الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
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UMMARY AND C ONCLUSION
nfertility has been always addressed as one of the important, serious and costly health issues in different societies. According to the previous studies performed in different countries, about 10-15% of couples suffering from infertility regard this disability as the worst experience in their life.
Poor ovarian response (POR) is a condition that in a group of IVF and ICSI cycles, despite the appropriate ovarian stimulation, the number of oocytes collected is below the expected value. POR presents approximately in 5–18% in all assisted reproductive technology (ART) cycles, with a pregnancy rate as low as 2—4%.Therefore, POR is considered as one of the success-limiting factors for IVF/ICSI outcomes,Due to heterogeneous risk factors, there is not a distinct definition for POR.
In 2016, Alviggiet proposed clinically relevant criteria that can help to guide the physician in the management of patients. In detail, it suggests a more specific new definition of ―low prognosis‖ patients. The issues mentioned above constitute the cornerstones of the novel POSEIDON (Patient-Oriented Strategies Encompassing Individualized Oocyte Number) criteria for ―low prognosis‖ patients undergoing ART. The POSEIDON criteria propose a shift from the terminology of poor ovarian response (POR) to the concept of low prognosis. The low prognosis patient is classified into four groups according to the
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results of ovarian reserve markers (AMH, AFC, or both), female age, and the number of oocytes retrieved in previous cycles of conventional ovarian stimulation.
Although lacking FDA approval for its use in an IVF cycle, other than in the setting of GH deficiency, GH is most commonly used as an adjunct to ovarian stimulation for women who had a poor response to ovarian stimulation in a preceding IVF cycle. Despite the 25 years of use of GH to assist in the treatment of female infertility, its role in IVF treatment is still debated today.
GH is reported to modulate the action of follicular stimulating hormones on granulosa cells by up-regulating the local synthesis of insulin like growth factor-1 (IGF-1). This interest has been stimulated by animal trials which suggest that GH may increase the intraovarian production of IGF-1.The interaction between GH and IGF-1 is of significance since IGF-1 has been shown to play an important part in ovarian function in both animal and human models.
The addition of IGF-1 to gonadotrophins in granulosa cell cultures increased gonadotrophin action on the ovary by several mechanisms including augmentation of aromatase activity,17 beta-oestradiol and progesterone production and luteinizing hormone receptor formation.
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This study was conducted on women complaining from infertility at assisted reproductive techniques unit at Ain Shams University Maternity Hospital and queens fertility center that fulfill criteria of Poseidon group. One hundred thirty-two (132) patients were enrolled in the study, 66 patients in each group. Groups were comparable in demographic data (in terms of age, BMI, duration of infertility and hormonal profile and there was no statistically significant difference between groups except for LH level.
As regard pregnancy outcome, there was no significant difference between the two groups regarding biochemical pregnancy (26 (39.4%) vs. 27 (40.9%), P 0.859), clinical pregnancy rate (25 (37.9%) vs. 27 (40.9%), P 0.722) and ongoing pregnancy rate (18 (27.3%) vs. 18 (27.3%), P 1),The relative risk and odds ration regarding ongoing pregnancy rate between control group and exposure to growth hormone is 1.
Several studies have since been published with inconsistent results. Because of the inconsistencies in study findings, both ASRM and ESHRE have failed to support the universal use of GH in the ovarian stimulation protocol of poor responder patients.
Despite adequate statistical power, meta-analyses also have shown contradictory impacts on clinical outcomes, supporting the utility of additional research efforts.
Conclusion