Impact of growth hormone supplementation on improving oocyte competence in unexplained poor embryonic development patients of various ages

Abstract

Objectives

To evaluate the effectiveness of Growth hormone (GH) co-treatment during in vitro fertilization (IVF) cycles in women of different ages who manifest unexplained poor embryonic development.

Method

This cohort study included a total of 2647 patients with unexplained poor embryonic development in their previous IVF procedures: 872 women received GH co-treatment and 1775 untreated women served as a control group. Patients were divided into 6 groups according to treatment and stratified by age (<35 years of age, A-GH group and A-control group; 35–40 years, B-GH group and B-control group; and ≥40 years, C-GH group and C-control group). The primary outcome was the oocyte-cleavage rate and the clinical pregnancy rate (CPR).

Results

The oocyte-cleavage rates among the three age groups were significantly higher in the GH group compared to the same-aged control group. In both group A and group B, there was no significant difference in clinical pregnancy rate between the GH group and controls. However, in patients ≥40 years of age, the clinical pregnancy rate in the GH group was significantly higher than in the control group (31.8% vs. 13.7%, p = 0.019). In the three age groups, there was no significant difference in the live birth rate between the GH group and controls. In the multivariate logistic regression analysis model, in both group A and group B, the number of cleaved embryos was independent predictors for CPR (OR = 1.464, 95% CI: 1.311–1.634; respectively, OR = 1.336, 95% CI: 1.126–1.586); Besides, in both group B and group C, age was independent predictors for CPR (OR = 0.657, 95%CI: 0.555–0.778; respectively, OR = 0.622, 95%CI: 0.391–0.989). However, only in group C, supplementation GH increased CPR as compared with not supplementation GH (OR = 2.339, 95%CI: 1.182–6.670).

Conclusions

For patients with unexplained poor embryonic development, supplementation with GH increased the oocyte-cleavage rates in all three age groups, and the clinical pregnancy rate gradually improved commensurate with increasing age. There was no difference in the clinical pregnancy rate in group A and group B, but group C improved significantly. Therefore, compared with patients under 40 years of age, patients ≥40 may benefit more from GH supplementation.

补充生长激素对不同年龄人群不明原因胚胎发育不良患者卵泡治疗的影响 摘要

目的：评估生长激素（GH）联合治疗在体外受精（IVF）周期中对不同年龄的不明原因胚胎发育不良女性的疗效。

方法：这项队列研究共纳入2647名既往体外受精过程中出现不明原因胚胎发育不良的患者：872名女性接受生长激素联合治疗, 1775名未经治疗的女性作为对照组。患者根据治疗分为6组, 并按年龄分层（35岁以下, A-GH组和A-对照组；35-40岁, B-GH组和B-对照组；≥40岁, C-GH组和C-对照组）。主要结局是卵裂率和临床妊娠率（CPR）。

结果：生长激素组三个年龄组的卵裂率明显高于同年龄对照组。在A组和B组中, 生长激素组和对照组之间的临床妊娠率没有显著差异。然而≥40岁时, 生长激素组临床妊娠率显著高于对照组（31.8%:13.7%, p=0.019）。在三个年龄组中, 生长激素组和对照组之间活产率没有显著差异。在多元逻辑回归分析模型中, 在A组和B组中, 早期胚胎数量是CPR的独立预测因子（OR=1.464, 95%可信区间：1.311-1.634；OR=1.336, 95%可信区间：1.126-1.586）；此外, 在B组和C组中, 年龄都是CPR的独立预测因素（OR分别为=0.657, 95%可信区间：0.555-0.778；OR分别为=0.622, 95%可信区间：0.391-0.989）。然而, 仅在C组与未补充生长激素相比, 补充生长激素增加了CPR（OR=2.339, 95%可信区间：1.182-6.670）。

结论：对于不明原因胚胎发育不良患者, 补充生长激素可提高所有三个年龄组的卵裂率, 临床妊娠率随着年龄的增长而逐渐提高。A组和B组的临床妊娠率没有差异, 但C组明显改善。因此, 与40岁以下的患者相比, ≥40岁患者可能通过补充生长激素获益更多。

Keywords:

• Unexplained poor embryonic development
• age
• GH
• clinical pregnancy

Acknowledgments

Not applicable.

Ethics approval and consent to participate

Ethics approval and consent to participate this study were approved by the Institutional Review Board (IRB) of Chongqing Health Center for Women and Children. In accordance with the measures of the People’s Republic of China on the administration of Human Assisted Reproductive Technology, the ethical principles of the Human Assisted Reproductive Technology as well as the Helsinki declaration. In addition, written and informed consent was obtained from each participant that accepted the use of adjuvants, and they were required to pay for these adjuvants over and above the IVF treatment charges.

Consent for publication

Not applicable.

Authors’ contributions

QLC designed the cohort; QLC, WHC, LP, and GNH conducted the trial; JS and XDZ executed the statistical analyses and prepared the tables with oversight by HY; QLC and JS drafted the manuscript. All authors were involved in data collection, interpreted the data, provided critical input to the manuscript, and approved the submitted version.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Availability of data and materials

The datasets used and analyzed in the current study are available from the corresponding author on reasonable request.

Additional information

Funding

This study was supported by a grant from the Medical Research Foundation of Chongqing to Qiao-Li Chen [grant number 2020MSXM090].