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 patients with diminished ovarian reserve (DOR). While growth hormone (GH) and Kuntai capsule are proposed adjuvants to enhance outcomes in DOR, their efficacy within this specific treatment context is not well-established. This study aimed to determine whether pretreatment with these adjuvants improves IVF/ICSI outcomes, particularly live birth rates. Methods We conducted a large retrospective cohort study at a single tertiary center (2015–2025), including 2,969 DOR patients undergoing PPOS cycles. Participants were stratified into a control group (n = 1,665), a Kuntai capsule pretreatment group (n = 524), and a GH pretreatment group (n = 778). Propensity score matching (1:1:1) was applied to balance baseline characteristics, yielding 439 patients per group for final analysis. The primary outcome was the number of oocytes retrieved. Secondary outcomes encompassed embryo quality parameters, biochemical pregnancy, clinical pregnancy, and live birth rates. Generalized estimating equations (GEE) were employed to control for confounders. Results GH supplementation significantly enhanced ovarian response, demonstrated by higher peak E₂ levels (607 vs. 518 pg/mL, p < 0.001), increased oocyte yield (3.0 vs. 2.0, p < 0.001), and a greater number of available embryos (2.0 vs. 1.0, p = 0.002) compared to the control. This translated to a higher biochemical pregnancy rate (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%) remained comparable to controls (p > 0.05). GEE models confirmed GH was not a significant predictor of live birth (adjusted OR 0.85, 95% CI 0.54–1.33). In contrast, Kuntai capsule pretreatment showed no significant improvement over the control in any ovarian response parameters, embryo quality metrics, or clinical outcomes, including live birth (27.0% vs. 28.2%, p > 0.05). Multivariate analysis identified advanced maternal age (> 37 years) as the strongest negative predictor of success (live birth adjusted OR 0.36, p < 0.001). Conclusion In DOR patients managed with a PPOS and freeze-all strategy, GH pretreatment improves quantitative stimulation metrics and early pregnancy biomarkers but does not increase the likelihood of clinical pregnancy or live birth. Kuntai capsule pretreatment demonstrated no beneficial effects across all evaluated endpoints. These findings do not support the routine use of these adjuvants in this specific treatment paradigm.