Effect Of Low-dose Growth Hormone On Early Pregnancy Outcome In Infertile Women With Polycystic Ovary Syndrome

Objective:To retrospectively analyze the effect of low dose growth hormone(GH)on early pregnancy outcome and ovulation induction in infertile women with polycystic ovary syndrome(PCOS)treated with Letrozole(LE)combined with human menopausal gonadotropin(HMG).Method:A retrospective analysis was made of 205 cases of intrauterine pregnancy diagnosed by LE combined with HMG and LE,HMG,GH combined ovulation induction treatment in the reproductive medicine center of the North War Zone General Hospital from September 2016 to August 2018.The patients aged 21 to 35 years were infertile due to PCOS.According to the different drugs used for ovulation induction,they were divided into two groups:A(GH+HMG+LE),B(LE+HMG);further analysis was made according to the infertility years(infertility<2 years,infertility>2 years),BMI(BMI>25 kg/m~2?BMI?25 kg/m~2),the early abortion rate was observed and analyzed in each group,and the number of mature follicles,the growth time of follicles,the endometrial thickness of HCG day,the period of ovulation induction,the dosage of HMG and the early stage of abortion were compared.Abortion related factors were considered.SPSS 23.0 was used for statistical analysis.T test was used for quantitative data of normal distribution,rank sum test was used for non-normal distribution,and two-way disordered X2 test was used for qualitative data.Logistic stepwise regression was used to analyze the related factors affecting clinical pregnancy outcomes.The difference was statistically significant with P<0.05.Result:1.General data comparison:There was no significant difference in age,infertility time,BMI and basal endocrine level between group A and B(P>0.05).2.Comparisons of infertility years:There was no significant difference in infertility time between groups with infertility years less than 2 years and those with infertility years>2 years(P>0.05);there was no significant difference in BMI between groups(P>0.05);there was no significant difference in BMI stratification between groups A and B(P>0.05).3.Comparison of early pregnancy outcomes:The early abortion rates in group A and B were 26.2%(17/65)and 29.3%(41/140),respectively,with no significant difference(P>0.05).According to further BMI analysis,the early abortion rate of patients with BMI<25 and BMI?25 were 30.0%(9/30)and 22.9%(8/35),respectively,with no significant difference(P>0.05);the abortion rate of patients with BMI?25 kg/m~2 in group B were 38.1%(24/63),higher than those of patients with BMI<25 kg/m~2(17/77),with significant difference(P<0.05).4.Clinical effect of ovulation induction:The endometrial thickness and number of mature follicles on HCG days in group A were higher than those in group B(P<0.05),and the ovulation induction cycle and follicle growth time in group A were lower than those in group B(P<0.05).5.Clinical effect of ovulation promotion was analyzed and compared according to infertility years and BMI stratified groups:in group A,the ovulation promotion period of patients with infertility years was less than or equal to 2 years,the data was shorter than that of patients with infertility years more than 2 years(P?0.05);in group A,the number of mature follicles of patients with BMI<25 kg/m~2 was more than that of patients with BMI?25 kg/m~2(P?0.05);in group B,the thickness of endometrium on HCG days was thicker than that of patients with BMI<25 kg/m~2(P?0.05).In group B,the follicle growth time and ovulation stimulation cycle of patients with infertility less than or equal to 2 years were significantly shorter than those with infertility longer than2 years(P<0.05),and the intima thickness of HCG day was thicker than those with infertility longer than 2 years(P<0.05).6.Clinical ovulation promotion effect was analyzed and compared by infertility years and BMI stratification groups:infertility years were less than or equal to 2 years stratification,follicle growth time and ovulation promotion cycle in group A were shorter than those in group B(P<0.05);infertility years were longer than 2 years stratification,the number of mature follicles and the thickness of endometrium in group A were higher than those in group B(P<0.05),follicle growth time and ovulation promotion cycle in group A were shorter than those in group B(P<0.05).In group A,the endometrial thickness on HCG day was thicker than that in group B,and the dosage of HMG was less than that in group B(P<0.05).7.Logistic regression results showed that the risk of abortion in BMI?25 kg/m~2was 1.423 times higher than BMI<25 kg/m~2 in group A,the risk of early abortion was1.2 times that in group B.Conclusion:1.Adding low dose growth hormone in ovulation induction therapy can increase endometrial thickness,shorten ovulation induction cycle,reduce HMG dosage and increase the number of mature follicles,which can increase the chance of conception.2.The addition of low-dose growth hormone in letrozole combined with urogonadotropin ovulation induction therapy is more suitable for patients with BMI>25 kg/m~2 and infertility longer than 2 years,and the solution is safe and practical.3.Adding low dose growth hormone to ovulation induction program did not significantly improve the early abortion rate of non-elderly PCOS patients.