Growth hormone enhances ovarian response but not live births in DOR patients undergoing PPOS with freeze-all strategy: a retrospective cohort study contrasted with Kuntai capsule.

OBJECTIVE: The Progestin-Primed Ovarian Stimulation (PPOS) protocol with a freeze-all strategy is increasingly used for diminished ovarian reserve (DOR) patients. While growth hormone (GH) and Kuntai capsule are proposed adjuvants, their efficacy in this specific context remains unclear. This study aimed to determine whether pretreatment with these adjuvants improves live birth rates. METHODS: This retrospective cohort study (2015-2025) included 2, 969 DOR patients undergoing PPOS cycles. Participants were stratified into control (n=1, 665), Kuntai capsule (n=524), and GH (n=778) groups. Propensity score matching (1:1:1) balanced baseline characteristics, yielding 439 patients per group. The primary outcome was oocyte yield; secondary outcomes included embryological parameters, biochemical pregnancy, clinical pregnancy, and live birth. Generalized estimating equations controlled for confounders. RESULTS: GH significantly enhanced ovarian response versus control: higher peak E2 (607 vs. 518 pg/mL, p<0.001), increased oocyte yield (3.0 vs. 2.0, p<0.001), and more available embryos (2.0 vs. 1.0, p=0.002). Biochemical pregnancy was higher with GH (67.4% vs. 57.3%, p=0.006). However, clinical pregnancy (45.7% vs. 44.5%) and live birth rates (27.8% vs. 28.2%) were comparable (p>0.05). GEE confirmed GH was not a predictor of live birth (aOR 0.85, 95% CI 0.54-1.33). Kuntai capsule showed no significant improvement in any ovarian response, embryo quality, or clinical outcomes, including live birth (27.0% vs. 28.2%, p>0.05). Multivariate analysis identified advanced age (>37 years) as the strongest negative predictor of live birth (aOR 0.36, p<0.001). CONCLUSION: In DOR patients managed with PPOS and freeze-all, GH pretreatment improves quantitative stimulation metrics and biochemical pregnancy but does not increase clinical pregnancy or live birth. Kuntai capsule demonstrates no beneficial effects across all endpoints. These findings do not support routine use of these adjuvants in this treatment paradigm.