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Growth hormone: in search of the Holy Grail for poor responders (or a felony)

      Growth hormone has been used as an adjunctive treatment in reproductive medicine for more than 25 years. Through its stimulation of hepatic production of insulin-like growth factor 1, growth hormone is thought to potentiate the action of follicle-stimulating hormone via folliculogenesis and granulosa cell differentiation (
      • Zhou P.
      • Baumgarten S.C.
      • Wu Y.
      • Bennett J.
      • Winston N.
      • Hirshfeld-Cytron J.
      • et al.
      IGF-I signaling is essential for FSH stimulation of AKT and steroidogenic genes in granulosa cells.
      ). There have been several retrospective and prospective studies over the years which have sought to identify a role for growth hormone in patients with polycystic ovaries, advanced maternal age, poor oocyte or embryo quality, and even thin endometria. Presently, growth hormone is most commonly used in the treatment of women classified as “poor responders.” A 2010 Cochrane Database review by Duffy et al. (
      • Duffy J.M.
      • Ahmad G.
      • Mohiyiddeen L.
      • Nardo L.G.
      • Watson A.
      Growth hormone for in vitro fertilization.
      ) suggested that adjuvant use of growth hormone in poor responders was associated with an increase in live birth and pregnancy rates (odds ratio [OR] = 5.39, 95% confidence interval [CI] = 1.89−15.35, and OR = 3.28, 95% CI = 1.74−6.20).
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      References

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        IGF-I signaling is essential for FSH stimulation of AKT and steroidogenic genes in granulosa cells.
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