No Evidence that a Single Injection of Granulocyte Colony Stimulating Factor in the Late Follicular Phase Improves Fecundity with in Vitro Fertilization- Embryo Transfer in Women of Advanced Age with Diminished Oocyte Reserve
Jerome H Check* and Carrie Wilson
ABSTRACT
A woman with primary infertility and diminished oocyte reserve (DOR) had the luteinized unruptured follicle (LUF) syndrome. Egg release from the follicle was finally achieved using an experimental treatment of a single injection at the time of peak follicular maturation of granulocyte colony stimulating factor (G-CSF). Not only did she conceive at the age of 42 and deliver a healthy full-term baby, but she also conceived at age 46.5 and delivered a full-time baby when she released her egg on the first cycle with G-CSF followed by 10,000 IU of human chorionic gonadotropins. Complicating the advanced reproductive age was the fact that she was in overt menopause, but was able to mature a follicle by lowering the very high serum FSH with ethinyl estradiol thus up regulating down regulated FSH receptors and making her follicle sensitive again to endogenous gonadotropins. The odds of 2 out of 2 successful pregnancies despite these clinical circumstances, we have to wonder was the G-CSF injection that somehow so it reads injection somehow the cause of marked reduced fecundity with advancing age?
Thus, patients with marked DOR needing or wanting to do in vitro fertilization embryo transfer (IVF-ET) were given the option of adding G-CSF to their FSH receptor up-regulation follicle stimulation protocol. The 8.3% live delivered pregnancy rate (LDPR) in the 24 women who had an embryo transferred was not higher than the expected LDPR for similar type patients at our infertility center. Thus, we did not begin to undergo controlled trials with G-CSF based on the results of the pilot study.
