| Objective:The purpose of this study was to evaluate the effect of growth hormone preconditioning on ovarian responsiveness and clinical outcomes in grups 3 and 4 of Poseidon criteria..Methods:The third and fourth groups ofPOR patients based on Poseidon criteria who underwent in vitro fertilization and assisted pregnancy in Zhongshan Bo’ai Hospital from January 2016 to 2021 were retrospectively analyzed The included population was divided into 2 groups:PG3(age<35 years,AFC<5,AMH<1.2 ng/ml);PG4(age≥35 years,AFC<5,AMH<1.2 ng/ml).The patients were further subdivided into the medication group and the control group according to the presence or absence of GH pretreatment.The patients who experienced multiple cycles and experienced GH preconditioning and those without GH preconditioning were selected as self-control.After 1:1 matching by propensity scone matching,there were 105 people in both the control group and the medication group in the PG3 group.There were 281 people the control group and the medication group in the PG4 group,and subgroup analysis was performed.There were 15 people in the self-control PG3 group and 32 people in the PG4 group.The effects of GH treatment on ovarian reactivity and clinical pregnancy outcomes were compared between groups.Results:There was no significant difference in the starting dose of Gn,the total dose of Gn,and the use time of Gn after matching between the PG3 case and control group(P>0.05).There was a statistically significant difference in the composition ratio of ovulation induction programs between the two groups(P<0.05).There was no statistical difference in the number of retrieved,the number of fertilization,the number of available embryos,and the number of high-quality embryos between the two groups(P>0.05).There was no statistical difference in the cumulative live birth rate between the two groups(P>0.05).PG3 antagonist regimen subgroup:There were no statistically significant differences in the starting dose of Gn,total Gn dose,and Gn use days between the two groups,and the differences in the number of oocytes retrieved,the number of available embryos,and the high-quality embryo groups were also not statistically significant(P>0.05).In terms of clinical outcomes,there was no statistical difference in the clinical pregnancy rate of fresh cycles between the control group and the medication group(51.43%vs.44.12%)、the cumulative pregnanncy rate(55 26%vs.39.68%)and the cumulative live birth rate(41.98%vs.2839%)(P>0.05).PG3 long regimen subgroup:the total dose of Gn(2928.13±78534vs.2323.81±795.28)and the total number of days of Gn(10.81±1.28 vs.8.88±2.00)in the control group were higher than those in the medication group,with staistical difference(P<0.05).There was no significant difference in the number of oocytes retrieved,the number of cleavage,the number of available embryos,and the number of high-quality embryos between the two groups.PG3 self-control:There were no significant differences in the starting dose of Gn,the total dose of Gn,and the days of use of Gn between the two groups(P>0.05).The number of high-quality embryos in the medication group was higher than that in the control group,and the difference was statistically significant(P<0.05).The number of oocytes retrieved,the number of available embryos the rate of available embryos,the clinical pregnancy rate of the fresh cycle,the cumulative pregnancy rate,and the cumulative live birth rate of the drug group were higher than those of the control group,and the difference was not statistically significant(P>0.05).There were statistical differences in the starting dose of Gn,the total dose of Gn,and the use time of Gn after matching between the PG4 case and control group(P<0.05),and there was a statistical difference in the ovulation induction scheme between the two groups(P<0.05).The number of oocytes retrieved(rate),the number of fertilized eggs the number of available embryos(rate),and the number of high-quality embryos(rate)in the drug group were higher than those in the control group,with statistical differences(P<0.05);the cumulative live birth rate in the drug group was higher Compared with the control group(26.05%vs.15.67%),the difference was statistically significant(P<0.05).Subgroup analysis:In the antagonist regimen,the difference in total Gn dose between the two groups was not statistically significant The number of oocytes retrieved,the number of cleavage(rate),and the number of available embryos in the control group were lower than those in the medication group,and the difference was statistically significant(P<0.05).There was no significant difference in clinical pregnancy rate,cumulative pregnancy rate and cumulative live birth rate between the two groups(P>0.05).Long regimen:There was no significant difference in the total number of days of Gn and the total dose of Gn between the two groups(P>0.05).There were no statistically significant differences in clinical outcomes.Self-control:Gn starting dose,Gn total dose,Gn use days and other differences between the two groups were not statistically significant(P>0.05).There were no significant differences in the number of oocytes retrieved,the number of available embryos,the number of high-quality embryos,the rate of available embryos and the rate of high-quality embryos(P>0.05).The difference in clinical outcome was not statically significant(P>0.05).Cooclusion:1.In the randomized controlled experiment,the number of oocytes retrieved,the number of available embryos,the mumber of high-quality embryos,and the cumulative live birth rate were significantlly improved in the PG4 population after pretreatment with growth hormone;the number of oocytes retrieved and excellent embryos in the gonadotropin-releasing hormone antagonist.However,However,in the self-controlled experiment due to the small sample size,the above indicators have not been significantly improved.Therefore,growth hormone pretreatment may be beneficial to improve the ovarian response of Poseidon group 4 population,and even improve pregnancy outcomes.2 In randomized controlled trials and self-controlled trials there was no significant improvement in ovarian response and pregnancy outcomes after pretreatment with growth hormone in PG3 population.Therefore,growth hormone preconditioning may not significantly improve ovarian responsiveness and pregnancy outcomes in the Poseidon group 3 population. |
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