Intrauterine administration of granulocyte colony-stimulating factor promotes the transformation of endometrium immune phenotype and the onset of pregnancy in patients with recurrent implantation failures.

AIM OF THE STUDY: The aim of the study was to determine the effectiveness of intrauterine administration of granulocyte-colony-stimulating factor (G-CSF) depending on immune phenotype of endometrium in patients with recurrent implantation failures in embryo transfer programs.

MATERIAL AND

METHODS

Patients with recurrent implantation failure underwent endometrial biopsy during the implantation window in an artificial cycle before and (in some patients) after intrauterine administration of G-CSF. Pregnancy and live birth rates were determined depending on the immune phenotype of the endometrium in patients with repeated implantation failures after intrauterine administration of G-CSF in an embryo transfer program. Flow cytometry was used to count the classes and subclasses of endometrial lymphocytes in endometrial tissue samples.

RESULTS

The endometria of patients who became pregnant as a result of embryo transfer after G-CSF irrigation of the uterine cavity showed significantly higher expression of HLA-DR on T cells and Th, and HLA-DR and CD16 on uterine natural killers (uNK). There was a high correlation between not transformed endometrium, that is, increased levels of HLA-DR (>55 %) and CD16 (>50 %) on uNK, with successful implantation after G-CSF irrigation of the uterine cavity (OR=7.700, p = 0.0174). In patients with a not transformed immune endometrial phenotype, the pregnancy (53.8 %) and live birth (46.1 %) rates were twice as high as those in patients with other variants of immune abnormalities or without immune profile changes (pregnancy and live birth rates - 19.2 %). Intrauterine G-CSF caused a significant decrease in the high expression of HLA-DR and CD16 in uNK cells without affecting other immune markers.

CONCLUSIONS

Elevated expression of HLA-DR and CD16 on uNK was associated with successful implantation after intrauterine use of G-CSF in embryo transfer program.