of gonadotropin treatment (SMD, -0.82, 95% CI, -1.25, -0.39, and SMD, -0.63, 95% CI, -1.04, -0.22, respectively). The meta-regression analysis found no linear relationship between clinical pregnancy, live birth rate, or cycle cancelation rate and the outcomes measured (p>0.1). Based on the available evidence, GH supplementation appears to improve the outcomes of IVF or ICSI in women with poor response. However, there is a need for further RCTs with larger sample sizes to determine the cost-effectiveness of adding GH to conventional protocols of IVF/ICSI for treating infertility in women with poor ovarian response.

Bu çalışmanın amacı zayıf yumurtalık yanıtı olan kadınlarda büyüme hormonu (GH) takviyesinin in vitro fertilizasyon (IVF) veya intrasitoplazmik sperm enjeksiyonu (ICSI) sonuçları üzerindeki etkisini değerlendirmektir. İlgili randomize kontrollü çalışmalar (RKÇ) PubMed, Scopus, Clinicaltrials.gov, Google Scholar ve Cochrane Kütüphanesi dahil olmak üzere çeşitli veri tabanlarında arama yapılarak elde edildi. Sonlanım ölçümleri arasında canlı doğum oranı, klinik gebelik oranı, siklus iptal oranı, alınan oosit sayısı, transfer edilen embriyo sayısı, toplam gonadotropin dozu, gonadotropin tedavisinin süresi ve en yüksek östradiol seviyesi yer aldı. Ek olarak, bu sonuçlar ile IVF başarısı arasındaki olası doğrusal ilişkileri belirlemek için bir meta-regresyon analizi gerçekleştirildi. Toplam 1870 hastayı kapsayan 18 RKÇ’nin analizinden sonra, GH desteğinin alınan oosit sayısını [standartlaştırılmış ortalama fark (SOF), 0,65; %95 güven aralığı (GA), 0,29-1,00] ve transfer edilen embriyo grubunu (SOF, 0,80, %95 GA, 0,39, 1,21) ve pik E2 seviyesini (SOF, 1,20; %95 GA, 0,59, 1,81) iyileştirdiği; Gonadotropin tedavisinin toplam dozunu ve süresini azalttığı (sırasıyla SOF, -0,82, %95 GA, - 1,25, -0,39 ve SOF, -0,63, %95 GA, - 1,04, -0,22) bulundu. Meta-regresyon analizi klinik gebelik, canlı doğum oranı veya siklus iptal oranı ile ölçülen sonlanımlar arasında doğrusal bir ilişki bulamadı (p>0,1). Mevcut kanıtlara göre, GH takviyesi zayıf yanıt veren kadınlarda IVF veya ICSI sonuçlarını iyileştiriyor gibi görünmektedir. Ancak, zayıf yumurtalık yanıtı olan kadınlarda kısırlığı tedavi etmek için IVF/ICSI’nın geleneksel protokollerine GH eklemenin maliyet etkinliğini belirlemek için daha büyük örneklem boyutlarına sahip daha fazla RKÇ’ye ihtiyaç vardır.

Keywords: Growth hormone; IVF; gonadotropin; meta-analysis; systematic review.

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Conflict of interest statement

Conflict of Interest: No conflict of interest was declared by the authors.

Figures

Figure 1
Figure 1
PRISMA flow diagram for current systematic review PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-analyses for Protocols
Figure 2
Figure 2
Forest plot for demographics; A) Age, B) BMI, C) Duration of infertility CI: Confidence interval, SMD: Standardized mean difference, BMI: Body mass index
Figure 3
Figure 3
Forest plot for Secondary outcomes; A) Number of retrieved oocytes, B) Number of transferred embryo CI: Confidence interval, SMD: Standardized mean difference
Figure 4
Figure 4
Forest plot for secondary outcomes; A) Total gonadotropin, B) Duration of gonadotropin therapy, C) Peak E2 level CI: Confidence interval, SMD: Standardized mean difference
Figure 5
Figure 5
Funnel plot of the studies represented in the meta-analysis SMD: Standardized mean difference
See this image and copyright information in PMC

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