Effect Of GH Supplementation On Outcomes Of Patients With POR In GnRH Antagonist Protocol

Objective:Poor ovarian response(POR)is a pathological condition of ovarian response to gonadotropin(Gn)during controlled ovarian stimulation(COS),with a incidence of 9-25%,which seriously affects female reproductive function and the success rate of assisted reproductive technology.Growth hormone(GH)is an indispensable hormone for human growth,and also plays a critical role in reproductive function.Previous studies have reported that GH can help improve the outcome of assisted reproductive technology in patients with POR,however the conclusion is controversial.The objective of the study is to investigate the outcomes of In vitro fertilization-embryo transfer(IVF-ET)in POR patients with and without GH supplementation.Methods:A total of 181 patients who received IVF-ET during Jan 2019 to Jun 2020 were retrospectively analyzed.The study was conducted in the department of reproductive genetics,the First Affiliated Hospital of Kunming Medical University.According to the Bologna Criteria for POR,patients were divided into study group(with GH supplementation,83 cases)and control group(without GH supplementation,98 cases).All patients were treated with gonadotropin releasing hormone antagonist protocol(GnRH-A).Fresh embryo transfer was performed in 65 cases and fresh embryo transfer was performed in 65 cases.Controlled ovarian stimulation(total doses and duration of Gn,reproductive hormone level on HCG day),total number of oocytes obtained,fertilization and embryo status(normal fertilization,available embryos and high-quality embryos),implantation rate and clinical pregnancy rate were analyzed between the study group and the control group.Results:According to the study,some results were found as follows.①No significant difference in basic data was found between the study group and the control group(P>0.05).②The total doses and duration of Gn in the study group were significantly lower than those in the control group(P<0.05)(the average total doses of Gn in the study group was 2429.80± 695.52U,the average duration of Gn in the study group was 9.05± 1.94 days;the average total doses of Gn in the control group was 2706.02± 907.11U,the average duration of Gn in the control group was 9.43±2.33 days);The levels of E2,P and FSH on HCG day in the study group were significantly lower than those in the control group(P<0.05)(the average level of E2 on HCG day was 1151.79± 621.49pg/mL in the study group,the average level of P on HCG day was 0.47 ± 0.44ng/mL in the study group,the average level of FSH on HCG day was 16.74± 4.68mIU/mL in the study group;the average level of E2 on HCG day was 1508.97± 914.83pg/mL in the control group,the average level of P on HCG day was 0.66± 0.53ng/mL in the control group,the average level of FSH on HCG day was 20.05± 6.03mIU/mL in the control group).Nevertheless there was no significant difference in the level of LH on HCG day between the two groups(P>0.05).③There was no significant difference in the total number of oocytes obtained,the number of normal fertilization,available embryos and high-quality embryos between the two groups.(P>0.05).④In fresh embryo transfer cycles,the embryo implantation rate and clinical pregnancy rate of the study group was significantly higher than the control group(P<0.05)(embryo implantation rate was 38.71%and clinical pregnancy rate was 47.22%in the study group and embryo implantation rate was 13.64%and clinical pregnancy rate was 20.69%in the control group)⑤In frozen embryo transfer cycles,there was no significant difference in embryo implantation rate and clinical pregnancy rate between the two groups(P>0.05).Conclusion:Growth hormone supplement to antagonist protocol can improve the ovarian response of POR patients,reduce the total doses and duration of Gn.It can also improve the outcomes in fresh embryo transfer cycles,increasing the embryo implantation rate and clinical pregnancy rate,but it has no significant effect on the clinical outcome in frozen embryo transfer cycles.