Growth Hormone for Poor Responders in IVF: Worth It?

What "poor responder" means

A poor (or "low") responder is someone whose ovaries produce fewer eggs than expected despite standard or high doses of stimulation medication. Definitions vary. Some use the number of eggs from a previous cycle, others use AMH and antral follicle count, and research groups such as POSEIDON use their own categories. That variation turns out to matter a lot for the growth hormone story, as you'll see below.

Poor response is common with diminished ovarian reserve and with age. It's one of the hardest situations in IVF, partly because so many add-ons are marketed to people in it. Growth hormone is one of the most established of those add-ons, but that doesn't mean it's proven.

Why growth hormone was tried

Growth hormone acts partly through insulin-like growth factor 1 (IGF-1), which interacts with the hormones that drive follicle development. The theory is that adding GH might make the ovaries more sensitive to stimulation drugs, or improve egg quality, so poor responders get more or better eggs from the same cycle.

Growth hormone medications are approved for specific growth disorders. The US label for Genotropin, for example, lists pediatric growth failure conditions and adult growth hormone deficiency. In IVF it's used outside those labeled indications, as an adjunct during stimulation.

What the evidence shows

The Cochrane review

Cochrane's 2021 review, with evidence current to November 2020, pooled 16 randomized trials with 1,352 women. Fourteen trials (1,272 women) looked at poor responders. For poor responders, the review found:

Cochrane Gynaecology and Fertility Group, Growth hormone for in vitro fertilisation (IVF), 2021.

The authors wrote that GH "slightly increases the number of oocytes retrieved and pregnancy rates in poor responders," but that the results "need to be interpreted with caution, as the included trials were small and few in number." Very low certainty means the true effect could be quite different from the estimate, and that includes no effect.

The LIGHT trial

One of the more rigorous individual trials is the Australian LIGHT trial (Norman and colleagues, Reproductive BioMedicine Online, 2019). It was double-blind and placebo-controlled. It enrolled women who had previously produced five or fewer eggs despite high doses of FSH, and who were under 41.

• Live birth: 9 of 62 (14.5%) with GH vs 7 of 51 (13.7%) with placebo.
• The difference of 0.8 percentage points had a wide confidence interval, from about 12 points worse to about 14 points better.
• Some intermediate measures looked more favorable with GH. Live birth, the outcome that matters, was essentially identical.

The trial stopped after four years without reaching its planned size, so it can't rule out a small benefit. Its title states the conclusion plainly: it "provides no evidence for improved live birth rate."

Putting the two together

The Cochrane estimate and the LIGHT result can look like they contradict each other, but they mostly don't. Cochrane's live-birth range is very wide, from almost no effect to a meaningful one, and it rests on very low certainty evidence. LIGHT's own range is also wide. Together they fit a modest benefit, or none, more comfortably than a large one. Neither can promise you a better result. If a clinic presents GH as something that clearly "works" for poor responders, that's more confidence than the evidence supports.

Why the studies disagree

• Small trials. When trials have a few dozen participants each, chance alone can create or hide effects.
• Different definitions of poor responder. A trial of women who had one bad cycle and a trial of women with very low reserve aren't studying the same group.
• Different doses and schedules. GH has been started at different times and given for different lengths of time. There's no single standard protocol.
• Intermediate outcomes. More eggs or more embryos don't always mean more babies. The outcome patients care about is live birth, and that's where the evidence is weakest.
• Reporting gaps. Cochrane flagged poor reporting of methods and missing adverse-event data in many trials.

What guidelines say

ESHRE's guideline on ovarian stimulation for IVF/ICSI (2025 update) addresses GH directly:

• "Use of adjunct growth hormone before and/or during ovarian stimulation is probably not recommended for low responders."
• "Use of adjunct growth hormone before and/or during ovarian stimulation is not recommended for normal responders."

"Probably not recommended" is a conditional recommendation. ESHRE is saying the evidence doesn't support routine use in low responders, while leaving room for individual decisions. For people who respond normally, the guidance is a clear no.

DHEA and testosterone: the other usual suspects

GH is often offered alongside, or instead of, two other "priming" options. The same ESHRE guideline says:

• DHEA: "not recommended for low responders" (and not recommended for normal responders).
• Testosterone before stimulation: "probably not recommended for low responders."

If you're being offered a bundle of adjuvants, ask which ones the clinic thinks are doing the work, and why.

How to decide

A fair way to frame it: GH might offer a small benefit, it might offer none, and the best-designed trial didn't find one. Whether that's worth it depends on things only you and your doctor can weigh:

• Cost relative to your budget. If GH would use money you'd otherwise spend on another retrieval or a transfer, the extra cycle may be the better bet. Get a written price for the full course.
• Your specific history. Ask whether your clinic sees a difference in patients like you, and how it measures that.
• Other strategies. Some people with low response focus on accumulating eggs or embryos over several retrievals. DuoStim mainly speeds that up. Others consider donor eggs. Experimental options like ovarian PRP have even less support than GH.
• Side effects and injections. Ask what side effects the product label lists and how many extra injections the plan involves.

If you decide to try it, agree in advance how you'll judge it. "We'll compare egg and embryo numbers to last time" is honest. Keep in mind that the next cycle often looks better than an unusually bad one anyway.

Questions to ask your clinic

• Why are you recommending GH for me specifically? What about my response pattern makes you think it could help?
• What dose and schedule do you use, and when would it start?
• What will the full course cost, and is it bundled with other add-ons?
• How does your clinic measure whether GH helped, and do you track live births for patients who use it?
• Given ESHRE's 2025 guidance, why do you still offer it?
• If I put the GH money toward another retrieval instead, which would you choose?

Frequently asked questions

Sources