Treatment Of Thin Endometrium Using Intrauterine Perfusion Of Granulocyte Macrophage Colony-Stimulating Factor During Frozen-Thawed Embryo Transfer Cycles

BackgroundThe most commonly used assisted reproductive technologies for the treatment of infertility are in vitro fertilization(IVF)and intracytoplasmic sperm injection(ICSI),however,the live birth rate generally does not exceed 50%.Embryo quality,endometrial receptivity and the interaction between embryo and maternal endometrial are important factors affecting pregnancy,and endometrial receptivity is a key factor for embryo implantation and pregnancy maintenance.A large number of studies have shown that endometrial thickness is an independent factor affecting pregnancy outcomes,and thin endometrium is an important prognostic factor for adverse pregnancy outcomes.It is generally considered that the endometrial thickness<7mm is a thin endometrium.Current treatments for thin endometrium are limited and specific treatments are lacking.Intrauterine infusion of granulocyte macrophage-colony stimulating factor(GM-CSF)is one of the emerging treatment methods,but its effectiveness remains to be confirmed by research.ObjectiveTo evaluate the effects of intrauterine infusion of GM-CSF on endometrial thickness,pregnancy outcomes and obstetric-related outcomes in patients with thin endometrium during frozen-thawed embryo transfer(FET)cycles.MethodsTwo-hundred eight infertile women with thin endometrium were included in this retrospective cohort study.One-hundred four women underwent intrauterine perfusion of GM-CSF on days 7 to 10 of menstruation during the FET cycle;these women comprised the GM-CSF group.The other 104 women without intrauterine perfusion of GM-CSF comprised the control group.We divided the GM-CSF group into two subgroups based on whether they conceived(GM-CSF conception subgroup&GM-CSF non-conception subgroup).We also divided the GM-CSF group into three subgroups based on the different endometrial preparation schemes used during the FET cycles(Natural cycle、Hormone replacement therapy cycle&Ovulation induction cycle).ResultsIn the baseline characteristics and demographics of the GM-CSF group and the control group,no statistically significant differences were observed between groups except for the cause of infertility.Before GM-CSF perfusion,the EMT of the GM-CSF group and that of the control group were significantly different(0.60[0.50-0.65]vs 0.70[0.65-0.75];p<0.001).After perfusion,the EMT of the GM-CSF group increased significantly(0.60[0.50-0.65]vs 0.70[0.60-0.80];p<0.001)and reached the EMT of the control group.When comparing the GM-CSF subgroups,we observed no differences in the EMT before GM-CSF perfusion,no differences in the EMT after GM-CSF perfusion,and no differences in the EMT increase.No significant differences were observed in terms of the biochemical pregnancy rates,clinical pregnancy rates,biochemical pregnancy loss rates,first trimester pregnancy loss rates,second trimester pregnancy loss rates,live birth rates,preterm delivery rates,cesarean delivery rates,hypertensive disorder rates,and gestational diabetes mellitus rates between the the GM-CSF and control groups.There were no significant differences in the results of the univariate regression analysis of GM-CSF perfusion,pregnancy outcomes,and obstetric outcomes.After adjusting for confounding factors,causes of infertility,age,AMH and FSH,there were still no significant differences in the pregnancy or obstetric outcomes of the GM-CSF and control groups.ConclusionsIntrauterine perfusion of GM-CSF can increase the EMT of patients with thin endometrium during the FET cycle.However,it has no effect on pregnancy outcomes and obstetric outcomes.