One of the greatest challenges that we face in treating couples with infertility, is what options to offer beyond the typical treatment protocols. Clearly, most of our patients are well served with the basic ovarian stimulation methods but in some patients that may exacerbate or simply ignore an underlying hormone imbalance that’s compromising success rates. Therefore, one of the greatest challenges is to figure out how and when to tweak the typical combination of meds in order to shift the hormone balance back to a more favorable outcome. This is the reason that we should now reconsider the use of human growth hormone (hGH) for patients that have failed previous IVF treatment.
I trained under Dr. David Meldrum at UCLA-Harbor Medical Center in Los Angeles. Back in the early 1990’s he was advocating the consideration of adding hGH to the protocol of certain patients. His reasoning was good. First of all, we know from previous research [u1] that healthy developing eggs produce a growth hormone analogue known as IGF-2. Better still, other studies [u2] have demonstrated that hGH could possibly increase the ability of eggs to repair damaged DNA. Finally, several studies have found that growth hormone can improve the response of the ovaries to stimulation during an IVF cycle. Given that all of this information has been available for quite some time, it may be surprising to a patient that there hasn’t been wider use of hGH during IVF treatment. Recently, Dr. Meldrum and several other experts [u3] suggested that this was because there remained too much confusion amongst specialists on which patients would benefit from the use of this somewhat expensive but also possibly game-changing hormone.
The good news is that recent studies [u4] have more carefully defined the characteristics of the patients that were receiving hGH. As a result, we have some new data to better guide us as to which women may be most likely to benefit from hGH. Here is a summary of what they found:
- In women >40 years of age, they found a higher implantation rate and better on-going pregnancy rate in women treated with hGH during ovarian stimulation.
- In women that are poor responders to ovarian stimulation—defined as three or fewer eggs produced per IVF cycle—there was a marked improvement in pregnancy rate with growth hormone supplementation. They also found an improved outcome in FET cycles from embryos created during these cycles.
- In women that have poor embryo quality and low pregnancy rate in otherwise encouraging ART cycles, there is not be a clear benefit of using growth hormone. Instead, other causes of poor embryo quality should be explored. Once those have all been addressed, reconsideration of hGH is worthwhile.
Robert Greene, MD, FACOG
Enhancing Fertility 
I have been TTC for 4 years and have had 4 miscarriages. I’m 32. Undiagnosed septate uterues fixed in 12/12. The 3rd miscarriage my chromosomes test was ok and thats when we found the septate uterus. I just miscarried my 4th and are waiting results but my RE said with a low heart beat found in u/s that he is very sure that this was chromosomal. My FSH level is 16. My AMH level is .58. I realize i have a very, very SLIM chance to conceive and have a live birth.
My question for you is HGH in Natural cycle to build better egg quality/quantity. I’m already on CQ10, DHEA, and I’m curious about what you think HGH would do in a case like me.
Dear Amy,
I am so sorry to learn of all that you have been through. Unfortunately, I do not have nearly enough information to provide specific advice or guidance on your specific treatment course. This would be a worthwhile discussion for you to have with your reproductive endocrinologist. You should be able to provide them with copies of the studies that I have linked in this blog post to foster your discussion. If that does not go well, consider arranging a consultation with another center for a second opinion. In the process, if I can assist in any way please let me know.
Best thoughts,
~Robert
Robert Greene, MD, FACOG
CNY Fertility Center
Please provide the references for
In women >40 years of age, they found a higher implantation rate and better on-going pregnancy rate in women treated with hGH during ovarian stimulation.
In women that are poor responders to ovarian stimulation—defined as three or fewer eggs produced per IVF cycle—there was a marked improvement in pregnancy rate with growth hormone supplementation. They also found an improved outcome in FET cycles from embryos created during these cycles.
In women that have poor embryo quality and low pregnancy rate in otherwise encouraging ART cycles, there is not be a clear benefit of using growth hormone. Instead, other causes of poor embryo quality should be explored. Once those have all been addressed, reconsideration of hGH is worthwhile.
There are four references attached to the blog post and each has many more links to other studies. Just checked and I can see and access the references. Please scroll down to see if you can as well.
Best thoughts,
~Robert
Robert Greene, MD, FACOG
CNY Fertility Center
Dr. Greene,
I’m curious about your thoughts regarding ongoing HCG boosters post transfer? In my particular case it would be post FET.
Thanks so much!
Denise
Dear Denise,
There is no simple rule to most of our treatments. Each situation warrants a consideration of the potential risk in a specific case vs. the potential benefit. In fresh cycles, the use of hCG post transfer can increase the risk of Ovarian Hyperstimulation Syndrome. This is not a significant concern post FET. Then again, I am not convinced that there is a mesasureable benefit for most patients going through treatment. That however is a conversation that is best between you and your doctor since they are most familiar with your entire history. I hope that this is helpful.
Best thoughts,
~Robert
Robert Greene, MD, FACOG
CNY Fertility Center
Can human growth hormone help with implantation during and after FET? I have repeat implantation failure and my RE has given me an endometrial scratch, I will be taking heparin and prednisolone on this FET but I wonder if whether i should suggest adding HGH around the time of transfer would help improve Implantation as well? Any thoughts on this please?
Dear Angela,
There is no evidence that hGH can bolster implantation. The rationale for it’s use during egg recruitment and development is to foster repair of subtle genetic damage. Trying to correct such problems after blastocyst formation is beyond the theory and the data available. Sorry that this does not seem to be a helpful. That said, do not assume that your frozen embryos need any help either. Remain cautiously optimistic.
Best thoughts,
~Robert
Robert Greene, MD, FACOG
CNY Fertility Center
Thank you for your quick and informative response. Mt AF came today and so the FET cycle has started and I’m 21 days or less from transfer! My thinking wasn’t regarding improving egg quality, it was more about aiding the endo scratch with HGH to help new cell growth and cytokines in the implantation process, I kinda wondered if there was any evidence to support it helping my uterus rather than the embryos! I have 2 day 6 blasts, 1 hatching and 1 expanded, I’m quite excited about those little ones + hope they thaw (frozen by vitrification). I also hope the fact that my body hasn’t been through the retrieval process will help along with the medication. Do you know of any research with regards to using HGH to aid the new cell growth after an endometrial scratch? I know the process is very new, I just like to equip myself with every bit of sound information and advice that I can! The journey my husband and I have been on has been a long one yet has strengthened our relationship! Thank you for your time once again. Angela
I am not aware of any studies investigating your query. You may wish to consider requesting INTRALIPID therapy. There is some evidence that this can help augment pregnancy rates in women with a history of “implantation failure.” You can read more about this on the post titled “Neither High Fat nor Low Fat but the RIGHT Fat.”
Best to you,
~Robert
Robert Greene, MD, FACOG
CNY Fertility Center