Comparison of Frozen Embryo Transfer Outcomes Between Uterine Infusion of Granulocyte Colony-Stimulating Factor and Growth Hormone Application in Patients With Thin Endometrium: A Retrospective Study.

Lei Jiang,Baojun Shi,Ni Yang,Xin Xu,Ziyu Cao,Qian Li,Shaoqing Wang,Luning Wang,Guimin Hao,Xiuhua Xu

doi:10.3389/fendo.2021.725202

Abstract

ObjectiveTo investigate the effect of two treatments on the outcome of freeze-thaw embryo transfer for pregnancy assistance in thin endometrium.MethodsA retrospective study was conducted on 66 patients who failed in the first cycle treated in the reproductive medicine center of the Second Hospital of Hebei Medical University from January 2018 to December 2019. Granulocyte colony stimulating factor (G-CSF) was used through cavity infusion in one group (n=25, and growth hormone (GH) was subcutaneously injected in the group (n=41). The clinical data of the two groups were compared, including morphology and thickness of the endometrium, biochemical pregnancy rate, clinical pregnancy rate, implantation rate, miscarriage rate, and live birth rate in each period of the hormone replacement cycle.ResultsThere was no significant difference in age, BMI, AMH, FSH, LH, E2, infertility years, number of transferred embryos, basal endometrium, and thickness of endometrium on the day of P administration before and after treatment (P> 0.05). After treatment, compared to the GH group, the G-CSF group presented higher biochemical pregnancy rate (56% versus 48.8%; P=0.569), clinical pregnancy rate (52% versus 46.3%; P=0.655), implantation rate (34.8% versus 27.5%; P=0.391), and live birth rate (40% versus 31.7%; P=0.493), but the differences were not statistically significant (P > 0.05). On the 5th day of treatment, the endometrial thickness in the G-CSF group was thinner than that in the GH group (4.83 ± 0.85 versus 5.75 ± 1.27; P< 0.05), but it had no correlation with pregnancy outcome (P > 0.05). There was no significant difference in endometrial thickness between the two groups on the 7th, 9th day of treatment and the day of P administration (P > 0.05). On the 5th day of treatment, the proportion of endometrial type A morphology in the GH group was significantly higher than that in the G-CSF group (P < 0.05), while the type B morphology in the G-CSF group was significantly higher than that in the GH group (P< 0.05).ConclusionAlthough G-CSF and GH may not have a role in increasing endometrium, both of them can improve the pregnancy outcomes of patients with thin endometrium in the FET cycle. And the effects of the two treatments were similar.

Highlights

With the development of vitrification freezing technology, the implantation and live birth rates of FET has met or exceed those of fresh embryo transfer, especially for infertile women with slow embryo development or early elevated progesterone
In China, with the liberalization of the second-child policy, FET cycles are on the rise year by year, and a non-Cochrane systematic study reported that FET cycles have higher clinical pregnancy rates and lower miscarriage rates compared with conventional IVF/ICSI fresh transfer strategies [9]
A retrospective study of 513 patients over the age of 35 found that the clinical pregnancy rate and live birth rate were significantly higher in the frozen-thawed embryo transfer cycle than in the fresh embryo transfer cycle [10]

Summary

Introduction

With the development of vitrification freezing technology, the implantation and live birth rates of FET has met or exceed those of fresh embryo transfer, especially for infertile women with slow embryo development or early elevated progesterone. Endometrial receptivity, embryo quality, and synchronization of both during the FET cycle are important factors for successful embryo implantation. Embryo freezing and thawing technology is more mature and the recovery rate can reach more than 90%, but the clinical pregnancy rate of the FET cycle still fluctuates between 30% to 60% in various fertility centers in China and abroad [2]. In the field of reproduction, G-CSF has been found to be involved in follicular growth and development, ovulation and pregnancy, and has a bidirectional regulatory role in the maternalembryonic exchange. The aim of current study was to compare the efficacy of G-CSF and GH on thin endometrium in order to select a more optimal approach for clinical treatment of thin endometrium patients with FET-assisted pregnancy, improving their endometrial receptivity and pregnancy outcomes

Methods

Results

Conclusion