Efficacy of intrauterine perfusion of granulocyte colony‐stimulating factor (G‐CSF) for Infertile women with thin endometrium: A systematic review and meta‐analysis

Abstract

This meta‐analysis aimed to explore the efficiency of intrauterine perfusion of granulocyte colony‐stimulating factor (G‐CSF) on infertile women with thin endometrium. Following PRISMA protocol, we conducted a comprehensive search of academic literatures on various databases including PubMed, EMbase, and Cochrane Library. Studies published in English before July 1, 2016 were included for primary screening. Data on the thickness of endometrium, cycle cancelation rate,clinical pregnancy rate, and embryo implantation rate were extracted and analyzed, respectively. Eleven eligible studies involving 683 patients were included in this meta‐analysis. Compared with control group, G‐CSF perfusion could significantly improve endometrial thickness (mean difference [MD]=1.79, 95% confidence interval (CI): 0.92‐2.67), clinical pregnancy rate (risk ratio [RR]=2.52, 95% CI: 1.39‐4.55), and embryo implantation rate (RR=2.35, 95% CI: 1.20‐4.60), while it could decrease cycle cancelation rate (RR=0.38, 95% CI: 0.25‐0.58). Funnel plots revealed that there was no evidence of publication bias. The current data indicate that intrauterine perfusion of G‐CSF can improve endometrial thickness, clinical pregnancy rate, and embryo implantation rate, but decrease the cycle cancelation rate in women with thin endometrium.

Granulocyte colony-stimulating factor as a checkpoint of the embryo invasive potential and endometrial receptivity

“…По данным метаанализа 2017 г. с включением 682 пациенток (339 в группе G-CSF vs. 343 в группе сравнения) из 11 соответствующих критериям анализа исследований установлено, что внутриматочная перфузия G-CSF влияет на толщину эндометрия (ΔM = 1,79, [37]. В результате метаанализа 2017 г., включающего в себя данные исключительно рандомизированных исследований, не было выявлено статистически значимого увеличения толщины эндометрия после перфузии G-CSF у женщин с тонким эндометрием, при этом отмечена значительно более высокая частота наступления клинической беременности (ОШ = 2,43, 95 % ДИ 1,09-5,40), включая когорту пациенток с неудачными попытками ЭКО в анамнезе (ОШ = 2,51, 95 % ДИ 1,36-4,63) [38].…”

Non-invasive intra-uterine administration of Botulinum Toxin A enhances endometrial angiogenesis and improves the rates of embryo implantation

“…Recent studies showing the increased expression levels of angiogenesis-related factor, VEGF, and its receptor in the late secretory and early pregnancy strongly suggest that the endometrial angiogenesis plays crucial roles in endometrial response to the implanting blastocyst, likely a key factor of endometrial vasculature in determining the endometrial receptivity [3,12]. Even though there are several trials to improve endometrial environment via inducing angiogenic effect with many kinds of substances including granulocyte colony-stimulating factor (G-CSF), mesenchymal stem cells (MSC), and platelet-rich plasma (PRP) [13][14][15], the e cacy of those substances is still controversial due to the lack of evidences [16][17][18].…”

Embryo-Derived Chemokine CXCL12 Enhances Pregnancy Outcome via Improvement of Endometrial Receptivity

“…The endometrium becomes thicker with mature vascular network and increased blood ow, which re ect su cient endometrial receptivity during the implantation [21]. Various substances including granulocyte colony-stimulating factor (G-CSF), mesenchymal stem cells (MSC), and platelet-rich plasma (PRP) have been suggested to enhance endometrial angiogenesis and receptivity for patients who are suffering from implantation failure with poor endometrial receptivity [22][23][24]. However, the e cacy of those substances still has not been fully evidenced yet [25][26][27].…”