生长激素在卵巢低反应人群中的应用

Application of growth hormone in poor ovarian responders

人类生长激素（GH）是由脑垂体前叶嗜酸性细胞分泌的一种重要的肽类激素，基因定位于17q24．2，分子量22kDa，含有191氨基酸。其分子结构与垂体催乳素（PRL）和胎盘生乳素（hPL）具有同源性，通过作用于靶细胞受体参与调控细胞生长与增殖功能。下丘脑生长激素释放激素和生长抑素是调控垂体GH合成与分泌两个主要环节。应急刺激、睡眠状态、大脑皮质活动程度和外周血胰岛素样生长因子（IGF）-1、Ghrelin、雌、雄激素水平可通过反馈方式调节其合成与分泌活动。

In the controlled ovulation stimulation （COS） of assisted reproductive technology, co- treatment of growth hormone （GH） is considered as an adjuvant therapy to improve the outcome of in vitro fertilization-embryo transfer （IVF-ET）, especially for women with poor ovarian response. The experimental studies have confirmed that exogenous GH can increase the IGF-1 levels in serum and follicular fluid by stimulating the liver synthesis of IGF-1 that can bind to IGF-1 receptor on granulosa cells and activate lots of downstream signaling pathways, which boosts the ovarian response to gonadotropin （Gn） and thus promotes the follicular maturation and steroidogenesis. So far, the clinical data have shown that Gn combined with GH contributes to the improvement of oocyte and embryo quality, as well as live birth rate in poor ovarian responders undertaking COS procedure. However, the effect of GH is still controversial because of the small sample size and the exogenous GH timing and dose differences in the clinical studies. Clarifying the treatment protocol of Gn combined with GH will be beneficial to the amelioration of its therapeutic effect.