Abstract


OBJECTIVE: To compare the efficacy of addition of granulocyte macrophage colony stimulating factor (GMCSF) or hyaluronan in transfer media over conventional cleavage transfer media on implantation and clinical pregnancy rate in day3 frozen cycles in in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) cycles.
DESIGN: A prospective observational study done between January 2014 to May 2016. view more

OBJECTIVE: To compare the efficacy of addition of granulocyte macrophage colony stimulating factor (GMCSF) or hyaluronan in transfer media over conventional cleavage transfer media on implantation and clinical pregnancy rate in day3 frozen cycles in in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) cycles.
DESIGN: A prospective observational study done between January 2014 to May 2016.
MATERIALS AND METHODS: A total of 233 patients with ≥ 2embryo transfer (ET) failure (fresh and frozen) undergoing day3 frozen ET were included in the study. Endometrium was prepared using oral estradiol from day 2 of cycle. Endometrial thickness was measured using transvaginal ultrasound from day 12 onwards. Progesterone was administered when endometrial thickness reached ≥7 mm. Patients were divided into three groups: Group A (n=73) had ET with media enriched with 2 ng/ml of GMCSF, Group B (n=78) with 0.5 mg/ml hyaluronan containing transfer media and Group C (n=87) had transfer with conventional cleavage media. Embryos were preincubated with GMCSF or hyaluronan containing media in Group A & B for 30 min before ET. Luteal support was given and serum βhCG estimated on day 14 of ET. Clinical pregnancy was confirmed by transvaginal ultrasound after 4 weeks of ET. Implantation rate, clinical pregnancy and live birth rates were main outcome measures. Statistical analyses were applied using chi-square and t-test, as applicable.
RESULTS: Baseline clinical parameters and grade1 embryo transferred were found to be comparable in all three groups. A significant increase in implantation rate was observed in group A (23.97%) and group B (17.31%) as compared with group C (9.2%) (p<0.01). Clinical pregnancy rate was also found to be significantly higher in group A (38.36%) and B (30.77%) compared to group C (17.24%) (p<0.05). Live birth rate in group A (24.66%) and B (23.08%) was significantly higher than Group C (11.49%).
CONCLUSIONS: We observed that transfer media with GMCSF or hyaluronan for frozen day3 ET may improve implantation and clinical pregnancy rates. Further, GMCSF treatment showed better implantation and clinical pregnancy rates than hyaluronan treated transfer media. This positive result may be due to effect of GMCSF on embryo development and improved endometrial receptivity.

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