Elsevier

Fertility and Sterility

Volume 95, Issue 6, May 2011, Pages 2123.e13-2123.e17
Fertility and Sterility

Case report
Successful treatment of unresponsive thin endometrium

https://doi.org/10.1016/j.fertnstert.2011.01.143Get rights and content

Objective

To assess whether inadequate, thin endometrium (<7 mm), after failure to expand with standard treatment options, will be responsive to cytokine treatment.

Design

Prospective cohort study of four patients.

Setting

Two independent IVF centers in New York City.

Patient(s)

Four consecutive women undergoing IVF who, after standard endometrial preparation, still demonstrated highly inadequate endometrium.

Intervention(s)

Transvaginal endometrial perfusion with granulocyte colony-stimulating factor (G-CSF).

Main Outcome Measure(s)

Endometrial thickness on day of ET, with pregnancy as secondary endpoint.

Result(s)

We report successful endometrial expansion to at least minimal thickness of 7 mm after uterine perfusion with G-CSF in four patients previously resistant to treatment with estrogen and vasodilators. All four patients therefore reached ET, and all four also conceived, although one pregnancy required termination because of intramural, corneal ectopic location. Endometrial expansion to minimal thickness occurred within approximately 48 hours from infusion.

Conclusion(s)

Uterine perfusion with G-CSF represents a promising new tool for the currently mostly intractable problem of inadequate, thin endometrium. This treatment also deserves further investigation for its potential to improve implantation chances in association with IVF and, therefore, pregnancy rates.

Section snippets

Case report

On the basis of anecdotal reports and a US patent application (7), we sporadically used subcutaneously injected G-CSF (Neupogen, Filgastrim; Amgen Manufacturing, Thousand Oaks, CA), off label and with appropriate experimental informed consent, in suspected implantation failure.

Because diagnosis of implantation failure is always tentative, clinical effects of G-CSF in this indication are difficult to assess. In contrast, however, potential proliferative effects on endometrium can be

Discussion

We here report four IVF patients, in two infertility centers, with extraordinarily poor endometrial quality, despite maximal standard therapy with estrogen and vasodilator therapy. All four without G-CSF perfusion in all likelihood would have experienced cycle cancellation or other unsatisfactory alternative treatments, reducing pregnancy chances and increasing costs as well as emotional distress.

These cases are reported ahead of two ongoing, prospectively randomized studies of G-CSF because of

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    N.G. has nothing to disclose. A.V. has nothing to disclose. D.H.B. has nothing to disclose.

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