Abstract
Successful implantation requires a receptive endometrium and a good quality egg. The challenges a physician encounters with regard to this in assisted reproductive technology are obtaining good quality embryo, achieving optimal endometrial thickness (EMT), and subsequently implantation, which is denotive of a receptive endometrium. Granulocyte colony-stimulating factor (G-CSF) has been observed to be a biomarker of oocyte quality and has been shown to enhance EMT and implantation because of its immunological effects. A systematic search for all relevant articles on G-CSF in follicular fluid and its therapeutic benefit in thin endometrium and recurrent implantation failure was performed, and peer-reviewed, full-text articles related to humans were included in the study. As a tool to determine the potentiality of oocyte, G-CSF shows promise with its predictability increasing in combination with morphological embryo scoring or interleukin 15. For the thin endometrium, G-CSF is especially useful in patients who are refractory to other treatment modalities. In recurrent implantation failure (RIF), G-CSF showed potential in a subset of patients with immunological deficiency lacking killer cell immunoglobulin-like receptor genes. This review highlights the various forms of usage of G-CSF and the effectiveness of G-CSF in infertility. G-CSF equips embryologists with a tool to determine the potentiality of oocyte and physicians with therapy for thin endometrium and RIF, especially since the available treatment options are ineffective.
Highlights
IntroductionA 35-year-old woman presented with primary infertility with associated male-factor infertility of oligozoospermia for which intracytoplasmic sperm injection (ICSI) was recommended
Background“Medicine is the restoration of discordant elements; sickness is the discord of the elements infused into the living body.”: Leonardo Da Vinci.A 35-year-old woman presented with primary infertility with associated male-factor infertility of oligozoospermia for which intracytoplasmic sperm injection (ICSI) was recommended
A systematic search for all relevant articles on Granulocyte colony-stimulating factor (G-CSF) in follicular fluid and its therapeutic benefit in thin endometrium and recurrent implantation failure was performed, and peerreviewed, full-text articles related to humans were included in the study
Summary
A 35-year-old woman presented with primary infertility with associated male-factor infertility of oligozoospermia for which intracytoplasmic sperm injection (ICSI) was recommended. During the first cycle of ICSI, good follicular growth was observed, endometrial thickness (EMT) was 4 mm despite the use of estradiol and vasodilators. At the patient’s insistence, embryo transfer (ET) was performed, but it did not yield a positive result. She opted for frozen embryo transfer (FET) to improve her chances of having a thicker endometrium. This time, even with proper estrogen priming of the endometrium, the thickness remained below 7 mm. The patient pressed for another option to improve her endometrium as she could not afford another ICSI cycle.
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