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The use of GH for ovarian stimulation

Dear Colleagues

Kindly I want to ask about the use of human growth hormone (hGH) in women older than 35, undergoing an IVF trial.
Are there any evidence based?
How much the dosage that should be used?
When to start and for how many days?

Thank you and have my best regards.

Dr. Enas Alakkam
Specialist Ob/Gyn

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Answer by John Yovich

GH use in IVF indicates benefits in a very small sub-group (~5% of my population)
You firstly need to define a clear poor-prognosis group.
Unfortunately the Bologna Criteria of 2011 has limited value as the focus is on egg numbers rather than egg quality (plus other limitations).
My study (Yovich & Stanger, 2010, RBM Online 21, 37-49) applied a sequential crossover trial.
Saizen 10 iu (actually 9 iu) X 6 amps in IVF lead-up gave 3-8 fold benefits in live births (productivity rate = live births from fresh & frozen embryos) via improved egg quality.
The better results were in younger <35 yrs, with repetitive poor egg & embryo quality.
The picture was not so clear for women >40yrs, although we matched data of Jan Tesarik (Tesarik et al 2005 Hum Reprod1, 29-31) showing nearly 3-fold better chance of live-birth.
Since then we have compared Scitropin (Omnitrope) daily 1 iu with very similar results (Abstract at FSA).
My clinic doctors are now using GH for wider groups, especially older, and the benefits are not so clear, but no major side-effects have been noted. Cease GH if hand oedema or joint swellings.
In extending use of adjuvants to larger groups, e.g. 15% of clinic population, it appears 3 months DHEA (we use self-made 50 mg trochets) shows equivalent outcomes ? beneficial.
My academic-affiliated group is examining the science of GH on granulosa cells as well as the oocyte; positive information to report soon.
High level clinical RCT is currently in process in Australia under leadership of Rob Norman (Light Study), results probably available end-2014?
Adjuvant drugs (performance-enhancing) is attracting world-wide interest; we must be careful and apply them through appropriate ethics committee oversight.
John Yovich, Australia

Answer by Seang Lin Tan

Hi, there are several studies showing better results with growth hormone, esp with poor responders. I can't cite the studies offhand as I'm on holiday in Malaysia but there were in the chapter in the book Gab published 3 years ago. I used Saizen 8 units daily before but very expensive. I use omnitrope 1 IU a day about 2 weeks before the start of stimulation. John Yovich above has the most experience.
Seang Lin Tan, Canada

Answer by Alex Steinleitner

An important issue with growth hormone as an adjunct for controlled ovarian hyperstimulation is patient heterogeneity. Clearly there are a number of underlying problems in patients that are either poor responders or produce poor quality eggs/embryos. It appears that a subset of these patients respond to co-treatment with growth hormone, but clearly there are no clear criteria for treatment.
In our unit we have followed Schoolcraft's protocol (Fertil Steril 1997 Jan;67(1):93-7), treating patients with growth hormone (Omnitrope 1.4 mg daily) from cycle day 1 of stimulation. We find that a substantial proportion of patients respond with improved egg numbers and embryo quality in followup cycles. Clearly this is an anecdotal experience.
Additionally, we find that treatment with growth hormone improves stimulation in resistant polycystic ovarian syndrome patients.
Alex Steinleitner, USA

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