Growth hormone improves insulin-like growth factor 1 and steroid hormone levels in follicle fluid, expression of hormone receptors in granulosa cells, and in vitro fertilization outcomes of poor ovarian responders

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Authors:

Yan Gong, M.D., Kun Zhang, Ph.D., Gideon Verwoerd, M.Med., Yanan Zhang, M.D., Weixin Liu, M.D., Wei Lai, M.D.

Abstract:

Objective

To investigate the effects of different growth hormone (GH) treatment protocols on steroid hormone and insulin-like growth factor (IGF) levels in follicle fluid (FF), hormone receptors in granulosa cells (GCs), and in vitro fertilization and embryo-transfer outcomes in poor ovarian responders.


Design

Prospectively randomized trial.


Setting

Reproductive medicine center.


Patient(s)

Two hundred thirty poor ovarian responders.


Intervention(s)

The patients were randomly assigned to 3 groups: group A, GH pretreatment (4 IU/d) from day 2 of the previous menstrual cycle until the trigger day; group B, GH treatment (4 IU/d) from day 2 of the menstrual cycle until the trigger day; group C, without GH treatment.


Main Outcome Measure(s)

The primary outcome was the live birth rate. The secondary outcomes were IGF and steroid hormone levels in FF and hormone receptors in GCs.


Result(s)

The live birth rate per treatment cycle started (27.03% vs. 11.43% vs. 5.33%) and per patient randomized (25.97% vs. 10.81% vs. 5.06%) was significantly increased in group A compared with groups B and C. The levels of estrogen (1488.30 ± 307.68 ng/mL vs. 1144.49 ± 461.42 ng/mL vs. 639.23 ± 229.80 ng/mL), progesterone (31.02 ± 9.79 μg/mL vs. 25.34 ± 10.83 μg/mL vs. 18.25 ± 8.42 μg/mL), testosterone (13.44 ± 5.01 ng/mL vs. 11.33 ± 3.89 ng/mL vs. 7.75 ± 4.58 ng/mL), GH (1.53 ± 0.61 ng/mL vs. 1.04 ± 0.33 ng/mL vs. 0.72 ± 0.28 ng/mL), and IGF-1 (100.42 ± 23.54 ng/mL vs. 75.00 ± 23.32 ng/mL vs. 42.24 ± 20.24 ng/mL) in FF and the mRNA levels of GH receptor, follicle-stimulating hormone receptor, and luteinizing hormone receptor in GCs were significantly different among the 3 groups, showing an increasing trend with the long GH treatment protocol.


Conclusion(s)

GH improved the levels of IGF-1 and steroid hormones in FF and hormone receptors in GCs, with an obvious uptrend in the long-course treatment protocol. GH pretreatment from the previous menstrual cycle improved the in vitro fertilization outcomes in poor ovarian responders.


Clinical Trial Registration Number

ChiCTR1800016106 (Chinese Clinical Trial Registry). (http://www.chictr.org.cn/edit.aspx?pid=27205&htm=4)

Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.