Granulocyte colony-stimulating factor in repeated IVF failure

GCSF, granulocyte colony-stimulating factor, is a glycoprotein with growth factor and cytokine functions produced in different tissues, first used in 1980s. It plays a key role during the embryo implantation process, modulating genes responsible for embryo adhesion, cell migration, tissue remodeling, and angiogenesis.

A relatively recent 2016 study from Tehran University of Medical Sciences, Iran, have revealed key roles for granulocyte colony-stimulating factor (GCSF) in embryo implantation process and pregnancy maturation.  Promising results have been shown by using local intrauterine infusion of GCSF in women undergoing IVF procedures.

112 women with previous history of IVF failures participated in the study, half of them belonging to intervention group and other half to the control group. Though further studies are needed, it seems that systemic single-dose subcutaneous GCSF administration on the embryo transfer day is more effective and associated with higher success rate compared to local intrauterine perfusion.

The successful implantation, chemical pregnancy, and clinical pregnancy rates were significantly higher in the intervention group than in the control group.

Even with the positive results we should not underestimate the small sample size and unintended selection bias.

Some authors have suggested that systemic administration of GCSF might be more effective than local infusion.

The study was conducted on infertile women with repeated IVF failure to evaluate the efficacy of systemic subcutaneous GCSF administration on IVF success, implantation, and pregnancy rates.

Repeated IVF failure is determined when transferred embryos fail to implant after several IVF cycles. In our study, repeated IVF failure was defined as failure of implantation in at least three consecutive IVF attempts, in which three embryos of high-grade quality are transferred in each cycle.

Eligibility criteria for women in the study was their age <40 years, history of IVF failures, absence of contraindications for GCSF treatment, and absence of any systemic disease.

One to three high quality evaluated embryos were transferred.

While a single-dose of GCSF proved to be safer and more tolerable, as well as economically justifiable to administer, suitable dose has not yet been determined. Compared to repeated GCSF administration, proposed subcutaneous single-dose was easier to asses later on. Given only 1 hour before embryo transfer this treatment significantly increases IVF success, implantation, and pregnancy rates in infertile women.