Title: THE EFFECT OF GROWTH HORMONE ON CLINICAL OUTCOMES OF POOR OVARIAN RESPONDER UNDERGOING IN VITRO FERTILIZATION/INTRACYTOPLASMIC SPERM INJECTION TREATMENT: A RETROSPECTIVE STUDY BASED ON POSEIDON CRITERIA
Abstract: Poor ovarian responder (POR) had been dramatically increased among patients require assisted reproductive technology. The effect of growth hormone (GH) adjuvant in POR had been widely discussed. The novel POSEIDON criteria could better differentiate patients with minor heterogeneity[1]. The aim of this retrospective analysis is to explore whether GH treatment is beneficial for POR patients undertaken in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment. Retrospective cohort study. POR meet the POSEIDON criteria were recruited and stratified into the 4 subgroups according to ovarian reserve and patients age [1]. Patients in each subgroup were further divided into GH adjuvant group (GH+ group) and the counterpart without GH pretreatment (GH- group). One-to-one case-control matching was performed to adjust essential confounding factors between GH+ group and GH- group in two layers, normal ovarian reserve and poor oavarian reserve. Conventional ovarian stimulation protocols were applied for IVF/ICSI treatment. The demographic data, cycle characteristic and clinical outcomes between GH+ group and GH- group in each subgroup were compared separately. A total of 1104 patients were included in this study, among which 428 with normal ovarian reserve and 676 with poor ovarian reserve. GH adjuvant showed a beneficial effect on the ovarian response and live birth rate in poor ovarian reserve subgroups (PG3 and PG4). The further stratification revealed that in the PG4, the number of good-quality embryos were significantly increased in the GH+ group than in the GH- group (1.58±1.71 vs. 1.25±1.55, P =0.032), the miscarriage rate (6.7% vs. 13.8%, P=0.173) and live birth rate (29.89% vs. 17.65%, P =0.028) were also greatly improved, these effects failed to been detected in patients with normal ovarian reserve(PG1,PG2) or in poor ovarian responder younger than 35 (PG3). In conclusion, GH pretreatment is beneficial for promoting ovarian response and live birth rate, further decreasing miscarriage rate in poor ovarian reserve patients older than 35 (PG4).