Before starting an in-vitro fertilisation cycle, some women need help to ovulate and the use of growth hormone therapy may help these women. This aims to reduce the use of gonadotropin therapy to stimulate ovulation, a hormone that can cause multiple pregnancy. The review of trials found no evidence that growth hormone helps improve birth rates in women who are undergoing ovulation induction prior to in-vitro fertilisation. However there is some evidence of increased pregnancy and birth rates in women who are considered 'poor responders' to in-vitro fertilisation. More research is needed.
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.
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'.
To assess the effectiveness of adjuvant growth hormone in in-vitro fertilisation protocols.
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).
All randomised controlled trials were included if they addressed the research question and provided outcome data for intervention and control participants.
Assessment of trial risk of bias and extraction of relevant data was performed independently by two reviewers.
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.