Intrauterine G-CSF in IUI cycles for women with thin endometrium may improve endometrial thickness and pregnancy...

Optimum endometrial thickness (ET) which grows in synchrony with growing follicle in stimulated intra-uterine insemination (IUI) cycles, is essential for achieving pregnancy. However, in some women, endometrium is unresponsive and fails to reach optimal thickness. Few studies have explored the role of intrauterine infusion of granulocyte colony-stimulating factor (G-CSF) to improve ET. This study was done to evaluate efficacy of intrauterine G-CSF infusion in improving ET, and pregnancy rates in IUI cycles with thin endometrium.

In this prospective randomized controlled study, 120 infertile women with thin endometrium (<7 mm) on the day of human chorionic gonadotropin (hCG) trigger were randomized. Study group (60) received 1 ml G-CSF (300 μg), by slow intrauterine infusion using IUI catheter. Control group (60) received 1 ml normal saline as placebo. hCG was administered at 2200 h on same day. ET was reassessed 36 h later by trans-vaginal scan (TVS) before IUI.

Twenty-seven (27) of 60 study group patients (45%) achieved optimal ET of ≥7 mm, whereas 19 of 60 control group patients (31.67%) achieved optimal ET. In the study group, 6 of 27 patients (22.22%) had positive urine pregnancy test, versus 3 of 19 patients (15.79%) in control group. Of these 5 patients (18.52%) in the study group and 2 patients (10.53%) in control group continued to have clinical pregnancy. Improved outcomes seen in G-CSF group were not statistically significant.

Our study suggests that G-CSF might have potential to improve ET and clinical pregnancy rate in women with thin endometrium undergoing IUI.