Effect of Intra Uterine Granulocyte Colony Stimulating Factor vs. Human Chorionic Gonadotropin at Ovum Pick Up Day on Pregnancy Rate in IVF/ICSI Cases With Recurrent Implantation Failure

Does Intrauterine Injection of hCG Improve IVF Outcome? A Systematic Review and a Meta-Analysis

“…Fifty-four papers were assessed for eligibility. Eighteen RCTs were included in the qualitative and quantitative analysis [ 10 , 11 , 15 , 16 , 17 , 18 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 37 , 38 , 39 , 40 , 41 ]. The baseline characteristics of the studies included are reported in Table 1 .…”

“…Only four studies investigated the effect of hCG in women with a history of recurrent implantation failure. Among them, only one RCT included women with recurrent implantation failure consistent with ESHRE criteria [ 28 ]. A significantly higher clinical pregnancy rate was observed in women who underwent hCG intrauterine injection versus controls (RR 1.56, 95% CI 1.26–1.94, I 2 : 0%, p < 0.0001) ( Supplementary Figure S3 ).…”

“…The most recent Cochrane review includes 17 RCTs, 6 of which are conference abstracts, and concluded that women undergoing cleavage-stage transfer might benefit from intrauterine hCG [ 20 ]. Since the publication of the latter paper, another seven RCTs have been published [ 22 , 23 , 24 , 25 , 26 , 27 , 28 ]. More recently, a comprehensive meta-analysis of different interventions, including intrauterine hCG during embryo transfer, concluded that intrauterine hCG could significantly increase the clinical pregnancy rate [ 29 ].…”

“…Given the relevance of the topic and recent results [ 25 , 26 , 28 ], it is pertinent to update previous data. Consequently, we conducted a review and meta-analysis to assess IVF outcomes by comparing couples who underwent intrauterine hCG injection transfer versus those who underwent embryo transfer with intrauterine injection, placebo, or without any additional intervention.…”

Endometrial thickness: How thin is too thin?

“…The use of G-CSF was first reported in 2011 in a series of 4 donor oocyte recipients with a history of a thin lining, all of whom conceived after G-CSF infusion (92). Since that time, many studies have been published on the use of G-CSF as an add-on for several indications, including a thin endometrium, recurrent implantation failure, and endometriosis (93,94). The proposed mechanism of G-CSF is to promote endometrial regeneration and improve vascularization.…”