G-CSF Intrauterine for Thin Endometrium, and Pregnancy Outcome

  • Ensieh Tehraninejad Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran
  • Fateme Davari Tanha Department of Reproductive Endocrinology, Women’s Hospital, Tehran University of Medical Sciences, Tehran, Iran
  • Ebrahim Asadi Department of Reproductive Biology, Women’s Hospital, Tehran University of MedicalSciences, Tehran, Iran
  • Koorosh Kamali Department of Public Health, School of Public Health, Zanjan University of Medical Sciences, Zanjan, Iran
  • Elham Aziminikoo Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran
  • Elahe Rezayof Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran
Keywords: ART cycle, Thin endometrium, G-CSF


Objective:To evaluate effects ofG-CSF on a cancelled ART cycle due to thin endometrium.Materials and methods:In a nonrandomized clinical trial from January 2011 to January 2013 in two tertiary university based hospitals fifteen patients undergoing embryo transfer and with the history of cycle cancellation due to thin endometrium were studied. Intrauterine infusion of G-CSF was done on the day of oocyte pick-up or 5 days before embryo transfer. The primary outcome to be measured was an endometrium thickened to at least 6 mm and the secondary outcome was clinical pregnancy rate and consequently take-home baby. All previous cycles were considered as control for each patient.Results:The G-CSF was infused at the day of oocyte retrieval or 5 days before embryo transfer. The endometrial thickness reached from3.593±0.251 mm to 7.120±0.84 mm. The mean age, gravidity, parity, and FSH were 35.13± 9.531 years,3, 1 and32.78± 31.10 mIU/ml, respectively. The clinical pregnancy rate was 20%, and there was one missed abortion, a mother death at 34 weeks, and a preterm labor at 30 weeks due to PROM.Conclusion:G-CSF may increase endometrial thickness in the small group of patients who had no choice except cycle cancellation or surrogacy.


Senturk LM, Erel CT. Thin endometrium in assisted reproductive technology.Curr Opin Obstet Gynecol 2008;20:221-8.

Loke YW, King A, Burrows TD. Decidua in human implantation. Hum Reprod 1995;10 Suppl 2:14-21.

Zhou L, Li R, Wang R, Huang HX, Zhong K. Local injury to the endometrium in controlled ovarian hyperstimulation ycles improves implantation rates. Fertil Steril 2008;89:1166-76.

Barash A, Dekel N, Fieldust S, Segal I, Schechtman E, Granot I. Local injury to the endometrium doubles the incidence of successful pregnancies in patients undergoing in vitro fertilization. Fertil Steril 2003;79:1317-22.

Spandorfer SD, Barmat LI, Liu HC, Mele C, Veeck L, Rosenwaks Z. Granulocyte macrophage-colony stimulating actor production by autologous endometrial co-culture is associated with outcome for in vitro fertilization patients with a history of multiple implantation failures. Am J Reprod Immunol 1998;40:377-81.

Salmassi A, Schmutzler AG, Schaefer S, Koch K, Hedderich J, Jonat W, et al. Is granulocyte colonystimulating

factor level predictive for human IVF outcome? Hum Reprod 2005;20:2434-40.

Bakos O, Lundkvist O, Bergh T. Transvaginal sonographic evaluation of endometrial growth and texture in pontaneous ovulatory cycles--a descriptive study. Hum Reprod 1993;8:799-806.

Grow DR, Iromloo K. Oral contraceptives maintain a very thin endometrium before operative hysteroscopy. Fertil Steril 2006;85:204-7.

Zhang X, Chen CH, Confino E, Barnes R, Milad M,Kazer RR. Increased endometrial thickness is associated with improved treatment outcome for selected patients undergoing in vitro fertilizationembryo transfer. Fertil Steril 2005;83:336-40.

Esmailzadeh S, Faramarzi M. Endometrial thickness and pregnancy outcome after intrauterine insemination. Fertil Steril 2007;88:432-7.

Shapiro H, Cowell C, Casper RF. The use of vaginal ultrasound for monitoring endometrial preparation in a donor oocyte program. Fertil Steril 1993;59:1055-8.

Sundström P. Establishment of a successful pregnancy following in-vitro fertilization with an endometrial thickness of no more than 4 mm. Hum Reprod 1998;13:1550-2.

Ohno Y, Fujimoto Y. Endometrial oestrogen and progesterone receptors and their relationship to onographic appearance of the endometrium. Hum Reprod Update 1998 ;4 :560-4.

Weckstein LN, Jacobson A, Galen D, Hampton K,Hammel J. Low-dose aspirin for oocyte donation recipients with a thin endometrium: prospective,randomized study. Fertil Steril 1997;68:927-30.

Sher G, Fisch JD. Effect of vaginal sildenafil on the outcome of in vitro fertilization (IVF) after multiple IVF failures attributed to poor endometrial development. Fertil Steril 2002;78:1073-6.

Lédée-Bataille N, Olivennes F, Lefaix JL, Chaouat G, frydman R, Delanian S. Combined treatment by entoxifylline and tocopherol for recipient women with a thin endometrium enrolled in an oocyte donation programme. Hum Reprod 2002;17:1249-53.

Al-Ghamdi A, Coskun S, Al-Hassan S, Al-Rejjal R, Awartani K. The correlation between endometrial thickness and outcome of in vitro fertilization and embryo transfer (IVF-ET) outcome. Reprod Biol Endocrinol 2008;6:37.

Würfel W. Approaches to a better implantation. J Ass reprod Genet 2000;17:473.

Loureiro B, Bonilla L, Block J, Fear JM, Bonilla AQ,Hansen PJ. Colony-stimulating factor 2 (CSF-2) improves development and posttransfer survival of bovine embryos produced in vitro. Endocrinology 2009;150:5046-54.

Miyama M, Umesaki N, Kawabata M. Identification of the granulocyte colony-stimulating factor (G-CSF) producing cell population in human decidua and its biological action on trophoblast cell. Osaka City Med J 1998;44:85-96.

Uzumaki H, Okabe T, Sasaki N, Hagiwara K, Takaku F, Tobita M, et al. Identification and characterization of receptors for granulocyte colony-stimulating factor on human placenta and trophoblastic cells. Proc Natl Acad Sci U S A 1989;86:9323-6.

Check JH, Choe JK, Cohen R, Summers-Chase D.Failure to Increase the Thickness of Thin Endometria with intrauterine Infusion of Gamma Colony Stimulation Factor (G-CSF). Fertility and Sterility 2013; 99: S22.

Gleicher N, Vidali A, Barad DH. Successful treatment of unresponsive thin endometrium. Fertil Steril 2011;95:2123.

Gleicher N, Kim A, Michaeli T, Lee HJ, Shohat-Tal A, Lazzaroni E, et al. A pilot cohort study of granulocyte colony-stimulating factor in the treatment of unresponsive thin endometrium resistant to standard therapies. Hum Reprod 2013;28:172-7.

How to Cite
Tehraninejad E, Davari Tanha F, Asadi E, Kamali K, Aziminikoo E, Rezayof E. G-CSF Intrauterine for Thin Endometrium, and Pregnancy Outcome. J Fam Reprod Health. 9(3):107-112.
Original Articles