P-439 Role of Growth hormone in increasing the endometrial receptivity in aged women with thin endometrium undergoing Frozen embryo transfer cycle

Abstract Study question Is there a role for Growth hormone in increasing the clinical pregnancy rate by increasing the endometrial receptivity in aged women with thin endometrium ? Summary answer Growth hormone significantly increases the clinical pregnancy rate by increasing the endometrial receptivity in aged women with thin endometrium What is known already Growth hormone is a peptide hormone secreted by anterior Pituitary gland. There is an age related decline in the production of growth hormone. In aged women, Growth hormone supplementation increases the oocyte development and oocyte competence, thereby increasing the number of mature oocytes retrieved and increasing the fertilization potential augmenting IVF success rate. Growth hormone promotes granulosa cell proliferation and cumulus cell functions Beneficial effects of growth hormone are exerted via IGF1 and Growth Hormone receptors (GHR). Similar Growth Hormone Receptors are identified in endometrium as well which can promote the endometrial proliferation and endometrial vascularity . Study design, size, duration This is a Case Control study involving 90 patients , aged > 40 years with thin endometrium. 45 participants in Treatment group received Growth hormone 4 IU SC every alternative days along with Hormone Replacement Therapy from day 2 till embryo transfer . 45 participants in Control group received only HRT. Women with Uterine anomalies , previously scarred uterus and Ashermann Syndrome were excluded . Study period extended from January 2023 to December 2024 . Participants/materials, setting, methods Patients with thin endometrium were included in this study - Endometrial thickness less than 7 mm after 15 days of Estradiol valerate therapy in a frozen embryo transfer cycle. Patients were allotted in Treatment and Control group based on personal choice after informed consent . Clinical pregnancy rate was the primary outcome analyzed . Endometrial thickness and endometrial vascularity were the secondary outcomes analyzed. Main results and the role of chance There were no significant differences in socio demographic characteristics between groups. Age , BMI , sperm factor and number of cancelled Frozen embryo transfer cycles were matched. All patients enrolled in this study had at least 1 cancelled Frozen Embryo Transfer cycle due to thin endometrium .Treatment group who received Growth hormone therapy had a clinical pregnancy rate of 66.6 % (30/45) documented by the presence of a gestational sac in uterine cavity in TVS, 20 days after embryo transfer whereas Control group had a clinical pregnancy rate of 46.6%(21/45) . Endometrial thickness on the day of start of progesterone and Endometrial vascularity on the day of embryo transfer were comparable between both groups and not significantly different . 12 patients in Treatment group and 9 patients in Control group underwent Oocyte donation cycles . Further follow up of pregnancy till delivery was not done - so miscarriage rate and live birth rate were not analyzed in this study . Limitations, reasons for caution Results need to be interpreted with caution because of limited sample size. Pre Implantation Genetic Diagnosis for Aneuploidy (PGD A ) was not done on all embryos that were transferred . Total dosage of Growth hormone used in treatment group differed slightly between patients . Wider implications of the findings Growth hormone being a mitogen positively can up regulate the mRNA coding genes for implantation promoting cytokines, which can benefit women with Recurrent Implantation Failure . Dosage , duration , Frequency and route of administration of growth hormone has to be standardized . Trial registration number Yes