Clinical applications of growth hormone for ovarian stimulation

The realization of the existence of an intra-ovarian regulating mechanism involving insulin-like growth factor-I (IGF-I), a mediator of growth hormone (GH) action that augments the ovarian response to gonadotrophins, has prompted a number of clinical trials exploring the use of GH as an adjuvant for ovarian stimulation with human menopausal gonadotrophin. A critical review of these studies pinpoints a select group of infertile patients who may benefit from this co-treatment, particularly those who have a surgical, pathological or medically induced dysfunction of GH kinetics. The mechanism of this action, the effective dose needed and the implications regarding the interface of GH, IGF-I and ovarian physiology and pathology are now becoming clearer. A greater understanding of GH action on the ovary may in future benefit patients afflicted by anovulatory infertility and those requiring ovulation induction for in-vitro fertilization.