Growth Hormone (Omnitrope) for IVF: Does it Improve Your Chance for Success?
Omnitrope Growth hormone for IVF? Should you be using it? What does the evidence say?
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?
Understanding how eggs and follicles develop in the ovaries
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.
FSH Receptors in the ovary and Use of FSH injections
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.
LH receptors in the ovary and Use of LH or hCG injections
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.
IVF poor responders
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.
Growth hormone as a 3rd IVF medication. How does it work?
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.
IVF Growth hormone studies
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.
Effect on number of eggs retrieved
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 the extra eggs obtains 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!
Do you get more embryos for transfer?
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.
Do couples who use Growth hormone for IVF have higher pregnancy rates?
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.
What is the cost of growth hormone for IVF?
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 bottom line
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.