生長激素``要~~~怎麼打~~~才有效？

生長激素要怎麼打才有效？1 2346 7 9 10 11

生長激素growth hormone（GH）發現可以增加卵泡對於gonadotropins的反應性，促進卵泡的形成（folliculogenesis）. GH部分是透過肝臟所產生的Insulin-like growth factor 1(IGF-1)來作用。此外，過去的研究，發現排卵誘發卵泡內的各種荷爾蒙濃度，若是卵泡內具有較高濃度的生長激素growth hormone（GH）則與卵子的成熟度，胚胎的型態上與之後的著床能力有一致性正面關係。 接續下來很自然產生的想法：在排卵刺激的同時給予GH在對抗隨著年齡上升導致的卵子品質下降能有效

GH 在 previous poor responders的病人發現對於活產率有顯著的改善




(1) Tesarik J 等人針對40歲以上的婦女所做的prospective randomize 研究 ，在gonadotrophin治療的第七天固定每天皮下給予8 IU的GH治療，這組的病人在取卵數、 胚胎數與懷孕率與placebo 組比較差不多，但是給予GH的群組有較少的懷孕losses數，所以有較高的delivery rate 及活產率。這些病人有較高的serum E2 濃度且在pre-ovulatory 卵泡液中有較高的GH及E2濃度。 結論在於：在排卵刺激的同時給予GH可以減低隨著年齡上升導致的人工生殖技術效率的下降，這個效果主要是由於改善卵子發展潛力（development potential ），但也有可能GH是作用在子宮上面。




(2) Kucuk T 在2008年prospective randomize則是針對Poor responder women接受再一次試管嬰兒療程時，同時給予GH（且在前一黃體期day21就給予）與傳統的長方程比較，可以獲得較多的卵子，較高的受精率 臨床懷孕率




(1)
Kucuk et al. (Journal of Assisted Reproduction and Genetics, 2008) conducted a prospective, randomized study to determine the efficacy of GH co-stimulation with the long luteal gonadotropin releasing hormone analogue (GnRHa) regimen, in 61 IVF patients who responded poorly to controlled ovarian hyperstimulation (COH) in their first cycles. Among them, 31 subjects were co-stimulated with daily subcutaneous injections of 4 mg GH, from day 21 of the previous cycle (in conjunction with GnRHa) till the day of human chorionic gonadotropin (hCG) administration. Similar treatment protocol without the administration of GH was followed in the controls (n=30).
In conclusion, this prospective randomized study shows that women aged more than 40 years undergoing assisted reproduction treatment and co-stimulated with GH achieve more ongoing pregnancies and suffer less pregnancy wastage, resulting in more deliveries and live births, as compared with women of the same age category stimulated with gonadotrophins alone. Further study is needed to determine the mechanism of this effect.




(2)
Improvement of delivery and live birth rates after ICSI in women aged more than 40 years by ovarian co-stimulation with growth hormone
Jan Tesarik1,2,5, André Hazout3 and Carmen Mendoza1,4
1 MAR&Gen, Molecular Assisted Reproduction and Genetics, Gracia 36, 18002 Granada, Spain, 2 Laboratoire d'Eylau, 55 rue Saint-Didier, 75116 Paris, 3 ARCEFAR, 15 rue Faraday, 75017 Paris, France and 4 University of Granada, Campus Fuentenueva, 18004 Granada, Spain




resulting in a higher clinical pregnancy rate (26 versus 6%;

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