Effect Of Recombinant Human Growth Hormone On The Outcome Of In Vitro Fertilization-embryo Transfer In Patients With PCOS

Objective:To study the effect of Recombinant Human Growth Hormone(r-hGH)on pregnancy outcome of Polycystic Ovary Syndrome(PCOS)patients undergoing In Vitro Fertilization Embryo Transfer(IVF-ET).Methods:Patients were randomly divided into experimental group and control group according to random number table method.Patients in experimental group were given injection of r-hGH 4U qod starting from the initiation day of Gn to the hCG trigger day.Basic information such as age,years of infertility,BMI,OGTT-insulin release test results,AMH,AFC,basal sex hormone levels,etc.;metabolic indicators such as blood glucose,lipids,insulin before and after treatment;COH treatment-related information such as COH protocol,total Gn dose,number of Gn days,and the number of eggs obtained.The data related to pregnancy outcome such as the number of embryos transferred,the type of embryos transferred,the number of β-hCG positive cycles,the number of clinical pregnancy cycles,gestational sacs,early miscarriage cycles and live birth cycles,to calculate the biochemical pregnancy rate,clinical pregnancy rate,implantation rate,miscarriage rate,and live birth rate.The study was analyzed by Per protocol,using SPSS version 25.0 statistical analysis.Data from continuous variables that were normally distributed were subjected to t-test,expressed as mean ± standard deviation(x±S),and compared with t test and Two-Way ANOVA.Data for categorical variables were expressed as rates using χ test or Fisher’s exact probability test.Finally,binary logistic regression model was used to verify the results,and OR and 95%CI were used as evaluation indexes.Differences were considered statistically significant at P<0.05.Results:(1)Adj uvant treatment of r-hGH in IVF-ET assisted pregnancy in PCOS patients could reduce the abortion rate(21.9%vs.40.0%,P=0.110)and increase the live birth rate(45.5%vs.35.6,P=0.284)to a certain extent,but did not significantly improve the outcome of assisted pregnancy.(2)The number of eggs obtained in PCOS patients with IR was significantly lower than those without IR(17.8±6.8 vs.22.0±5.5,P=0.015).Adjuvant therapy with r-hGH could increase the number of eggs obtained in PCOS patients to a certain extent,but the difference was not statistically significant.(3)PCOS patients with IR had significantly lower implantation rate(36.4%vs.64.3%,P=0.016),higher miscarriage rate(61.1%vs.23.5%,P=0.025)and lower live birth rate(22.9%vs.54.2%,P=0.014)than those without IR.After r-hGH adjuvant treatment,the miscarriage rate of PCOS patients was significantly reduced(27.3%vs.61.1%,P=0.031)and the live birth rate was significantly increased(48.5%vs.22.9%,P=0.027).The difference was statistically significant.The positive rate of β-hCG,implant rate and live birth rate of the former were also increased to a certain extent,however it is not statistically significant.(4)The results of binary logistic regression analysis showed that in the overall PCOS patients and non-insulin resistant PCOS patients,whether the addition of GH had no significant effect on the live birth rate,and in the PCOS patients with insulin resistance,the addition of GH was beneficial to improve the live birth rate(P=0.005,95%CI:1.825,32.546).Conclusion:(1)The general addition of r-hGH adjuvant therapy to PCOS patients receiving IVF-ET assisted pregnancy does not improve the pregnancy outcome.(2)For patients with insulin resistance PCOS in IVF-ET assisted pregnancy COH treatment,starting Gn synchronous addition of r-hGH can reduce the abortion rate and improve the live birth rate,to a certain extent,increase the number of eggs obtained,βHCG positive rate,implantation rate and live birth rate.However,non-insulin resistant PCOS patients did not benefit from the addition of r-hGH.(3)The binary logistic regression analysis showed that r-hGH did not significantly improve the live birth rate in non-insulin resistant PCOS patients,but it could improve the live birth rate in insulin resistant PCOS patients,thus providing clinical research support for refined treatment of PCOS patients.