(19) Somatotropin Administration During In-Vitro Fertilization (IVF) Stimulation Was Associated With Improved Euploid and Transferable Embryo Yield But Was Not Significant When Matched to Controls

Patricia Xu1; Kaleb Noruzi1; Sarah Rubin1; Alexa Setteducate1; Alexis Greene2; Martin D. Keltz1,2
1. School of Medicine, New York Medical College, Valhalla, United State
2. WestMed Reproductive Services, Purchase, United States
 

Abstract Text:

Several studies have found that somatotropin supplementation is associated with increased retrieved oocytes, higher proportion of metaphase II oocytes, improved embryo quality, enhanced endometrial thickness, higher live birth rates, and lower cycle cancellation rates. However, to our knowledge, there have been no studies investigating the effect of somatotropin on IVF outcomes that exclusively included low prognosis patients with one or zero euploid embryos yielded in a prior cycle. Our study aims to assess the impact of somatotropin on IVF outcomes in patients with fewer than two euploid embryos yielded in an initial IVF cycle when compared to a matched control group.

We conducted a single-institution case-control study including patients between 2018 and 2024 who underwent freeze-all preimplantation genetic testing for aneuploidy IVF cycle yielding fewer than two euploid embryos within a year of a subsequent cycle without change in protocol or intervention besides somatotropin. We compared outcomes of patients who received somatotropin in their second cycles to those who had no change in their IVF protocol between their first and second cycles. Somatotropin was administered by daily subcutaneous injection of 1.25 mg, equivalent to 4 IU, for 10 days starting on day one of ovarian stimulation.

The primary outcome was the yield of transferable embryos per cycle, defined as the sum of euploid and transferable mosaic embryos. Secondary outcomes were yield of blastocysts and euploid embryos. First and second cycle outcomes in each group were compared with paired t-tests or Wilcoxon signed-rank tests. To compare outcomes of the somatotropin and control groups, a delta was calculated as the difference in outcomes between cycles for each group and compared with Wilcoxon rank-sum test. Gamma regression was performed to adjust for age.

36 patients received somatotropin and 338 patients were included as controls. The somatotropin group was older than the control group (39.7±3.0 vs 38.2±3.9, p=0.008), but there was no difference in anti-mullerian hormone level (1.6±1.5 vs 1.9±1.8 ng/mL, p=0.4), or total gonadotropin dose in the first cycle (5376 vs 5307 IU, p=0.8) or second cycle (5248 vs 5289 IU, p=0.9). 

After somatotropin treatment, blastocyst (1.4±1.5 to 2.3±2.5, p=0.05), euploid (0.1±0.3 to 0.7±1.3, p=0.009), and transferable embryo (0.2±0.4 to 0.7±1.3, p=0.03) yield increased. In patients with anti-mullerian hormone ≥ 1 ng/ml, blastocyst (2±1.7 to 3.7±2.9, p=0.04), euploid (0.2±0.4 to 1.3±1.7, p=0.01), and transferable embryo (0.3±0.5 to 1.3±1.7, p=0.02) yield increased. In patients with anti-mullerian hormone < 1 ng/ml, there was no change in blastocyst (0.7±0.9 to 0.9±1, p=0.7), euploid (0.06±0.2 to 0.06±0.2, p=1), or transferable embryo yield (0.1±0.3 to 0.1±0.3, p=1).

The control group had a significant increase in blastocyst (1.7±1.6 to 2.5±2.5, p</span> < 0.001), euploid (0.3±0.4 to 0.9±1.3, p</span> < 0.001), and transferable embryo (0.5±0.7 to 1.2±1.6, p</span> < 0.001) yield. 

When comparing the delta of outcomes between somatotropin and control groups, there was no difference in yield of blastocyst (0.9±2.6 vs 0.8±2.3, p=1), euploid (0.6±1.4 vs. 0.6±1.3, p=0.6), or transferable embryos (0.5±1.4 vs. 0.7±1.6, p=0.5) after adjusting for age at every anti-mullerian hormone level.

Although there was a significant improvement in blastocyst, euploid, and transferable embryo yield when somatotropin was administered daily during stimulation following a poor outcome IVF cycle, no difference was observed when compared to a matched control group. Thus, any observed improvement is likely due to regression to the mean rather than a direct benefit of somatotropin.