Clinical Analysis Of Recombinant Human Growth Hormone In The First IVF/ICSI Treatment

Objective: To explore the clinical effect of recombinant human growth hormone(rhGH)pretreatment in the first IVF / ICSI treatment,and to find a suitable population.Methods: From January 2018 to December 2019,6515 patients were selected for the first IVF / ICSI treatment in Jiangxi Province Maternity and Child Health Hospital,576 patients were pretreated with rhGH and 5939 patients were untreated.By using PSM technology to control the confounding factors and matching according to 1:1,569 cases in the treatment group and the control group were matched,and the clinical outcomes of the two groups were compared and stratified.Results: There were significant differences in age,basal AFC,AMH and Gn starting dose between the two groups of baseline conditions without matching.By multivariate logistic regression analysis,age,basal AFC,tubular factors,and Intrauterine adhesions were screened as independent predictors of whether rhGH pretreatment was used.According to propensity score matching,there were significant differences in BMI(21.96 + 3 VS 22.35 + 3.03,P = 0.0285)and scar uterus(14.24% VS 18.63%,P = 0.0455).There were no significant differences in days of stimulation,dose of Gn,E2,LH,Endometrium thickness and number of oocytes retrieved on the day of HCG between the two groups in ovulation induction treatment,and there were significant differences in P on hCG trigger day(0.44 [0.309,0.62] VS 0.5 [0.351,0.74],P=0.0003).There were no statistical differences in fertilization protocol,number of normal fertilized,Good-quality embryos on Day 3,number of available embryos,normal cleavage rate and rate of high-quality embryos in laboratory embryo culture,and there were statistical differences in two pronucler(2PN)fertilization rate(64.32% VS 66.75%,P=0.0055).There were no significant differences in the discarded rate,fresh embryo transfer rate,type of embryo transferred and number of embryos transferred among the embryo transfer.There were no differences in the incidence of moderate-to-severe OHSS,biochemical pregnancy rate,clinical pregnancy rate,multiple pregnancy and implantation rate between the two groups.In the age subgroup analysis,there was no difference in the clinical pregnancy rate between the treatment group and the control group <35 years old(64.76% VS 63.77,P=0.788).There was a statistical difference in the clinical pregnancy rate between the treatment group and the control group aged 35-37 years old(62.5% VS 48.45%,P=0.0496).The treatment group aged >38 years had a tendency to increase in the clinical pregnancy rate compared with the control group(45.05% VS 41.84%,P=0.0496).P=0.6406);AFC subgroup analysis 1-7 treatment groups and control group clinical pregnancy rate were statistically different(58.82% VS 45.83%,P=0.02);AMH subgroup analysis was no statisticant difference.Conclusion: For the first IVF / ICSI patients,the application of recombinant human growth hormone should be strictly standardized.rhGH pretreatment can not benefit in the young patients(<35)or with better ovarian reserve(AFC>7),but it can benefit in the patients who old(>35)or poor ovarian reserve(AFC<7).