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Abstract：
UNASSIGNED: To appraise the current randomized clinical trials (RCTs) for evidence of the association of growth hormone (GH) with improved outcomes in infertile women with diminished ovarian reserve (DOR) undergoing in vitro fertilization (IVF).
UNASSIGNED: Relevant RCTs published in Chinese or English were identified through a comprehensive search of nine databases from the period of database inception to April 20, 2023. We included trials investigating adjuvant GH during ovarian stimulation and reported the subsequent outcomes. The group with adjuvant GH treatment and the group without adjuvant GH treatment were set up as the trial and control groups, respectively. The quality of RCTs was measured according to the Cochrane Collaboration Handbook.
UNASSIGNED: Of the 579 studies initially identified, 10 RCTs comprising 852 infertile women with DOR were included. The GH dose of individual trials ranged between 3 and 5 IU/day. Overall, we judged the trials to be at high risk of bias in the blinding domain. Pooled results showed that GH was associated with an increased clinical pregnancy rate (RR = 1.63, 95%CI [1.31, 2.03], p < 0.0001) and a greater number of oocytes retrieved (MD = 0.91, 95%CI [0.47, 1.35], p < 0.0001). Favorable associations were also observed when ovarian stimulation was combined with GH therapy for improving the optimal embryos rate (RR = 1.84, 95%CI [1.30, 2.59], p = 0.0005) and the number of optimal embryos (MD = 0.28, 95%CI [0.08, 0.48], p = 0.005) along with reducing the cycle cancellation rate (RR = 0.46, 95%CI [0.24, 0.89], p = 0.02). Moreover, GH resulted in an increase in the fertilization rate (RR = 1.33, 95%CI [1.18, 1.50], p < 0.00001) and the embryo implantation rate (RR = 1.56, 95%CI [1.21, 2.01], p = 0.0006). In addition, there was a significant enhancement in estradiol levels (SMD = 1.18, 95%CI [0.46, 1.91], p = 0.001) and endometrial thickness (MD = 0.75, 95%CI [0.41, 1.09], p < 0.0001) on the day of hCG. With regard to the total number of days and total dose of gonadotrophins used, GH treatment was correlated with shorter days (MD = -0.26, 95%CI [-0.46, -0.06], p = 0.01) and lower dose (MD = -460.97, 95%CI [-617.20, -304.73], p < 0.00001) of gonadotrophins applied during ovarian stimulation. Furthermore, GH in conjunction with the GnRH antagonist protocol was more conducive to improving the number of oocytes retrieved when compared with the GnRH agonist protocol (p < 0.0001). Moreover, a notable association was also seen in IVF combined with GH more than or equal to 4.5 IU/day to increase the number of optimal embryos and estradiol levels on the day of hCG (p < 0.05).
UNASSIGNED: For infertile women with DOR undergoing IVF, adjuvant treatment with GH during ovarian stimulation protocols showed better clinical outcomes, shorter days and lower dosages of gonadotrophin required. Furthermore, well-designed RCTs are needed to verify our results in the future.
UNASSIGNED: https://www.crd.york.ac.uk PROSPERO (CRD42023421739).
UNASSIGNED: Relevant RCTs published in Chinese or English were identified through a comprehensive search of nine databases from the period of database inception to April 20, 2023. We included trials investigating adjuvant GH during ovarian stimulation and reported the subsequent outcomes. The group with adjuvant GH treatment and the group without adjuvant GH treatment were set up as the trial and control groups, respectively. The quality of RCTs was measured according to the Cochrane Collaboration Handbook.
UNASSIGNED: Of the 579 studies initially identified, 10 RCTs comprising 852 infertile women with DOR were included. The GH dose of individual trials ranged between 3 and 5 IU/day. Overall, we judged the trials to be at high risk of bias in the blinding domain. Pooled results showed that GH was associated with an increased clinical pregnancy rate (RR = 1.63, 95%CI [1.31, 2.03], p < 0.0001) and a greater number of oocytes retrieved (MD = 0.91, 95%CI [0.47, 1.35], p < 0.0001). Favorable associations were also observed when ovarian stimulation was combined with GH therapy for improving the optimal embryos rate (RR = 1.84, 95%CI [1.30, 2.59], p = 0.0005) and the number of optimal embryos (MD = 0.28, 95%CI [0.08, 0.48], p = 0.005) along with reducing the cycle cancellation rate (RR = 0.46, 95%CI [0.24, 0.89], p = 0.02). Moreover, GH resulted in an increase in the fertilization rate (RR = 1.33, 95%CI [1.18, 1.50], p < 0.00001) and the embryo implantation rate (RR = 1.56, 95%CI [1.21, 2.01], p = 0.0006). In addition, there was a significant enhancement in estradiol levels (SMD = 1.18, 95%CI [0.46, 1.91], p = 0.001) and endometrial thickness (MD = 0.75, 95%CI [0.41, 1.09], p < 0.0001) on the day of hCG. With regard to the total number of days and total dose of gonadotrophins used, GH treatment was correlated with shorter days (MD = -0.26, 95%CI [-0.46, -0.06], p = 0.01) and lower dose (MD = -460.97, 95%CI [-617.20, -304.73], p < 0.00001) of gonadotrophins applied during ovarian stimulation. Furthermore, GH in conjunction with the GnRH antagonist protocol was more conducive to improving the number of oocytes retrieved when compared with the GnRH agonist protocol (p < 0.0001). Moreover, a notable association was also seen in IVF combined with GH more than or equal to 4.5 IU/day to increase the number of optimal embryos and estradiol levels on the day of hCG (p < 0.05).
