The Effect Of GH Adjuvant Therapy On Poor Ovarian Response And/or Advanced Patients Undergoing In Vitro Fertilization

Objective1)To evaluate the effect of growth hormone（GH）adjuvant therapy on infertility patients with poor ovarian response（POR）and/or advanced undergoing in vitro fertilization（IVF）;2)To explore the role of GH combined with dehydroepiandrosterone（DHEA）adjuvant therapy on infertility patients with POR and/or advanced infertility.And compare whether it is superior to the single GH adjuvant therapy on the effect of improving ovarian reserve.MethodsThis study was divided into two parts.The first part was from May 2016 to August2017 in patients with POR.The patients with POR were pretreated with GH or GH combined with DHEA for 4 to 6 weeks.To compare the IVF outcome before and after pretreatment cycles.In GH pretreatment group,18 patients with POR were included,and 18 stimulation cycles that did not receive pretreatment and 19 Gn stimulation cycles that had entered the cycle after GH adjuvant therapy.In the GH combined with DHEA pretreatment group,14 POR patients were enrolled in the study.18 routine Gn stimulation cycles vs 15 Gn stimulation cycle with GH plus DHEA pretreated group.The IVF outcomes were compared between the two groups,respectively.The second part,from March 2017 to October 2017,A total of 114 infertile patients were recruited from the Reproductive Center of the first affiliated Hospital of Anhui Medical University,mainly due to the low response factors of the female ovary and/or advanced.According to the random number method,114 people were randomly assigned to the GH pretreatment group（37 cases）and the GH plus DHEA pretreatment group（38 cases）and the untreated control group（39 cases）.The GH pretreated group was subcutaneously injected with GH 2IU QD before entering the Gn stimulation cycle.GH combined with DHEA pretreatment group received subcutaneous injection of GH 2IU QD before cycle,and oral administration of DHEA 25mg TID.The duration of pretreatment in both groups was 4-6 weeks.In the two groups of pretreated patients,venous blood was drawn from 5 ml before and after pretreatment,which was used to detect the levels of FSH LH and E₂.Three groups of patients undergoing a unified ovulation stimulation protocol.Collecting follicular fluid and detecting the level of IGF-1 MDADX T-AOC OHdG.Granulosa cells were retained and GPx-4 levels in granulosa cells were detected by Western blot assay.ResultsPart Ⅰ:1)Self-control before and after GH adjuvant therapy,the blastocyst formation rate（P=0.009）,blastocyst rate（P=0.001）,clinical pregnancy rate（P=0.000）and implantation rate（P=0.010）in GH pretreated group were significantly higher than those in control group（P=0.009,P=0.008,P=0.010）.2)Self-control of GH combined with DHEA pretreatment group before and after treatment,although the clinical pregnancy rate was 33.33%vs 12.5%0.585)and the implantation rate was 21.43%vs 8.33%0.598),there was no significant difference between the two groups（P>0.05）.Part Ⅱ:1)After 4-6 weeks of pretreatment,FSH and FSH/LH were significantly decreased in the GH pretreatment group（P=0.001,P=0.028）,and AFC was significantly increased（P=0.000）.GH and DHEA pretreatment has the same effect.2)Compared with the control group,the blastocyst formation rate（46.07%vs 32.34%）,clinical pregnancy rate（51.85%vs 16.22%）and implantation rate（38.64%vs 10.53%）were higher in the GH pretreatment group than in the control group.There is a significant difference in the data（P<0.05）;Compared with the control group,the clinical pregnancy rate（45.83%vs 16.22%）and the implantation rate（54.17%vs10.53%）in the GH combined with DHEA pretreatment group were significantly higher than those in the control group（P<0.05）;The difference of IVF cycle between GH pretreatment group and GH combined with DHEA pretreatment group was not significant（P>0.05）.3)The levels ofIGF-1,SOD,T-AOC,and GPx in follicular fluid were significantly higher in the two pretreatment groups than in the control group（P<0.05）,but the data were not significantly different between the GH pretreatment group and the GH and DHEA pretreatment groups.（P>0.05）.4)The GPx-4 level in granular cells was significantly higher in the two pretreatment groups than in the control group（P<0.05）,but there was no significant difference between the two pretreatment groups（P>0.05）.Conclusion1)These observations confirm the beneficial effect of GH adjuvant therapy for infertility patients with POR and/or advanced.2)Although the combination of GH and DHEA adjuvant therapy can improve ovarian function on infertility patients with POR and/or advanced undergoing IVF,the combined use of GH and DHEA adjuvant therapy is not superior to single use of GH.