Norbert Gleicher1, Andrea Vidali, David H Barad. 1. Center for Human Reproduction and the Foundation for Reproductive Medicine, New York, New York 10021, USA. ngleicher@thechr.com
Abstract
OBJECTIVE: To assess whether inadequate, thin endometrium (<7 mm), after failure to expand with standard treatment options, will be responsive to cytokine treatment. DESIGN: Prospective cohort study of four patients. SETTING: Two independent IVF centers in New York City. PATIENT(S): Four consecutive women undergoing IVF who, after standard endometrial preparation, still demonstrated highly inadequate endometrium. INTERVENTION(S): Transvaginal endometrial perfusion with granulocyte colony-stimulating factor (G-CSF). MAIN OUTCOME MEASURE(S): Endometrial thickness on day of ET, with pregnancy as secondary endpoint. RESULT(S): We report successful endometrial expansion to at least minimal thickness of 7 mm after uterine perfusion with G-CSF in four patients previously resistant to treatment with estrogen and vasodilators. All four patients therefore reached ET, and all four also conceived, although one pregnancy required termination because of intramural, corneal ectopic location. Endometrial expansion to minimal thickness occurred within approximately 48 hours from infusion. CONCLUSION(S): Uterine perfusion with G-CSF represents a promising new tool for the currently mostly intractable problem of inadequate, thin endometrium. This treatment also deserves further investigation for its potential to improve implantation chances in association with IVF and, therefore, pregnancy rates.
OBJECTIVE: To assess whether inadequate, thin endometrium (<7 mm), after failure to expand with standard treatment options, will be responsive to cytokine treatment. DESIGN: Prospective cohort study of four patients. SETTING: Two independent IVF centers in New York City. PATIENT(S): Four consecutive women undergoing IVF who, after standard endometrial preparation, still demonstrated highly inadequate endometrium. INTERVENTION(S): Transvaginal endometrial perfusion with granulocyte colony-stimulating factor (G-CSF). MAIN OUTCOME MEASURE(S): Endometrial thickness on day of ET, with pregnancy as secondary endpoint. RESULT(S): We report successful endometrial expansion to at least minimal thickness of 7 mm after uterine perfusion with G-CSF in four patients previously resistant to treatment with estrogen and vasodilators. All four patients therefore reached ET, and all four also conceived, although one pregnancy required termination because of intramural, corneal ectopic location. Endometrial expansion to minimal thickness occurred within approximately 48 hours from infusion. CONCLUSION(S): Uterine perfusion with G-CSF represents a promising new tool for the currently mostly intractable problem of inadequate, thin endometrium. This treatment also deserves further investigation for its potential to improve implantation chances in association with IVF and, therefore, pregnancy rates.