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Fertility and Sterility Jul 2020To evaluate the effectiveness of growth hormone (GH) supplementation in improving the in vitro fertilization (IVF) outcomes of poor responders. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To evaluate the effectiveness of growth hormone (GH) supplementation in improving the in vitro fertilization (IVF) outcomes of poor responders.
DESIGN
Systematic review and meta-analysis.
SETTING
Not applicable.
PATIENT(S)
Poor ovarian responders undergoing conventional IVF or intracytoplasmic sperm injection (ICSI).
INTERVENTION(S)
Randomized controlled trials (RCTs) of poor ovarian responders undergoing a single IVF/ICSI cycle with GH supplementation versus conventional controlled ovarian stimulation. This review was registered in the PROSPERO database before starting data extraction (CRD42020151681).
MAIN OUTCOME MEASURE(S)
Primary outcome was live birth rate. Clinical pregnancy rate, miscarriage rate, ongoing pregnancy rate, number of oocytes, number of mature (metaphase II [MII]) oocytes and the number of embryos available to transfer were considered as secondary outcomes.
RESULT(S)
Twelve RCTs were included; 586 women were assigned to the intervention group and 553 to the control group. The analysis revealed that patients receiving GH supplementation did not show an increased live birth rate, miscarriage rate, or ongoing pregnancy rate. However, GH supplementation in poor responders increased clinical pregnancy rate, number of oocytes retrieved (mean difference 1.62), number of MII oocytes (mean difference 2.06), and number of embryos available to transfer (mean difference 0.76). Sensitivity and subgroup analyses did not provide statistical changes to pooled results.
CONCLUSION(S)
The present meta-analysis provides evidence that GH supplementation may improve some reproductive outcomes in poor responders, but not live birth rates.
Topics: Birth Rate; Drug Resistance; Drug Therapy, Combination; Female; Fertility Agents, Female; Fertilization in Vitro; Growth Hormone; Humans; Infant, Newborn; Infertility; Live Birth; Male; Oocyte Retrieval; Ovulation Induction; Pregnancy; Pregnancy Outcome; Pregnancy Rate; Randomized Controlled Trials as Topic; Sperm Injections, Intracytoplasmic; Treatment Outcome
PubMed: 32553470
DOI: 10.1016/j.fertnstert.2020.03.007 -
Acta Obstetricia Et Gynecologica... Oct 2019High levels of anti-Mullerian hormone and a high antral follicle count in women with polycystic ovary syndrome, reflecting increased ovarian antral follicles,... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
High levels of anti-Mullerian hormone and a high antral follicle count in women with polycystic ovary syndrome, reflecting increased ovarian antral follicles, predisposes them to have a high number of retrieved oocytes with in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) and an increased risk of ovarian hyperstimulation syndrome. Inositols, which act as insulin sensitizers, have the potential to alter folliculogenesis and the functional ovarian reserve, with subsequent benefits to reproductive outcomes following IVF/ICSI treatment. Published literature is, however, unable to provide definitive evidence of its efficacy. The objective of our review was to evaluate the effect of inositols on anti-Mullerian hormone, antral follicle count and reproductive outcomes in women with polycystic ovary syndrome undergoing IVF/ICSI.
MATERIAL AND METHODS
We performed a literature search using standard methodology recommended by Cochrane. Randomized controlled trials and non-randomized studies comparing inositols with no treatment, placebo or other treatment were included in the review. Using standard methodology recommended by Cochrane we pooled results using the random effects model; our findings were reported as relative risk or mean differences. PROSPERO registration: CRD42017082275.
RESULTS
We included 18 trials. The primary outcome was a change in anti-Mullerian hormone and antral follicle count before and after treatment, for which data were unsuitable for meta-analysis. A narrative review showed no consistent direction or size of effect. A meta-analysis for the secondary outcomes showed no evidence of a significant difference between inositol and control groups for any outcome: number of oocytes (mean difference -0.39, 95% confidence interval [CI] -1.11 to 0.33), number of metaphase II oocytes (mean difference 0.29, 95% CI -0.83 to 1.40), number of top grade embryos (risk ratio [RR] 1.02, 95% CI 0.93-1.12), clinical pregnancy rate (RR 1.16, 95% CI 0.87-1.53), and risk of ovarian hyperstimulation syndrome (RR 0.73, 95% CI 0.39-1.37). The quality of evidence was assessed as very low.
CONCLUSIONS
There is insufficient evidence for an effect of inositols on ovarian reserve markers and to support their use as pretreatment before IVF/ICSI in women with polycystic ovary syndrome.
Topics: Anti-Mullerian Hormone; Female; Fertilization in Vitro; Humans; Inositol; Ovarian Follicle; Ovarian Hyperstimulation Syndrome; Ovarian Reserve; Polycystic Ovary Syndrome; Sperm Injections, Intracytoplasmic
PubMed: 30993683
DOI: 10.1111/aogs.13625 -
Fertility and Sterility Apr 2018To assess the role of recombinant human LH (r-hLH) supplementation in ovarian stimulation for ART in specific subgroups of patients.
OBJECTIVE
To assess the role of recombinant human LH (r-hLH) supplementation in ovarian stimulation for ART in specific subgroups of patients.
DESIGN
Systematic review.
SETTING
Centers for reproductive care.
PATIENT(S)
Six populations were investigated: 1) women with a hyporesponse to recombinant human FSH (r-hFSH) monotherapy; 2) women at an advanced reproductive age; 3) women cotreated with the use of a GnRH antagonist; 4) women with profoundly suppressed LH levels after the administration of GnRH agonists; 5) normoresponder women to prevent ovarian hyperstimulation syndrome; and 6) women with a "poor response" to ovarian stimulation, including those who met the European Society for Human Reproduction and Embryology Bologna criteria.
INTERVENTION(S)
Systematic review.
MAIN OUTCOME MEASURE(S)
Implantation rate, number of oocytes retrieved, live birth rate, ongoing pregnancy rate, fertilization rate, and number of metaphase II oocytes.
RESULT(S)
Recombinant hLH supplementation appears to be beneficial in two subgroups of patients: 1) women with adequate prestimulation ovarian reserve parameters and an unexpected hyporesponse to r-hFSH monotherapy; and 2) women 36-39 years of age. Indeed, there is no evidence that r-hLH is beneficial in young (<35 y) normoresponders cotreated with the use of a GnRH antagonist. The use of r-hLH supplementation in women with suppressed endogenous LH levels caused by GnRH analogues and in poor responders remains controversial, whereas the use of r-hLH supplementation to prevent the development of ovarian hyperstimulation syndrome warrants further investigation.
CONCLUSION(S)
Recombinant hLH can be proposed for hyporesponders and women 36-39 years of age.
Topics: Adult; Embryo Transfer; Female; Fertility Agents, Female; Fertilization in Vitro; Humans; Infertility; Live Birth; Luteinizing Hormone; Middle Aged; Oocyte Retrieval; Ovulation; Ovulation Induction; Pregnancy; Pregnancy Rate; Recombinant Proteins; Risk Factors; Treatment Outcome
PubMed: 29653717
DOI: 10.1016/j.fertnstert.2018.01.003