The Effect Of Growth Hormone Administration On Embryo Quality In Poor Ovarian Responders Undergoing IVF Or ICSI: A Retrospective Study Based On POSEIDON Criteria

Backgroud Poor ovarian response(POR)remains one of the most challenging tasks for reproductive clinicians during controlled ovarian stimulation(COS).However,clinical guidelines to most optimally treat these women are lacking due to the absence of an optimal system to identify and classify these patients.To standardize the definition of POR,ESHRE proposed the Bologna criteria in 2011.But their use in clinical trials has been questioned because the Bologna criteria describe a heterogeneous population with different reproductive outcomes and the effect of age on oocyte quality was not taken into consideration.A novel system to classify infertility patients—the POSEIDON criteria—was developed to provide a more nuanced picture of POR in 2016.Growth hormone(GH)is a peptide hormone secreted from the pituitary gland,which has been used as an adjunct in the field of female infertility treatment for more than 30 years,especially in patients with POR.Although,its role in treating women with POR has not yet been clarified.Several underpowered studies have been performed on women with POR undergoing IVF treatment and pay attention to the effects of GH on oocyte quality and live birth rate.However,lack of explore whether GH pretreatment has a beneficial effect on oocyte quality of POSEIDON poor ovarian responsers.Objective To explore whether GH pretreatment has a beneficial effect on oocyte quality of POSEIDON poor ovarian responsers undertaking in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI)treatment.Methods This self-controlled,retrospective study was performed among 428 POR with a failed previous IVF/ICSI cycle due to no transferrable embryos or poor pregnancy outcomes and had GH adjuvant(GH+)in the next cycle at the Reproductive Hospital Affiliated to Shandong University,from March 2018 to December 2020.GH was injected daily beginning with the previous menstruation on days 2-3 or on days 15-21 and maintained until the day of human chorionic gonadotropin(hCG)triggering.The patients were divided into four groups according to POSEIDON classification.And each group was compared the outcome between the cycles treated with GH to those cycles treated without GH.Results In PG1,fixed effects in mixed linear models showed that the presence of GH was a independent significant factor of the number of oocytes retrieved,high-score day-3 embryos,good-quality blastocysts and embryos available after adjustment of patient’s age,COS protocal and gonadotropin dose(p<0.05).In PG2,fixed effects in mixed linear models showed that the presence of GH was a independent significant factor of the number of oocytes retrieved and embryos available(p<0.05).In PG3,fixed effects in mixed linear models showed that the presence of GH was a independent significant factor of the number of high-score day-3 embryos,good-quality blastocysts and embryos available(p<0.05).In PG4,mixed linear models showed that the presence of GH was a independent significant factor of the number of embryos available(p<0.05).Conclusions1.Supplementation with GH is beneficial in improving ovarian response of PG1 and PG2 patients,resulting in an increase in the number of oocytes retrieved in unexpected poor ovarian responders.2.GH has a clear beneficial influence on the morphological quality of oocytes and embryos,resulting in an increase in the number of embryos available.