The influence of different growth hormone addition protocols to poor ovarian responders on clinical outcomes in controlled ovary stimulation cycles: A systematic review and meta-analysis

Background: Growth hormone (GH) is used as an adjuvant therapy in in vitro fertilization and embryo transfer (IVF-ET) for poor ovarian responders, but findings for its effects on outcomes of IVF have been conflicting. The aim of the study was to compare IVF-ET outcomes among women with poor ovarian responders, and find which subgroup can benefit from the GH addition. Methods: We searched the databases, using the terms "growth hormone," "GH," "IVF," "in vitro fertilization." Randomized controlled trials (RCT) were included if they assessed pregnancy rate, live birth rate, collected oocytes, fertilization rate, and implantation rate. Extracted the data from the corresponding articles, Mantel-Haenszel random-effects model, or fixed-effects model was used. Eleven studies were included. Results: Clinical pregnancy rate (RR 1.65, 95% CI 1.23-2.22), live birth rate (RR1.73, 1.25-2.40), collected oocytes number (SMD 1.09, 95% CI 0.54-1.64), MII oocytes number (SMD 1.48, 0.84-2.13), and E2 on human chorionic gonadotropin (HCG) day (SMD 1.03, 0.18-1.89) were significantly increased in the GH group. The cancelled cycles rate (RR 0.65, 0.45-0.94) and the dose of gonadotropin (Gn) (SMD -0.83, -1.47, -0.19) were significantly lower in patients who received GH. Subgroup analysis indicated that the GH addition with Gn significantly increased the clinical pregnancy rate (RR 1.76, 1.25-2.48) and the live birth rate (RR 1.91, 1.29-2.83). Conclusion: The GH addition can significantly improve the clinical pregnancy rate and live birth rate. Furthermore, the GH addition time and collocation of medications may affect the pregnancy outcome.