To encourage women to generate eggs during an IVF cycle, gonadotropin treatment is required. Human growth hormone (HGH) administration as an additional treatment has the potential to enhance the effectiveness of gonadotropin therapy.
Why is HGH used in IVF?
In comparison to not getting growth hormone treatment, numerous evaluations of the advantages and hazards of growth hormone use in women undergoing IVF have been conducted.
The majority of “poor responders” to IVF treatment are elderly women with poor ovarian reserves or women who have previously had IVF treatment but had fewer than five eggs harvested despite the highest dose of stimulation medication. Young women are regarded as normal responders if they have a healthy ovarian reserve and a healthy ovarian response (> 5 eggs recovered) after ovarian stimulation. (1)
What is Human Growth Hormone?
Since the late 1980s, ovarian stimulation regimens for in vitro fertilization (IVF) have included the administration of growth hormone (GH). It has been demonstrated to enhance IVF clinical outcomes, supporting findings about the favorable association between the proportion of patients who have undergone IVF and the level of HGH in follicular fluid extracted from the ovaries with regard to treatment outcomes.
Nevertheless, despite these positive preliminary findings, some subsequent studies were unable to detect an improvement in the clinical outcomes of IVF following the addition of HGH to the protocol for ovarian stimulation. These findings raise the question of how to spot patients who might benefit from HGH medication and show that not all patients who respond poorly to ovarian stimulation will experience an improved IVF clinics in Turkey outcome. (2)
Who benefits from HGH?
The use of HGH in conjunction with ovarian stimulation may enhance the success of IVF in women over 40, according to strong data. However, some young women with prior IVF failures, poor responsiveness to high-dose stimulation, and low egg and embryo quality are also susceptible to it.
HGH may have an impact on oocyte quantity or quality, according to some research, while others have found that it affects the number of recoverable oocytes. Intriguingly, a recent study found that regardless of age, all women with poor ovarian response treated with HGH experienced an increase in the total number of mature and fertilized oocytes, existing embryos, and high-quality embryos retrieved, but not a significant rise in implantation.
The beneficial effects of HGH administration on IVF outcomes demonstrated in some patients may not be due solely to hormonal influence on ovarian function. In fact, recent data have shown that treatment with HGH can also promote embryo implantation by improving uterine receptivity. (3)
What do studies say?
In normal responders with GH use, the effect on the live birth rate is very uncertain; If the chance of a live birth without growth hormone is accepted as 15%, the chance of a live birth with growth hormone will be between 6% and 43%.
There was insufficient evidence to conclude clinical pregnancy rates, the number of women with at least one egg retrieved, embryo transfer, and the number of eggs retrieved in normal responders. Evidence is also very uncertain regarding the effect of growth hormone on the average gonadotropin units used in normal responders.
Based on eight trials, the evidence for the effect of growth hormone on the live birth rate for poor responders is very uncertain. If the chance of a live birth without growth hormone is accepted as 11%, the chance of a live birth with growth hormone will be between 13% and 25%.
Evidence on the effect of growth hormone in embryo transfer based on four trials is very uncertain. If the success chance of embryo transfer is accepted as 77%, the chance will be between 78% and 94% with the use of growth hormone.
Based on eight studies with low precision, the use of growth hormone results in a reduction in the average gonadotropin units used for stimulation in poor responders. (4)
When is the best time to inject Human Growth Hormone (HGH)?
The timing of HGH injection in relation to the ART cycle is important. HGH is typically administered daily, starting about a week before ovarian stimulation for IVF and continuing until the day of oocyte retrieval. This period of administration is called the pre-stimulation phase. The optimal dose and duration of HGH supplementation can vary depending on factors such as age, weight, and medical history, and should be determined by a physician.
HGH injections can help improve the quality and quantity of oocytes retrieved during an IVF cycle. Studies have shown that HGH supplementation during the pre-stimulation phase of IVF can increase the number of mature oocytes, improve embryo quality, and increase pregnancy rates. HGH can also help to counteract the negative effects of aging on oocyte quality and quantity.
The best time to inject HGH is during the pre-stimulation phase of an ART cycle, starting about a week before ovarian stimulation for IVF and continuing until the day of oocyte retrieval. The optimal dose and duration of HGH supplementation should be determined by a physician, and patients should be aware of potential side effects and costs associated with HGH treatment.
1,4-Cochrane Gynaecology and Fertility Group, Sood, A., Mohiyiddeen, G., Ahmad, G., Fitzgerald, C., Watson, A., & Mohiyiddeen, L. (1996). Growth hormone for in vitro fertilisation (IVF). Cochrane Database of Systematic Reviews, 2021(11).