The use of growth hormone in IVF

Introduction Since the introduction of IVF three decades ago, outcomes have steadily improved to the point where IVF units can now reliably offer most of their patients high implantation rates. Unfortunately, poor responders have not benefited to the same degree. This group of patients is still very difficult to manage and many strategies have been explored to improve their pregnancy rates. One such strategy is the use of growth hormone (GH) as an adjuvant for controlled ovarian stimulation (COH) during IVF treatment. Mode of action Growth hormone is a 191-amino acid, single-chain polypeptide. It is produced, stored, and secreted by the somatotroph cells in the anterior pituitary gland. The secretion of GH is principally under the control of two hypothalamic hormones. Growth hormone releasing hormone (GHRH) up-regulates the GH gene transcription and somatostatin has an inhibitory effect on the secretion of GH by the pituitary gland. Ghrelin, a gut-derived hormone, potentiates the release of GH by simultaneously facilitating the release of hypothalamic GHRH and inhibiting the action of somatostatin at the level of the pituitary [3].