Application Of Low Dose Growth Hormone Pretreatment In In Vitro Fertilization And Embryo Transfer

Objective :To explore the effect of pretreatment with low dose recombinant human growth hormone?rh GH?on embryo quality and pregnancy outcome in patients with diminished ovarian reserve?DOR?and those who had failed in the previous in vitro fertilization-embryo transfer?IVF-ET?treatment,so as to provide guidance for clinical work and achieve a more ideal pregnancy outcome.Methods:238 cases of infertility patients treated with IVF-ET in our hospital from September 2016 to December 2018 were selected,and the controlled ovarian hyperstimulation?COH?was conducted using antagonist protocol,modified long protocol and micro-stimulation protocol.This study is divided into two parts:Part 1: Comparison between groups based on whether rh GH pretreatment is applied to patients with DOR197 patients with DOR were enrolled and divided into two groups according to the COH protocol: antagonist or modified long protocol group?group A?,micro-stimulation protocol group?group B?;and then according to whether patients received rh GH pretreatment before COH,group A was divided into A₁ group?pretreated?,A₂ group?not pretreated?,respectively,53 cases,54 cases;Group B was divided into B₁ group?pretreated?,B₂ group?not pretreated?,respectively 35 cases,55 cases.The basic conditions,hyperstimulation of ovulation,laboratory indicators and pregnancy outcomes of each group were compared.Part 2: The former and the latter cycle self-controlled study after rhGH pretreatment in patients with previous IVF failureA total of 41 cases who had failed in the previous IVF cycle were included?number of oocytes retrieved ? 3,no available embryos,and poor quality of embryo resulted in pregnancy failure?.According to age,patients were divided into group C?< 35 years old?,21 cases;Group D??35 years old?,20 cases.According to whether patients received rh GH pretreatment before COH in the former and the latter cycle,patients were divided into C₁ group?pretreated?,C2 group?not pretreated?,D1 group?pretreated?,and D2 group?not pretreated?.The COH protocols of the patients were the same in the two cycles.The basic conditions,hyperstimulation of ovulation,laboratory indicators and pregnancy outcomes of each group were compared.Results:Part 1:1)Comparison between A₁ group and A₂ group: two groups of patients in age,BMI,AFC,duration of infertility,type of infertility,the levels of basic FSH,LH,E₂,days of Gn,total does of Gn,the levels of LH?E₂?P on the HCG day,endometrial thickness on the HCG day,number of oocytes retrieved,fertilization rate,2PN fertilization rate,total embryo number,the rate of high-quality embryos transferred and abortion rate of early pregnancy were compared,the difference was not statistically significant?P>0.05?;number of MII oocytes,available oocyte rate,high quality embryo rate,clinical pregnancy rate and embryo implantation rate in A₁ group were higher than A₂ group,difference was statistically significant?P<0.05?;No available embryonic cycle rate of A₁ group was lower than that of A₂ group,and the difference was statistically significant?P<0.05?.2)Comparison between B₁ group and B₂ group: endometrial thickness on the HCG day and high quality embryo rate of patients in B₁ group were significantly higher than those in B₂ group,and the differences were statistically significant?P < 0.05?.No available embryonic cycle rate of B₁ group was lower than that of B₂ group,and the difference was statistically significant?P<0.05?.There was no significant difference in other indicators?P>0.05?.Part 2:1)Age < 35 years old: Number of MII oocytes in C₁ group was higher than that in C2 group,and the difference was statistically significant?P < 0.05?;Abortion rate of early pregnancy in C₁ group was 25.00%.There was no significant difference in other indicators?P>0.05?.2)Age ? 35 years old: E₂ level on the HCG day,number of oocytes retrieved,number of MII oocytes,total number of embryos,high quality embryo rate and embryo implantation rate in D1 group were higher than those in D2 group,and the difference was statistically significant?P < 0.05?.No available embryonic cycle rate of D1 group was lower than that of D2 group,and the difference was statistically significant?P < 0.05?.The abortion rate of early pregnancy in the D1 group was 20.00%.There was no significant difference in other indicators?P>0.05?.Conclusion:1.For patients with DOR,low-dose rhGH pretreatment for 4-8 weeks before COH can increase the rate of high-quality embryos,and reduce the no available embryonic cycle rate,improve the pregnancy outcome;For patients with using micro-stimulation protocol,low-dose rh GH pretreatment can also increase the thickness of the endometrium,so as to improve the outcome of treatment.2.For patients with previous IVF treatment failure?number of oocytes retrieved ? 3,no available embryos,and poor quality of embryo resulted in pregnancy failure?,low-dose rh GH pretreatment is more effective in patients aged ?35 years,it can increase the E₂ level on the HCG day,increase number of oocytes retrieved,number of MII oocytes and the total number of embryos,improve the rate of high quality embryos,reduce the no available embryonic cycle rate,and increase the rate of embryo implantation.For patients with previous IVF failure who were <35 years old,low-dose rh GH pretreatment increased the number of MII oocytes,and the remaining treatment effect did not improve significantly.