UNASSIGNED: For infertile women with DOR undergoing IVF, adjuvant treatment with GH during ovarian stimulation protocols showed better clinical outcomes, shorter days and lower dosages of gonadotrophin required. Furthermore, well-designed RCTs are needed to verify our results in the future.
UNASSIGNED: https://www.crd.york.ac.uk PROSPERO (CRD42023421739).
摘要：
■评估目前的随机临床试验（RCT），以证明生长激素（GH）与卵巢储备功能降低（DOR）的不孕妇女接受体外受精（IVF）的结局改善有关。
■从数据库开始到2023年4月20日，通过对9个数据库的全面搜索，确定了以中文或英文发布的相关RCT。我们纳入了研究卵巢刺激期间辅助性GH的试验，并报告了随后的结局。设GH辅助治疗组和非GH辅助治疗组作为试验组和对照组,分别。RCT的质量根据Cochrane协作手册进行测量。
■在最初确定的579项研究中，纳入10项RCT，包括852名患有DOR的不育妇女。个别试验的GH剂量范围为3至5IU/天。总的来说,我们判断这些试验在盲法领域存在高偏倚风险.汇总结果显示，GH与临床妊娠率增加有关（RR=1.63,95CI[1.31,2.03]，p<0.0001）和更多数量的卵母细胞（MD=0.91，95CI[0.47，1.35]，p<0.0001)。当卵巢刺激与GH治疗相结合以改善最佳胚胎率时，也观察到了有利的关联（RR=1.84,95CI[1.30,2.59]，p=0.0005）和最佳胚胎数量（MD=0.28，95CI[0.08，0.48]，p=0.005)，同时降低循环取消率(RR=0.46，95CI[0.24，0.89]，p=0.02)。此外，GH导致受精率增加（RR=1.33，95CI[1.18，1.50]，p<0.00001）和胚胎着床率（RR=1.56，95CI[1.21，2.01]，p=0.0006)。此外,雌二醇水平显着提高（SMD=1.18,95CI[0.46,1.91]，p=0.001）和子宫内膜厚度（MD=0.75，95CI[0.41，1.09]，p<0.0001）在hCG当天。关于使用促性腺激素的总天数和总剂量，GH治疗与较短的天数相关(MD=-0.26,95CI[-0.46,-0.06],p=0.01）和较低剂量（MD=-460.97，95CI[-617.20，-304.73]，p<0.00001）在卵巢刺激期间应用的促性腺激素。此外，与GnRH激动剂方案相比，GH与GnRH拮抗剂方案联合更有利于提高卵母细胞的回收数量（p<0.0001）。此外，在IVF联合GH大于或等于4.5IU/天的情况下,也发现了显著的相关性,以增加hCG当天的最佳胚胎数量和雌二醇水平(p<0.05).
■对于接受IVF的DOR不育女性，在卵巢刺激方案期间用GH辅助治疗显示出更好的临床结果，需要更短的天数和更低剂量的促性腺激素。此外，我们需要精心设计的RCT来验证我们的结果。
■https://www.crd.约克。AC.英国PROSPERO（CRD42023421739）。
■从数据库开始到2023年4月20日，通过对9个数据库的全面搜索，确定了以中文或英文发布的相关RCT。我们纳入了研究卵巢刺激期间辅助性GH的试验，并报告了随后的结局。设GH辅助治疗组和非GH辅助治疗组作为试验组和对照组,分别。RCT的质量根据Cochrane协作手册进行测量。
■在最初确定的579项研究中，纳入10项RCT，包括852名患有DOR的不育妇女。个别试验的GH剂量范围为3至5IU/天。总的来说,我们判断这些试验在盲法领域存在高偏倚风险.汇总结果显示，GH与临床妊娠率增加有关（RR=1.63,95CI[1.31,2.03]，p<0.0001）和更多数量的卵母细胞（MD=0.91，95CI[0.47，1.35]，p<0.0001)。当卵巢刺激与GH治疗相结合以改善最佳胚胎率时，也观察到了有利的关联（RR=1.84,95CI[1.30,2.59]，p=0.0005）和最佳胚胎数量（MD=0.28，95CI[0.08，0.48]，p=0.005)，同时降低循环取消率(RR=0.46，95CI[0.24，0.89]，p=0.02)。此外，GH导致受精率增加（RR=1.33，95CI[1.18，1.50]，p<0.00001）和胚胎着床率（RR=1.56，95CI[1.21，2.01]，p=0.0006)。此外,雌二醇水平显着提高（SMD=1.18,95CI[0.46,1.91]，p=0.001）和子宫内膜厚度（MD=0.75，95CI[0.41，1.09]，p<0.0001）在hCG当天。关于使用促性腺激素的总天数和总剂量，GH治疗与较短的天数相关(MD=-0.26,95CI[-0.46,-0.06],p=0.01）和较低剂量（MD=-460.97，95CI[-617.20，-304.73]，p<0.00001）在卵巢刺激期间应用的促性腺激素。此外，与GnRH激动剂方案相比，GH与GnRH拮抗剂方案联合更有利于提高卵母细胞的回收数量（p<0.0001）。此外，在IVF联合GH大于或等于4.5IU/天的情况下,也发现了显著的相关性,以增加hCG当天的最佳胚胎数量和雌二醇水平(p<0.05).
■对于接受IVF的DOR不育女性，在卵巢刺激方案期间用GH辅助治疗显示出更好的临床结果，需要更短的天数和更低剂量的促性腺激素。此外，我们需要精心设计的RCT来验证我们的结果。
■https://www.crd.约克。AC.英国PROSPERO（CRD42023421739）。
