Granulocyte-colony stimulation factor (G-CSF) may improve pregnancy rate in patients with repeated implantation failures

Abstract

To assess the effectiveness of G-CSF for improving the implantation and pregnancy rates in in vitro fertilization (IVF) cycles of women with repeated implantation failures. It was a prospective randomized controlled clinic trial. Between November 2011 and March 2012, 20 women that would be submitted to an IVF cycle in IPGO (Sao Paulo, Brazil) were selected. The inclusion criteria were: 2 previous failures in IVF cycles with embryo transfer, normal early follicular phase serum levels of FSH and age no more than 40 years. A computer-based randomization was used to allocate the patients to two groups. All of them were submitted to the same protocol for ovarian stimulation with GnRH antagonist and hMG. In group 1, in addition to the usual luteal support, women received 0,25 ml of Filgrastim 300 mcg/ml subcutaneous every other day from the day after the embryo transfer until the confirmation of gestational sac with fetal heart beat documented by transvaginal ultrasound 6 weeks after embryo transfer. In group 2, they received only usual luteal support. The study variables were: age, number of oocytes, mature oocytes and embryos, expressed as mean; and pregnancy rate and implantation rate, expressed as percentage. There was no diference in age, number of oocytes, mature oocytes and embryos comparing the two groups. With the use of G-CSF, we observed an increasing in implantation rate from 10 to 19% and pregnancy rate from 20% to 40%. All the results have had no statistical significance, probably due to a small number of cases. G-CSF adjuvant therapy may improve the pregnancy rate in IVF cycles. Nevertheless, larger researches must be done to confirm the efficacy of G-CSF adjuvant therapy to improve the implantation and pregnancy rates in patients with repeated implantation failures and to define which group of patients could have benefits with this treatment.