Growth Hormone for Fertility Helps Poor Responders
Many times, women labeled as poor responders end up turning to donor eggs as the only option for getting pregnant. However, there are some treatments being tried by various infertility specialists that may help allow these women to attempt pregnancy utilizing their own eggs.
Typically, poor responders share these characteristics:
- They require increased dosing of gonadotropin therapy.
- They have poor ovarian reserve testing (i.e. increased FSH, low AMH).
- They are older in age (greater than 38).
These women may have previously attempted IVF cycles which failed to result in pregnancy or were cancelled due to lack of response to medication. There are of course exceptions to this rule in that even younger women may exhibit poor response to medication despite normal testing or may have premature ovarian failure.
Many different types of stimulation protocols have been proposed for poor responders. Some use additional medications in the hope of making the ovaries more sensitive to gonadotropins.
Growth Hormone May Help Diminished Ovarian Reserve Patients
One such medication is growth hormone. The potential benefits of combining growth hormone (GH) with ovarian stimulation were first reported 20 years ago.
Despite this, for a variety of reasons – including limited human data, no approval by the FDA, and high cost as the drug is not covered by insurance for IVF – the treatment has failed to gain widespread use despite small studies that suggest that supplementation may be beneficial.
The benefits of co-treatment of growth hormone (GH) supplements with ovarian stimulation were first reported 20 years ago. The treatment has failed to gain widespread use despite studies that suggest that supplementation can be beneficial.
GH is believed to help with oocyte maturation and improved egg quality. In animal studies, supplementation of GH caused an increase in Insulin-like growth factor 1 and 2 (IGF-1 and IGF-2) which are both believed to play a major role in maturation. It is also speculated that GH may be able to reverse age-related changes in the egg by increasing the capacity to repair DNA.
As the woman ages, her eggs do as well and aging can cause a weakness in the spindle apparatus in the egg along which chromosomes line up to divide following fertilization. When the spindle fails, as the fertilized egg begins to divide, chromosome may not distributed evenly . Instead of a pair of chromosomes going to each cell, three chromosomes may go into one cell, while one chromosome goes to the other. This results in an abnormal genetic makeup of the embryo which is either not compatible with life or may cause birth defects or genetic disorders such as trisomy 21, otherwise known as Down’s syndrome.
By administering GH to women who are poor responders, we may be able to minimize the effect that age has on the outcomes of ART and pregnancy rates. In studies of GH supplementation, it appears that pregnancy rates increase as well as live birth rates in women who are of advanced maternal age (greater than 35).
GH administration is not expected to increase the response to medication. However the eggs retrieved using ART with GH supplementation may be of higher quality than in women with similar protocols lacking GH supplements.
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