G-CSF Treatment in Women With Infertility Undergoing In Vitro Fertilization

Granulocyte colony‐stimulating factor (G-CSF) shows potential effectiveness for treating infertility in women with a thin endometrium undergoing in vitro fertilization (IVF), according to study findings in Reproductive Biology and Endocrinology.

Due to a lack of evidence on the effects of G-CSF on infertility in women, researchers conducted a meta-analysis using data from randomized controlled trials (RCTs) accessed via PubMed, Embase, and Cochrane Library. The screened studies focused on women undergoing IVF with a thin endometrium, with repeated implantation failure, and recurrent spontaneous abortion. The primary outcome was clinical pregnancy rate. Secondary outcomes were live birth rate or ongoing pregnancy rate, abortion rate, biochemical pregnancy rate, embryo implantation rate, and endometrium thickness.

A total of 20 RCTs were included in the final analysis and the trials were separated into 4 groups: general IVF (n=3), IVF with thin endometrium (n=3), IVF with repeated implantation failure (n=14), and IVF with recurrent spontaneous abortion (n=0). Of the 20 studies, 8 trials were conducted in Iran, 3 in India, and 3 in Italy. There was 1 study in each of the following countries: Germany, Turkey, Russia, China, Egypt, and the United States. The sample size of each study ranged from 28 to 157 participants with a total of 1966 women pooled for analysis.

Results indicated the pooled clinical pregnancy rate was higher in the G-CSF group compared with the control group (risk ratio [RR], 1.77; 95% CI, 1.52-2.05). The researchers noted a higher clinical pregnancy rate in the G-CSF group for women undergoing IVF with a thin endometrium (n=188; RR, 1.85; 95% CI, 1.07-3.18) and women undergoing IVF with repeated implantation failure (n=1387; RR, 1.93; 95% CI, 1.63-2.29). In the general IVF subgroup with 391 women, the researchers found no difference in clinical pregnancy rate between the G-CSF group and the control group (RR, 1.16; 95% CI, 0.8-1.69).

Among 1387 women undergoing IVF with repeated implantation failure, the clinical pregnancy rate was higher in the G-CSF subgroup compared to the control group (RR, 1.93; 95% CI, 1.63-2.29). Additionally, in the subgroup analysis of G-CSF administration conducted among women in the IVF with repeated implantation failure group, results showed an increased clinical pregnancy rate with subcutaneous injection (RR, 2.13; 95% CI, 1.68-2.69) and with intra-uterine injection (RR, 1.71; 95% CI, 1.35-2.16).

The combined results from 7 studies among 781 women revealed biochemical pregnancy rates were higher among the G-CSF group when compared with the control group. There were 2 studies with 76 patients reporting endometrial thickness and results showed the endometrium was thicker among the G-CSF group when compared to the control group (mean difference [MD], 2.25; 95% CI, 1.58-2.92).

The researchers reported no differences in pregnancy outcomes between the G-CSF group and the control group in the general IVF when comparing live birth rate, abortion rate, and ongoing pregnancy rate (RR, 1.56; 95% CI, 1.24-1.98).

Study limitations include the study’s heterogeneity, lack of data for women undergoing IVF with recurrent spontaneous abortion, and the inability to assess the safety of G-CSF.

“G-CSF can improve [clinical pregnancy rate] and endometrial thickness in patients with thin endometrium undergoing IVF,” the authors concluded. “For general IVF patients, no benefit was seen with the use of G-CSF.”