Update on Human Growth Hormone (HGH) Use in Female Fertility

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Dr. Norbert Gleicher

Human growth hormone (HGH) increasingly appears to be yet another “fashion of the moment,” as more and more IVF centers use it almost as a routine. It used to be rare to see patients who had been on HGH during their cycles; now, it happens almost every day. What makes this evolving practice appear rather peculiar is the fact that nothing has appeared in the literature to suggest that HGH really makes any difference in IVF outcomes.

We recently addressed the utilization of HGH in IVF, pointing out that adequate studies that would support routine HGH use in IVF are mostly lacking. Existing literature suggests, and does so with only relatively weak evidence, that HGH supplementation in women with very small oocyte yields may marginally improve egg numbers. Currently, however, there is absolutely no evidence that HGH improves IVF pregnancy and live birth chances.

Absence of evidence, of course, does not necessarily mean absence of positive effects on IVF outcomes. It, indeed, appears reasonable to assume that more eggs will result in more embryos and more embryos in better pregnancy and live birth rates. After all, after maternal age, number of available embryos for transfer represents the second most important positive predictor of pregnancy and live birth chances in IVF. But a good hypothesis does not replace evidence and, especially since HGH is quite expensive, one has to wonder about the sudden explosion in HGH utilization in IVF practice, with not even animal data being available to support its routine use.

How to use HGH in IVF cycles

What make this surge in utilization further suspicious is how HGH is used. Colleagues who prescribe HGH to their patients, quite obviously, often do not know why they prescribe it and, therefore, how to prescribe it. In almost all these cases, HGH supplementation is given just during IVF cycle stimulation. Only rarely, supplementation may be started 1-2 weeks before cycle start. Yet, HGH acts through IGF-1, produced in the liver, and this action, like androgen supplementation, is synergistic to FSH activity on granulosa cells (and, therefore, follicle growth) primarily at small growing follicle stages up to small pre-antral follicles.

Like in androgen supplementation, the follicles that benefit from HGH supplementation still require at least 6-8 weeks before they reach the gonadotropin-dependent stage and, therefore, become available in an IVF cycle. Practically, this means that HGH supplementation, like androgen supplementation, must be started at least 6-8 weeks before IVF cycle start. Supplementing with HGH only during IVF cycles or starting just 1-2 weeks before a cycle start, therefore, is unlikely to yield the intended results.

Watch Dr. Barad explain the HGH clinical trial at CHR.

It is also unknown how much HGH should be given on a daily basis. Following published formulas, CHR prescribes between 3-6 IU s.c. per day for at least 8 weeks prior to IVF cycle start. CHR is currently conducting a registered clinical trial of HGH supplementation, but progress has been slow because women are understandably hesitant to be randomized. If patients do not wish to be randomized, they have the option of receiving HGH off-label under an experimental consent.

Who may benefit from HGH for IVF

Though physicians at CHR routinely utilize HGH in selected patients, only a small minority of CHR’s patients receive this treatment. Furthermore, it is usually only as last resort in attempts to improve egg numbers. Besides costs, side effects are another reason for cautious utilization. The two most frequent side effects of HGH we have observed have been edema (swelling) in feet and hands and joint pain. Both usually respond quickly to lower dosing of HGH and/or discontinuation of the medication. Fully informed consent, therefore, should be an absolute prerequisite for the utilization of HGH in female infertility.

This is a part of the January 2020 CHR VOICE.

I discovered your clinic when I was at my lowest. I happened on a video on your you tube channel titled, "The burning out pcos." Just that video gave me much needed hope and direction because I couldn't get a diagnosis of why I was cold, lethargic and weak. I decided to become a patient for my fertility problems and fortunately I could consult online. Extending help internationally is really helpful. It is not easy to find this calibre, everywhere. I was 43 when I told Dr Gleicher I couldn't afford to travel there to do my IVF. He made sure he gave me some nuggets of wisdom to go with. For one, he insisted that my numbers showed I could have a child using my own eggs, like I wanted. The one clinic in my country doubted I could have a child in my late 30s. Another clinic in another country in the region would not even consult with me because I was 43 and not willing to use donor eggs. Another was willing to take me on but we had 2 failed IVF cycles. They also recommended donor eggs. I'm happy to share that I conceived naturally at 45 and I am looking at a perfectly healthy 5 month old baby boy. May the good Lord bless you and your work. You are truly doing the work of God. I could withstand the pressure to take donor eggs because you were very clear that my desire was possible. Congratulations and best wishes!

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Beautiful treatment and kindness. The Dr and front desk staff are incredible. Dr.B is someone special experienced beyond most practitioners .I highly recommend the continuity of treatment and the support is sacred. There is no such thing as NO anything is possible when it comes to your miracle @ CHR Thank you!

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The reception staff was kind and attentive, and Miss Ludmila and Dr. Barad were wonderful: kind, professional, thorough, and made things very comfortable.

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I have been blessed to find CHR on my journey. If anyone is lucky to find the clinic they will be surrounded not only by the greatest medical knowledge and research when it comes to IVF but a group of amazing professional.Everyone I have met there is just genuinely kind, professional and so helpful. I cannot say enough great things about CHR and the only way to know what I'm talking about is to give them a chance. Thank you CHR

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