2. Role of subcutaneous G CSF
infusion in thin endometrium
Dr Kaberi Banerjee
Dr Bhavana Singla
Dr Priyanka Verma
Advance Fertility and Gynae Centre,
6, Ring Road, Lajpat Nagar 4, New Delhi 110024

3. Endometrial thickness
• Maximal distance b/w
echogenic interfaces of
endometrium and
myometrium in plane of
central longitudinal axis of
the uterus
• Assess endometrial
receptivity

4. Thin endometrium (TEM)
• TEM <7 mm
– During fresh embryo transfer
cycles (on HCG day)
– Induced ovulation FET cycles (on
ovulation day with normal serum
oestradiol level)
– HRT cycles (after 10 days and the
maximum dose of oral oestradiol
valerate 5 to 7 mg BD)
El-Toukhy et al., 2008; Kumbak et al., 2009;
Wu Y et al., 2014

5. Granulocyte colony‐stimulating factor
(G‐CSF)
• Hematopoietic‐specific
cytokine
• MOA
– Increases endometrial stromal
cell decidualization mediated
through cAMP by apocrine and
paracrine action
– Inducing proliferation and
differentiation of endometrium

6. G‐CSF
• Route of administration
– Subcutaneous
– Intrauterine
• Dose – 300 mcg/ml per
injection
• Timing
– Given after 12 to 13 days of
estradiol, HCG day, OPU day
• Effects come in 48 to 72 hrs

7. • To assess the role of
subcutaneous
granulocyte colony-
stimulating factor (G-
CSF) in thin
endometrium cases.

8. Materials and Methods
• Design: Retrospective analysis
• Subjects: 107 infertile females with thin
endometrium (< 7 mm) on Day 12 or 13
undergoing ART cycles
• Age group: 23 to 40 years
• Duration: 6 months
• Groups: Group 1 (with G CSF) & Group 2
(without G CSF)

9. Materials and Methods
• Group 1
– 48 females,
– S/C infusion of G CSF (300 mcg/ml) was given at
10th or 12th day + sildenafil 50 mg + aspirin 75 mg
– Repeated in 72 hours - if lining was not > 7 mm
• Group 2
– 69 females
– Only sildenafil + aspirin
• Assessment of efficacy of G CSF - By
pregnancy outcome

10. Criteria of Embryo Transfer
• Embryo transfer performed when
– Thickness >7.5 mm
– Subjective improvement of echotexture in 2D USG
• Cancellation of ET
– In group 1 – 4 cases
– In group 2 – 15 cases

11. Results
• No difference in two groups regarding
demographic variables, egg reserve, sperm
parameters, number of embryos transferred
and embryo quality
• Pregnancy rate
– Group 1 - 59% (26 out of 44 cases)
– Group 2 - 27% (12 out of 44 cases)
• p value < 0.0001 (Significant)

12. Pregnancy Rates
59%
27%
0
5
10
15
20
25
30
Group 1 Group 2
p value < 0.0001

16. • Limitation
– Need more larger studies
– Check doppler flows in endometrium

17. Conclusion
• First study in India - showed subcutaneous
role of G CSF in thin endometrium
• Huge promising role in improving fertility outcome in
widely prevalent cases of endometritis and thin
endometrium