The effect of growth hormone supplementation on in vitro fertilization outcome: a prospective randomized placebo-controlled double-blind study.
OBJECTIVE
To determine the effect of growth hormone (GH) supplementation to a long gonadotropin-releasing hormone agonist (GnRH-a)/human menopausal gonadotropin (hMG) treatment protocol, on ovarian response, embryo quality, and clinical outcome in in vitro fertilization (IVF).


METHODS
Growth hormone or placebo were administered in a prospective randomized double-blind manner.


METHODS
Forty-two normal ovulatory, women who were 38 years of age or less with mechanical factor infertility and a normal male factor were selected for this study.


METHODS
Gonadotropin-releasing hormone agonist, 0.5 mg/d, was initiated in the midluteal phase of the preceding cycle and continued until the day of human chorionic gonadotropin (hCG) administration. Ovulation induction with hMG was started 14 days after pituitary down regulation (17 beta-estradiol [E2] serum level less than 30 pg/mL). Growth hormone (12 IU/d) or placebo were administered on days 1, 3, 5, and 7 of hMG treatment.


RESULTS
Breaking the code at the completion of the study revealed that 20 women received GH and 22 placebo. The age and duration of infertility did not differ between the two groups. Follicular phase duration, hMG ampules used, serum E2, and number of follicles (greater than or equal to 14 mm) on day of hCG as well as number of oocytes and embryos achieved were similar in both groups. Embryo morphology and rate of cleavage were also similar. Insulin-like growth factor-I (IGF-I) serum levels did not change after pituitary down regulation and increased significantly both after GH/hMG and placebo/hMG ovulation induction treatment. Clinical pregnancy rate (PR) per embryo transfer and implantation rate were 40% versus 32% and 17.9% versus 11.3% in the GH and placebo groups, respectively, and were not statistically different.


CONCLUSIONS
In normo-ovulatory women undergoing ovulation induction for IVF, GH supplementation to hMG after GnRH-a pituitary down regulation does not seem to augment ovarian response or improve embryo quality. The effect of this regimen on actual PRs and implantation rates needs further clarification.
Younis
J S
JS
Department of Obstetrics and Gynecology, Hadassah University Hospital, Ein-Karem, Jerusalem, Israel.
Simon
A
A
Koren
R
R
Dorembus
D
D
Schenker
J G
JG
Laufer
N
N
D000328:Adult; D006063:Chorionic Gonadotropin / Q000627:therapeutic use; D004311:Double-Blind Method; D010064:Embryo Implantation; D004624:Embryo Transfer; D004958:Estradiol / Q000097:blood; D005260:Female; D005307:Fertilization in Vitro; D005498:Follicular Phase; D007987:Gonadotropin-Releasing Hormone / Q000031:analogs & derivatives / Q000627:therapeutic use; D013006:Growth Hormone / Q000627:therapeutic use*; D006801:Humans; D007247:Infertility, Female / Q000628:therapy; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D008596:Menotropins / Q000627:therapeutic use; D011247:Pregnancy; D011446:Prospective Studies; D017329:Triptorelin Pamoate
D006063:Chorionic Gonadotropin; D017329:Triptorelin Pamoate; D007987:Gonadotropin-Releasing Hormone; D004958:Estradiol; D008596:Menotropins; D007334:Insulin-Like Growth Factor I; D013006:Growth Hormone