title: Growth Hormone Supplementation in the Luteal Phase Before Microdose GnRH Agonist Flare Protocol for In Vitro Fertilization.
abstract: OBJECTIVE
  Growth hormone (GH) acts in both early and late follicular development to stimulate the proliferation and differentiation of granulosa cells and to increase the production of estradiol in animal and human ovaries. Investigators have therefore explored GH supplementation to improve outcomes in women undergoing in vitro fertilization, with the greatest interest in women with diminished ovarian reserve. Recent meta-analyses indicate that GH supplementation can be beneficial for poor responders undergoing IVF. In most studies, GH has been given concomitantly with gonadotropins during the follicular phase; this may not be optimal, since follicular recruitment begins during the preceding luteal phase. We therefore wished to examine the effect of GH supplementation in the luteal phase before controlled ovarian stimulation (COH) with a microdose GnRH agonist flare (MDF) protocol in women undergoing in vitro fertilization.
  
  
  METHODS
  We performed a retrospective matched case-control study of patients undergoing treatment at a private IVF facility between June 2012 and July 2013. Patients identified as poor responders to COH were offered adjuvant GH treatment as part of their ovarian stimulation regimen. The patients in the experimental group chose to take GH, 3.33 mg daily by subcutaneous injection for 14 days, before starting COH. All patients had an MDF stimulation protocol using 450 IU of follicle stimulating hormone (FSH) daily.
  
  
  RESULTS
  A total of 42 women were included in the study. There were 14 women in the experimental group (GH) and 28 controls (C) matched for age, BMI, and day 3 FSH level. There was no difference between the groups in clinical pregnancy rate (GH = 29%, C = 32%, P = 0.99), number of mature oocytes retrieved (GH = 2.5, C = 5.0, P = 0.13), cycle cancellation rate (GH = 21%, C = 14%, P = 0.88), duration of COH (GH = 10.1, C = 10.1, P = 0.93), or mean peak estradiol level (GH = 4174 pmol/L, C = 5105 pmol/L, P = 0.44).
  
  
  CONCLUSIONS
  The administration of growth hormone during the luteal phase before a microdose GnRH agonist flare protocol for in vitro fertilization did not improve outcomes in "poor responder" patients.
authors.affiliation: Division of Reproductive Endocrinology and Infertility, University of British Columbia, Vancouver BC.
authors.forename: Caitlin
authors.initials: C
authors.lastname: Dunne
authors.affiliation: Division of Reproductive Endocrinology and Infertility, University of British Columbia, Vancouver BC; Pacific Centre for Reproductive Medicine, Vancouver BC.
authors.forename: Ken
authors.initials: K
authors.lastname: Seethram
authors.affiliation: Division of Reproductive Endocrinology and Infertility, University of British Columbia, Vancouver BC; Pacific Centre for Reproductive Medicine, Vancouver BC.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Roberts
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002985:Clinical Protocols; D005260:Female; D005307:Fertilization in Vitro; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists; D013006:Growth Hormone / Q000627:therapeutic use*; D006801:Humans; D008183:Luteal Phase / Q000187:drug effects*; D010062:Ovulation Induction; D012189:Retrospective Studies
chemical_list: D007987:Gonadotropin-Releasing Hormone; D013006:Growth Hormone
keywords: growth hormone; in vitro fertilization; microdose GnRH agonist flare; poor responder