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目的 研究生长激素（GH）预处理对卵巢储备功能减退（DOR）患者行体外受精/卵胞浆内单精子注射-胚胎移植技术（IVF/ICSI-ET）助孕临床结局的影响。方法 回顾性分析359例DOR患者行IVF/ICSI-ET助孕的临床资料，按照促排卵之前是否使用GH预处理及仅在促排卵过程中添加或不添加GH分成3组：促排卵前及促排卵过程中均未使用GH者为对照组（n=119）；促排卵前未使用GH预处理，但促排卵过程中添加GH 4 IU/d者为非GH预处理组（n=115）；促排卵前4～6周使用GH 2IU/d预处理，且促排卵过程中使用GH 4 IU/d者为GH预处理组（n=125）。观察比较3组患者基本资料、促排卵相关资料、胚胎情况及累积活产率（CLBR）。结果 (1) 3组患者女方年龄、男方年龄、不孕年限、体质量指数（BMI）、基础性激素水平、不同促排卵方案占比、HCG日内膜厚度、雌二醇（E2）、黄体生成素（LH）水平、每周期移植囊胚数差异均无统计学意义。(2) GH预处理组促性腺激素（Gn）使用总剂量、Gn总天数显著少于对照组与非GH预处理组（P<0.05）;GH预处理组获卵数、成熟卵子数、双原核（2PN）受精数、2PN卵裂数、可移植囊胚数、优质囊胚数、累积临床妊娠率、CLBR均显著高于对照组（P<0.05）；与非GH预处理组相比，GH预处理组可移植囊胚数、优质囊胚数、CLBR均显著增多（P<0.05）。(3)与对照组相比，非GH预处理组仅获卵数明显增多（P<0.05），但成熟卵子数、2PN受精数、2PN卵裂数、可移植囊胚数、优质囊胚数、累积临床妊娠率、CLBR差异均无统计学意义。结论 对于DOR患者，促排前使用GH预处理4～6周可以改善获卵数、胚胎质量，提高累积临床妊娠率、CLBR，改善体外受精胚胎移植助孕的临床结局。
Abstract：Objective To investigate the effect of growth hormone(GH) pretreatment on the clinical outcomes of in vitro fertilization/intracytoplasmic sperm injection-embryo transfer(IVF/ICSI-ET) in patients with diminished ovarian reserve(DOR).Methods A retrospective analysis was conducted on the clinical data of 359 DOR patients undergoing IVF/ICSI-ET. Based on the use of GH pretreatment before ovarian stimulation and/or its addition during the stimulation cycle, patients were divided into three groups: the Control group(n=119), receiving no GH pretreatment or addition; the Non-GH pretreatment group(n=115), receiving GH(4 IU/d) only during ovarian stimulation without pretreatment; and the GH pretreatment group(n=125), pretreated with GH(2 IU/d) for 4-6 weeks before stimulation and also receiving GH(4 IU/d) during stimulation. The basic characteristics, ovarian stimulation parameters, embryological data, and cumulative live birth rate(CLBR) were compared among the groups.Results(1) No significant differences were found among the three groups regarding female age, male age, duration of infertility, body mass index(BMI), basal hormone levels, distribution of ovarian stimulation protocols, endometrial thickness, serum estradiol(E2) and luteinizing hormone(LH) levels on the day of HCG trigger, or the number of blastocysts transferred per cycle.(2) The GH pretreatment group required significantly lower total gonadotropin(Gn) dosage and fewer days of stimulation than the Control and Non-GH pretreatment group(P<0. 05). Compared to the Control group, the GH pretreatment group showed significantly higher numbers of retrieved oocytes, the number of mature oocytes, 2-pronuclei(2 PN) zygotes, 2 PN cleaved embryos, transferable embryos, high-quality embryos, as well as higher cumulative clinical pregnancy rates and CLBR(P<0. 05). Compared to the Non-GH pretreatment group, the GH pretreatment group had significantly more transferable embryos, high-quality embryos, and a higher CLBR(P<0. 05).(3) Compared to the Control group, the Non-GH pretreatment group only had a significantly higher number of retrieved oocytes(P<0. 05), with no significant differences in the number of mature oocytes, 2 PN fertilized oocytes, 2 PN cleaved embryos, transferable blastocysts, high-quality blastocysts, cumulative clinical pregnancy rate, and CLBR.Conclusion For DOR patients, GH pretreatment for 4-6 weeks prior to ovarian stimulation can improve oocyte yield, embryo quality, cumulative clinical pregnancy rate, and CLBR, thereby enhancing the clinical outcomes of IVF/ICSI-ET.
