title: Growth hormone for in vitro fertilization.
abstract: BACKGROUND
  In an effort to improve outcomes of in-vitro fertilisation cycles the use of growth hormone has been considered. Improving the outcomes of in-vitro fertilisation is especially important for subfertile women who are considered 'poor responders'.
  
  
  OBJECTIVE
  To assess the effectiveness of adjuvant growth hormone in in-vitro fertilisation protocols.
  
  
  METHODS
  We searched the Cochrane Menstrual Disorders and Subfertility Groups trials register (June 2009), the Cochrane Central Register of Controlled Trials (Cochrane Library Issue 2, 2009), MEDLINE (1966 to June 2009), EMBASE (1988 to June 2009) and Biological Abstracts (1969 to June 2009).
  
  
  METHODS
  All randomised controlled trials were included if they addressed the research question and provided outcome data for intervention and control participants.
  
  
  METHODS
  Assessment of trial risk of bias and extraction of relevant data was performed independently by two reviewers.
  
  
  RESULTS
  Ten studies (440 subfertile couples) were included. Results of the meta-analysis demonstrated no difference in outcome measures and adverse events in the routine use of adjuvant growth hormone in in-vitro fertilisation protocols. However, meta-analysis demonstrated a statistically significant difference in both live birth rates and pregnancy rates favouring the use of adjuvant growth hormone in in-vitro fertilisation protocols in women who are considered poor responders without increasing adverse events, OR 5.39, 95% CI 1.89 to 15.35 and OR 3.28, 95% CI 1.74 to 6.20 respectively.
  
  
  CONCLUSIONS
  Although the use of growth hormone in poor responders has been found to show a significant improvement in live birth rates, we were unable to identify which sub-group of poor responders would benefit the most from adjuvant growth hormone. The result needs to be interpreted with caution, the included trials were few in number and small sample size. Therefore, before recommending growth hormone adjuvant in in-vitro fertilisation further research is necessary to fully define its role.
authors.affiliation: Guy's and St Thomas' Hospital, Westiminster Bridge Road, London, UK, SE1 7EH.
authors.forename: James Mn
authors.initials: JM
authors.lastname: Duffy
authors.forename: Gaity
authors.initials: G
authors.lastname: Ahmad
authors.forename: Lamiya
authors.initials: L
authors.lastname: Mohiyiddeen
authors.forename: Luciano G
authors.initials: LG
authors.lastname: Nardo
authors.forename: Andrew
authors.initials: A
authors.lastname: Watson
mesh_terms: D017024:Chemotherapy, Adjuvant; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods*; D013007:Growth Hormone-Releasing Hormone / Q000627:therapeutic use*; D019382:Human Growth Hormone / Q000627:therapeutic use*; D006801:Humans; D007247:Infertility, Female / Q000188:drug therapy; D050498:Live Birth; D010062:Ovulation Induction; D011247:Pregnancy; D018873:Pregnancy Rate; D016032:Randomized Controlled Trials as Topic
chemical_list: D019382:Human Growth Hormone; D013007:Growth Hormone-Releasing Hormone