The role played by granulocyte colony stimulating factor (G-CSF) on women submitted to in vitro fertilization associated with thin endometrium: systematic review

Abstract

Objective: To provide evidence available in the literature on the role of granulocyte colony stimulating factor (G-CSF) in women submitted to in vitro fertilization, with repeated implantation failure associated with thin endometrium. Methods: Systematic review of the use of G-CSF, as part of assisted reproduction techniques in women with repeated embryo implantation failures associated with thin endometrium. The study was carried out in the PubMed, BIREME and Elsevier databases from 2008 to 2018, in English, Spanish and Portuguese. Results: We included all the studies, which used intrauterine G-CSF. We found an increase in endometrial thickness in eight of the 10 studies included. Of these, the implantation rate improved significantly in two studies, but the gestation rate increased in only one. We found the highest rates of implantation (32%) and pregnancy (48%) in a non-randomized clinical trial. On the other hand, two other studies did not demonstrate an increase in endometrial thickness and in pregnancy rates in patients with thin endometrium submitted to the assisted reproduction in frozen embryo transfer cycles. Conclusion: Studies published so far point to a positive influence on the use of G-CSF in relation to the improvement in endometrial receptivity and pregnancy rates. Therefore, there is a need for further studies to determine whether to use it, as well as the period, route of administration, dosage and duration of treatment.

Vitamin D Promotes Trophoblast Cell Induced Separation of Vascular Smooth Muscle Cells in Vascular Remodeling via Induction of G-CSF

“…However, changes in serum G-CSF may not reflect local concentrations within the maternal-fetal interface and its paracrine/autocrine effects are likely to be more important for a contribution to the etiology of complications of pregnancy. Pre-conception administration of G-CSF may also be beneficial for a subset of women with recurrent pregnancy loss or recurrent implantation failure, although the mechanism of action is not yet fully understood ( Santjohanser et al, 2013 ; Eapen et al, 2019 ; Kamath et al, 2020 ; Rocha et al, 2020 ).…”

ESHRE good practice recommendations on recurrent implantation failure

“…However, to date, few studies have been conducted to evaluate its relevance for RIF patients with thin endometrium. Similarly, intrauterine granulocyte colony-stimulating factor (G-CSF) infusion for ART patients with thin endometrium has been proposed, and the limited published studies show conflicting results ( Rocha et al , 2020 ). Further studies should elucidate the value of these and other interventions following the detection of thin endometrium in patients with RIF.…”

Immune Cell Functionality during Decidualization and Potential Clinical Application

“…Locally it might improve endometrial receptivity, implantation processes, and angiogenesis. Thus, G-CSF can increase the live birth rate in patients undergoing IVF [ 265 , 266 , 267 ]. Although the exact mechanisms remain unclear, it is known that G-CSF is also produced during implantation.…”

“…G-CSF is a strong inhibitor of cytotoxic NK cell function [ 268 ], which is necessary for the uterine receptive milieu. The success of G-CSF in increasing pregnancy rate has been reviewed in detail (i.a., in [ 267 , 269 , 270 ]). Although not all studies found an improving effect of intrauterine perfusion of G-CSF [ 271 , 272 , 273 ].…”