GCSF in patients with thin endometrium − subcutaneous or intrauterine?

Abstract

Background: Granulocyte colony stimulating factor (GCSF) has a potential role in patients with persistently thin endometrium. Usually intrauterine route is employed for administering GCSF in patients with thin endometrium and data on subcutaneous route of administration is scarce. Methods: This was a randomized case control study from july 2018 to January 2019. Fifty patients with thin endometrium were enrolled in each group. In either group, GCSF was given if endometrium was less than 7mm on day 14, maximum of 2 doses. Primary outcome measured was increase in endometrium thickness and the secondary outcome was pregnancy rate. Results: Patients in both groups had similar endometrial thickness at the time of the initial evaluation: 5.27 mm in the subcutaneous and 5.34 mm in the intrauterine group. Similar change in the endometrial thickness was observed in the two groups: 1.76 in subcutaneous group and 1.84 in intrauterine group. It was observed that 61.2% had zone 3 blood flow in subcutaneous group compared to 74.1% in the intrauterine group, the difference being not statistically significant. Pregnancy rate of 40.1% in the subcutaneous group and 47.1% in intrauterine group was observed. (P>0.50). Conclusion: We concluded that G-CSF infusion leads to an improvement in endometrium thickness and this can achieved by both intrauterine and subcutaneous route. Intrauterine route is associated with slightly better results compared to subcutaneous route, though the improvement is not statistically significant. Hence, subcutaneous route can be offered to the patient, making it a viable option for administering GCSF to improve the endometrial thickness and flow in patients with thin endometrium undergoing embryo transfer.