Did your IVF protocol not go the way you wanted?
It's clear that IVF works better if you produce multiple eggs.
Fertility medications are required during IVF to stimulate the maturation
of multiple eggs in the ovaries. Some medications are used commonly like those
containing FSH. You may have heard however that some
doctors use growth hormone to stimulate the ovaries. Is this
something you should consider? Stay tuned.
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To understand the use of growth hormone in IVF
it's important to first understand how eggs mature in the ovaries.
Each egg in the ovaries is surrounded by cells
The egg in the surrounding cells together is called a follicle.
Follicle cells have receptors on the surface which react to hormones.
As an egg matures, the number of receptors
change and the type of receptors change, Before the egg starts maturing, the main
type of hormone receptor responds to FSH. FSH injections are
critically important during the first several days of stimulating the ovaries.
As the egg matures, the follicle enlarges and fills with fluid
and the number of FSH receptors decreases.
Larger follicles start to accumulate receptors for LH
Therefore, injections of FSH are less important after the first few days of stimulation.
This is why doctors will also use
medications that contain LH or hCG which can both work through
those LH receptors. IVF protocols containing
FSH and LH or FSH and hCG will work adequately to
stimulate the ovaries of most women during IVF. Some women, however,
don't seem to do very well with these hormones. Some women
don't respond very well to fertility medications and only produce a few eggs.
Other women produce eggs that seem to be of poor quality and as a result
don't produce good quality embryos. For patients like these,
doctors have looked at using growth hormone as a third medication to
stimulate the ovaries. Like FSH and LH, growth hormone is
normally produced in the pituitary gland. The follicle cells have receptors for
growth hormone, just like they have receptors for
FSH and LH. In addition to working directly on growth hormone receptors,
growth hormone might also work indirectly by
improving how the follicles respond to FSH and LH.
IVF doctors have studied whether adding growth hormone to the stimulation
protocol would help with some of these problem patients.
I'm going to focus on women who don't make very many eggs. Doctors call
this group of women "poor responders". There has been more
research about the use of growth hormone in IVF poor responders
than any other group. Recently, an analysis
looked at 12 high quality studies that had been done
using growth hormone for IVF poor responders.
Here's what they found. IVF poor responders using growth hormone were
able to increase the total number of eggs retrieved by about 66%!
While this sounds impressive, consider this:
By definition, poor responders produce very few eggs.
In the studies reviewed, the average number of eggs obtained in IVF cycles
without growth hormone was between 4 and 5. With growth
hormone, the average was in the 5 to 7 range.
So even if growth hormone works for you, you should not be expecting to see a
huge difference. Are these extra eggs usable? That brings
us to conclusion number two: The data showed that the extra eggs
produced by using growth hormone were mature eggs that could be used to
try to fertilize. In fact, the study showed that growth
hormone users would average about twice as many mature eggs. That's great!
Third, growth hormone increased the number of embryos available for an
embryo transfer, but again, it wasn't a lot. There was on average
less than one extra embryo for transfer
How can you have less than one extra embryo? Remember that we're talking
about groups here. If you had a group of five women and
they all produced an extra embryo that would be an average of one extra
embryo for the group. If you had five women and three produced
an extra embryo but the other two did not
then the group average would have increased by 0.6
or less than one embryo. This is important!
It means that not all poor responders will produce more embryos using growth
hormone. Finally, this review of available studies
did not find that the chance for pregnancy or live birth
was higher in the women who used growth hormone. Why not?
If growth hormone users produced more
eggs, more mature eggs and had more embryos for transfer
should there have been more pregnancies? It's important to understand that not
all of the studies reported pregnancy rates and even less reported live birth
rates. It's possible that there was a benefit to using growth hormone
but the available studies were too small to detect it.
It's also possible that growth hormone is simply ineffective
at increasing the live birth rate. At this point, we don't know for sure.
One final thing to understand about growth hormone before you consider
adding it to your IVF protocol. It is expensive! For a single IVF attempt
using growth hormone would add a few thousand dollars in medication costs!
Even if you are lucky enough to have IVF insurance coverage,
growth hormone still may not be covered. Our InfertilityTV bottom line is this:
If you are an IVF poor responder adding growth hormone to your medication
protocol may increase the number of eggs, mature eggs
and embryos that you make - a little. Whether it improves your
chances for taking home a baby is still uncertain. The cost is high and
it means giving an additional injection to yourself every day
but other than that, there does not appear to be any downside to trying.
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