Intrauterine instillation of granulocyte colony stimulating factor for infertile women with thin endometrium in intrauterine insemination cycle: a non-randomized clinical trial

Background: Endometrial thickness is one of the major factors for a receptive endometrium and successful implantation. Thin endometrium, generally measuring <7 mm are thought to be less able to support implantation and pregnancy. Several adjuvants have been investigated for their efficacy on thin endometrium in assisted reproductive technology. Granulocyte colony stimulating factor (G-CSF) is a glycoprotein that promotes endometrial stromal cell decidualization via cyclic adenosine monophosphate mediator and induces endometrial proliferation and differentiation. This study was done to evaluate the effect of G-CSF in improving endometrial thickness and pregnancy rate in infertile patients undergoing stimulated IUI (intrauterine instillation) having thin endometrium.Methods: This was a non-randomized clinical trial done among 40 infertile patients with thin endometrium (<7 mm) on the day of ovulation trigger in stimulated IUI patients. Study subjects were non randomly allocated into 2 groups. In group A 20 patients received intrauterine instillation of G-CSF (300 mcg/0.5 ml) via intrauterine catheter on triggering day and in group B another 20 patients received intrauterine instillation of 0.5 ml normal saline in the same procedure. After 48 hours endometrial thickness was measured in both groups. IUI was done on the same day. Pregnancy was detected by serum beta hCG level after 14 days of IUI.Results: In both groups most of the respondents were aged between 30-34 years, 14 (70%) in group A and 11 (55%) in group B. The mean±SD of age 32.4±3.1 in group A, 32.2±3.4 in group B and P value was 0.9. In group A the minimum endometrial thickness on day of ovulation trigger was 4.4 mm and after 48 hours of treatment with G-CSF, it was found 6.3 mm. The maximum endometrial thickness recorded in group A was 6.9 mm and it also increased to 8.7 mm after G-CSF treatment and followed by in group B min thickness 4.8 mm increase to 5.2 mm and max thickness 6.8 mm increased to 8.7 mm. The mean±SD of ET (mm) on the day of ovarian trigger was 5.8±0.8 which increased to 7.4±0.8 in group A and followed by 5.9±0.6 to 7.1±0.9 in group B. ET mean change (mean±SD) for group A was 1.6±0.7 which was greater than the group B 1.3±0.8. Pregnancy rate was 2 (10%) in group A and 1(5%) in group B.Conclusions: Mean increase in endometrial thickness and pregnancy rate was higher in G-CSF group than normal saline group, but the difference was not statistically significant.