[1]Jiao Z, Bukulmez O. Potential roles of experimental reproductive technologies in infertile women with diminished ovarian reserve[J]. J Assist Reprod Genet, 2021, 38(10):2507-17. doi:10. 1007/s10815-021-02246-6.
[2]Ipsa E, Cruzat V F, Kagize J N, et al. Growth hormone and insulin-like growth factor action in reproductive tissues[J]. Front Endocrinol, 2019, 10:777. doi:10. 3389/fendo. 2019. 00777.
[3]卵巢储备功能减退临床诊治专家共识专家组，中华预防医学会生育力保护分会生殖内分泌生育保护学组.卵巢储备功能减退临床诊治专家共识[J].生殖医学杂志，2022, 31(4):425-34. doi:10. 3969/j. issn. 1004-3845. 2022. 04. 001.[3]Expert Consensus Group on Clinical Diagnosis and Treatment of Ovarian Reserve Hypofunction, Reproductive Endocrinology and Fertility Protection Subgroup, Fertility Protection Branch of the Chinese Preventive Medicine Association. Consensus on clinical diagnosis and management of diminished ovarian reserve[J]. J Reprod Med, 2022, 31(4):425-34. doi:10. 3969/j. issn. 1004-3845. 2022. 04. 001.
[4]中国医师协会生殖医学专业委员会.人类卵裂期胚胎及囊胚形态学评价中国专家共识[J].中华生殖与避孕杂志，2022,42(12):1218-25. doi:10. 3760/cma. j. cn101441-20220619-00266.[4]Reproductive Medicine Committee of China Medical Doctor Association. Expert consensus on human embryo morphological assessment:cleavage-stage embryos and blastocysts grading criteria[J]. Chin J Reprod Contracept, 2022, 42(12):1218-25. doi:10. 3760/cma. j. cn101441-20220619-00266.
[5]Gardner D K, Lane M, Stevens J, et al. Reprint of:blastocyst score affects implantation and pregnancy outcome:towards a single blastocyst transfer[J]. Fertil Steril, 2019, 112(4Suppl1):e81-4. doi:10. 1016/j. fertnstert. 2019. 08. 077.
[6]Practice Committee of the American Society for Reproductive Medicine. Testing and interpreting measures of ovarian reserve:a committee opinion[J]. Fertil Steril, 2012, 98(6):1407-15.doi:10. 1016/j. fertnstert. 2012. 09. 036.
[7]Han L, Tian H, Guo X, et al. Regulation of ovarian function by growth hormone:potential intervention of ovarian aging[J]. Front Endocrinol, 2023, 13:1072313. doi:10. 3389/fendo. 2022. 1072313.
[8]Yang S, Luo W, Sun Y, et al. Novel perspectives on growth hormone regulation of ovarian function:mechanisms, formulations,and therapeutic applications[J]. Front Endocrinol, 2025, 16:1576333. doi:10. 3389/fendo. 2025. 1576333.
[9]Slot K A, Kastelijn J, Bachelot A, et al. Reduced recruitment and survival of primordial and growing follicles in GH receptor-deficient mice[J]. Reproduction, 2006, 131(3):525-32. doi:10. 1530/rep. 1. 00946.
[10]Xu Z, Tong W, Yang Z, et al. Comparative efficacy of different growth hormone supplementation protocols in improving clinical outcomes in women with poor ovarian response undergoing assisted reproductive therapy:a network meta-analysis[J]. Sci Rep, 2024, 14(1):3377. doi:10. 1038/s41598-024-53780-z.
[11]Chen J, Kong X, Luan Z, et al. The effects of growth hormone on the outcomes of in vitro fertilization and embryo transfer in agegrouped patients with decreased ovarian reserve:a prospective cohort study[J]. Front Endocrinol, 2025, 15:1457866. doi:10. 3389/fendo. 2024. 1457866.
