Successful treatment of unresponsive thin endometrium.

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.