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Randomized Controlled Trial
. 2025 Jan;311(1):175-182.
doi: 10.1007/s00404-024-07895-3. Epub 2024 Dec 21.

Effect of pyridostigmine on growth hormone and IGF-1 levels and outcomes of controlled ovarian stimulation cycle in women with poor ovarian response

Rana Karimi  1   2 , Farnaz Hadavi  2 , Mina Jafarabadi  3   4
Affiliations
Randomized Controlled Trial

Effect of pyridostigmine on growth hormone and IGF-1 levels and outcomes of controlled ovarian stimulation cycle in women with poor ovarian response

Rana Karimi et al. Arch Gynecol Obstet. 2025 Jan.

Abstract

Purpose: This study aimed to evaluate the effect of Pyridostigmine on IGF-1 and GH levels and the outcomes of COS cycles in women with POR.

Methods: A total of 110 eligible women were randomly allocated to Pyridostigmine (n: 55) and control (n: 55) groups. COS outcomes, including gonadotrophin doses, COS duration, cycle cancellation rate, number of retrieved oocytes, number of MII oocytes, and fertilization rate, were compared between the groups. Also, IGF-1 and GH levels were measured at three time points: baseline, on the 5th day of the cycle, and on the trigger day.

Results: A total of 92 participants (Pyridostigmine: 44, Control: 48) were included in the final analysis. The Pyridostigmine group required significantly lower gonadotrophin doses (P < 0.0022) and had a shorter COS duration (P = 0.0019). No significant differences were observed in cycle cancellation rate, number of retrieved oocytes, number of MII oocytes, or fertilization rate. Pyridostigmine significantly accelerated GH levels over time compared to the Control group, with larger mean differences observed at each time point. The interaction between time and group indicated that the effect of the intervention on GH levels varied over the course of the COS cycle. Specifically, the intervention augmented the effect of COS agents on GH levels, as evidenced by the higher GH levels observed in the intervention group compared to the control group. For IGF-1 levels, time had a highly significant effect (P < 0.0001), but the interaction between Time and Group was not significant (P = 0.5067). Mean IGF-1 levels were higher in the Pyridostigmine group, though not statistically significant.

Conclusion: Pyridostigmine improved COS efficiency by reducing gonadotrophin doses and COS duration. Further research is needed to explore its potential benefits in enhancing ovarian response in women with POR.

Trial registry information: Iranian Registry of Clinical Trials (IRCT). Registration date: 2023-08-05, Registration number: IRCT20100518003950N8.

Keywords: Acetylcholinesterase Inhibitors; Assisted reproductive technology; Controlled ovarian stimulation; Poor ovarian response; Pyridostigmine.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare no competing interests. Ethical approval: This study was designed and performed according to the Declaration of Helsinki. The study protocol was approved by the ethics committee of Imam Khomeini Hospital Complex-Tehran University of Medical Sciences (reference number: IR.TUMS.IKHC.REC.1402.173, approval date: 2023-07-19). Consent to participate: All participants provided informed written consent before enrollment. Consent to publish: N/A Clinical trial registry: The trial was registered with the Iranian Registry of Clinical Trials (registration number: IRCT20100518003950N8; registration date: 2023-08).

References

    1. Lundin K, Bentzen JG, Bozdag G et al (2023) Good practice recommendations on add-ons in reproductive medicine. Human Reprod. https://doi.org/10.1093/humrep/dead184 - DOI
    1. Liu FT, Hu KL, Li R (2021) Effects of growth hormone supplementation on poor ovarian responders in assisted reproductive technology: a systematic review and meta-analysis. Reprod Sci 28:936–948 - DOI - PubMed
    1. Cozzolino M, Cecchino GN, Troiano G, Romanelli C (2020) Growth hormone cotreatment for poor responders undergoing in vitro fertilization cycles: a systematic review and meta-analysis. Fertil Steril. https://doi.org/10.1016/j.fertnstert.2020.03.007 - DOI - PubMed
    1. Kim JJ, Accili D (2002) Signalling through IGF-I and insulin receptors: where is the specificity? Growth Hormone IGF Res 12:84–90 - DOI
    1. Hull KL, Harvey S (2001) Growth hormone: roles in female reproduction. J Endocrinol 168:1–23 - DOI - PubMed

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