[12]Li H X, Ma X L, Zhang L L, et al. 4D quantitative proteomics of ovarian granulosa cells reveals the involvement of oxidative phosphorylation in non-elderly women with diminished ovarian reserve[J]. J Ovarian Res, 2025, 18(1):104. doi:10. 1186/s13048-025-01688-1.
[13]Gong Y, Luo S, Fan P, et al. Growth hormone alleviates oxidative stress and improves oocyte quality in Chinese women with polycystic ovary syndrome:a randomized controlled trial[J]. Sci Rep, 2020, 10(1):18769. doi:10. 1038/s41598-020-75107-4.
[14]Luo Y Y, Zeng X, Zhu L, et al. Growth hormone reduces aneuploidy and improves oocytes quality by JAK2-MAPK3/1 pathway in aged mice[J]. J Transl Med, 2023, 21(1):426. doi:10. 1186/s12967-023-04296-z.
[15]Chang C W, Sung Y W, Hsueh Y W, et al. Growth hormone in fertility and infertility:mechanisms of action and clinical applications[J]. Front Endocrinol, 2022, 13:1040503. doi:10. 3389/fendo. 2022. 1040503.
[16]Liu Y, Ding F, Yang Y, et al. Growth hormone improves the pregnancy outcomes in poor ovarian responders undergoing in vitro fertilization:an umbrella review[J]. J Assist Reprod Genet,2025, 42(3):721-36. doi:10. 1007/s10815-025-03389-6.
[17]Zakerinasab F, Behfar Q, Parsaee R, et al. The effects of growth hormone supplementation in poor ovarian responders undergoing in vitro fertilization or Intracytoplasmic sperm injection:a systematic review and meta-analysis of randomized controlled trials[J].Turk J Obstet Gynecol, 2024, 21(3):208-18. doi:10. 4274/tjod. galenos. 2024. 59944.
[18]Sood A, Mohiyiddeen G, Ahmad G, et al. Growth hormone for in vitro fertilisation(IVF)[J]. Cochrane Database Syst Rev, 2021,11(11):CD000099. doi:10. 1002/14651858. CD000099. pub4.
[19]Liu F T, Hu K L, Li R. Effects of growth hormone supplementation on poor ovarian responders in assisted reproductive technology:a systematic review and meta-analysis[J]. Reprod Sci,2021, 28(4):936-48. doi:10. 1007/s43032-020-00298-0.
[20]Cai M H, Gao L Z, Liang X Y, et al. The effect of growth hormone on the clinical outcomes of poor ovarian reserve patients undergoing in vitro fertilization/intracytoplasmic sperm injection treatment:a retrospective study based on POSEIDON criteria[J]. Front Endocrinol, 2019, 10:775. doi:10. 3389/fendo.2019. 00775.
[21]史晓雨，潘宁宁，马彩虹.生长激素预治疗对卵巢储备功能低下患者IVF/ICSI-ET助孕结局的影响[J].中华生殖与避孕杂志，2023, 43(8):820-4. doi:10. 3760/cma. j. cn101441-20220403-00142.[21]Shi X Y, Pan N N, Ma C H. Effect of growth hormone pretreatment on IVF/ICSI-ET assisted pregnancy outcomes in patients with poor ovarian reserve[J]. Chin J Reprod Contracept, 2023,43(8):820-4. doi:10. 3760/cma. j. cn101441-20220403-00142.
基本信息:
DOI：10.19405/j.cnki.issn1000-1492.2026.08.019
中图分类号:R714.8
引用信息:
[1]韩丹,徐祖滢,汪诗羽,等.生长激素预处理对卵巢储备功能减退患者IVF/ICSI-ET临床结局的影响[J].安徽医科大学学报,2026(08):1472-1477.DOI:10.19405/j.cnki.issn1000-1492.2026.08.019.
基金信息:
国家重点研发计划课题(编号:2022YFC2703001); 安徽省高校优秀科研创新团队项目(编号:2022AH010072)
2026-07-20
2026-07-20
2026-07-20