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Harper K, Proctor M, Hughes E
Cochrane Database of Systematic
Reviews 2003, Issue 3. Art. No.: CD000099. DOI: 10.1002/14651858.CD000099
The purpose of this review was to assess the effectiveness of GH or
growth hormone releasing (GRF) adjuvant therapy, primarily in terms of
improving live birth rate, for women undergoing ovulation induction prior to
in vitro fertilization (IVF), in both patients with a history of poor
response and those with no previous history of poor response. Growth hormone
(GH) therapy is sometimes used in women who do not produce enough follicles
in their ovaries. This aims to reduce the use of gonadotropin therapy to
stimulate ovulation, a hormone that can cause multiple pregnancy.
This review analyzed randomized controlled clinical trials which
were identified from a search of the Cochrane Menstrual Disorders and
Subfertility Group's trials register, the Cochrane Central Register of
Controlled Trials, MEDLINE, EMBASE, Biological Abstracts and reference lists
of articles. The reviewers assessed studies for methodological quality and
extracted data from nine studies that addressed the research question and
provided outcome data for intervention and control subjects.
The studies included 401 couples. Six of the trials investigated a
total of 302 women, who had been previous poor responders to in vitro
fertilization. In this group there were no significant differences in live
birth when combining trials of GH and GRF. When trials using GH alone were
analyzed separately there was an increase in live births. The other three
trials investigated 91 women, with no history of poor response to IVF and
there was no evidence that routine use of GH affected the outcome of live
birth. There were no significant differences in any adverse events, but
these were poorly and inconsistently reported.
The review of trials found no evidence that growth hormone helps
improve birth rates in women who are undergoing ovulation induction prior to
IVF. However, there is some evidence of increased pregnancy and birth rates
in women who have a history of poor response to IVF. Due to the limited data
available GH should only be considered in the context of a clinical trial.