The Application Of Growth Hormone In Overweight And Obese Infertile Patients In IVF-ET

[Objective]1. To retrospectively analyze the effects of overweight and obese on in vitro fertilization embryo transfer process and the results of ovulation and pregnancy among female; 2. To investigate whether adding growth hormone (GH) in the process of controlled ovarian hyperstimulation (COH) of overweight and obese infertile patients with IVF-ET has an improving effect on ovulation process and the outcome of assisted reproductive.[materials and methods]The first part: the 1263 cycles from June 2013 to June 2014 of IVF-ET admitted to the Department of reproductive medicine of Second Affiliated Hospital of Kunming Medical University for assisted reproductive techniques were retrospectively analyzed. According to the Asian body weigh index (BMI) recommended by WHO classification criteria, the patients were divided into two groups. Group 1:Overweight and obesity group ((24 Kg/m2?BMI<36Kg/m2); group 2:normal weight group (18.5Kg/m2? BMI<24Kg/m2). The general situations -- age, total doses and days of gonadotropin, the level of estrodiol and endometrial thickness on the day of injecting HCG, the rate of eggs, mature eggs, normal fertilization, the cleavage, good quality embryos, implantation, and clinical pregnancy of two groups were recorded respectively, compared and statistically analyzed. The second part: The 91 cases of infertile couples due to female overweight and obese between July 2014 and January 2015 for IVF/ICSI in the Second Affiliated Hospital of Kunming Medical University were collected. Thereinto:33 cases were added Gn with GH 4.5u daily as experimental group 1,34 cases were added Gn with GH 4.5 every two days as experimental group 2, and 24 cases were treated with Gn alone as control group 3.SPSS20.0 software package was used for data processing, and RxC contingency table chi-square test was used to compare rates among count data set; measurement data were expressed as mean � standard deviation (x�s), t test was used between two groups, and among the three groups One-Way ANOVA analysis of variance was used.[results] 1.In the first part, no statistical significance of age was shown between Overweight and obese group with normal weight group, P> 0.05; The total doses and days of Gn were fewer in normal weight group. Moreover, estrodiol level and endometrial thickness on the day of injecting HCG, eggs rate, mature eggs rate, good quality embryos rate, fertilization rate, implantation rate, and clinical pregnancy rate were significantly lower inoverweight and obese group than in normal weight group: P<0.05.2. In the second part, no statistical significance of age, duration of infertility and BMI were shown among three groups, P> 0.05.3. There were no statistical significance among total doses and days of Gn, estrodiol level and endometrial thickness on the day of injecting HCG,eggs rate,implantation rate, and clinical pregnancy rate between Gn co-treatment GH 4.5u daily group with Gn co-treatment GH 4.5u every two days group, P> 0.05; maturation eggs rate, normal fertilization rate, good quality embryos rate, and cleavage rates were significantly higher in Gn co-treatment GH 4.5u daily group than Gn co-treatment GH 4.5u every two days group, P<0.05.4.No significant difference of Eggs rate was shown between Gn co-treatment GH 4.5u daily group and Gn alone group, P>0.05. However, the days of Gn was shorten, and the total doses of Gn decreased, while estrodiol level and endometrial thickness on the day of injecting HCG, good quality embryos rate, eggs rate, mature eggs rate, normal fertilization rate, cleavage rate, implantation rate, clinical pregnancy rate were significantly higher in Gn co-treatment GH 4.5u daily group, P<0.05.5.There were no statistical significance in eggs rate,maturation eggs rate, normal fertilization rate, good quality embryos rate, and cleavage rate between Gn co-treatment GH 4.5u every two days group and Gn alone group, P>0.05. However, the total doses of Gn decreased, and the days of Gn were shorten in Gn co-treatment GH 4.5u every two days group, while estrodiol level and endometrial thickness on the day of injecting HCG, implantation rate, and clinical pregnancy rate were higher in Gn co-treatment GH 4.5u every two days group than Gn alone group, P<0.01.[Conclusion] 1. Overweight and obesity may results in a negative effect on the process and outcome of ovulation and pregnancy outcome;2. The usage of Gn co-treatment GH in overweight and obesity may decrease the total doses and days of Gn, and increase estrodiol level and endometrial thickness on the day of injecting HCG,eggs rate,implantation rate, and clinical pregnancy rate;3. Daily treatment of Gn co-treatment GH 4.5u may be more useful in promoting follicular maturation and development and the division of embryos, thus further increase the number of available good quality embryos comparing with the every two days treatment of GH co-treatment Gn 4.5u;4. Em thickness may be more important to play an active role in assisted reproduction outcomes.5 GH can be applied in the clinical assisted reproduction treatment of overweight and obesity infertile patients, for the quality of embryos and IVF outcomes have been positive resultsand, continuous daily injection should provide a more promising treatment result.