Growth Hormone Administration to Improve Reproductive Outcomes in Women with Recurrent Implantation Failure (RIF): a Systematic Review

Recurrent implantation failure (RIF) has been used to describe embryos’ failure to implant following IVF, arising concerns about the importance of its treatment. Growth hormone (GH) has been studied as one of the possible co-interventions. Our updated review evaluated GH intervention vs. no intervention from randomized controlled trials (RCTs) in RIF patients. Electronic searches on The Menstrual Disorders and Subfertility Group (MDSG), The Cochrane Central Register for Clinical Trials, PubMed MEDLINE, EMBASE, PsycINFO, CINAHL, LILACS, and Google Scholar up to August 2021 identified 2 RCTs and compiled with the above inclusion criteria. The risk of bias (ROB) and the quality of evidence were assessed according to the Cochrane Collaboration tool and GRADE group guidelines. Meta-analysis found higher rates of clinical pregnancy (OR: 4.97 CI 95% 2.05 to 12.05), live birth (OR: 5.13 CI 95% 2.03 to 12.91), and implantation (OR: 3.88 CI 95% 1.91 to 7.88) when compared GH to no intervention; as well as an increased endometrial thickness (mean difference: 1.14 CI 95% -0.0 to 2.28). However, this review cannot provide a strong recommendation due to the quality of evidence rated as “very low quality of evidence” in all the outcomes for reasons such as methodology issues, heterogeneity, intervention regimen, and limited sample sizes with large confidence intervals and a low number of events. We emphasize the importance of upcoming high-quality research and the need for consensus concepts in RIF patients, which may be a minority; it is still one of the highest impacts on life quality.