Treatment of G-CSF in unexplained, repeated implantation failure: A systematic review and meta-analysis - 19/07/20
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Abstract |
Backgroud |
Repeated implantation failure (RIF) is a stressful situation for subfertile women undergoing in vitro fertilisation (IVF) treatment and caregivers. Granulocyte-colony stimulating factor (G-CSF) seems to play an important role in assisted reproductive techniques. However, it is currently unknown whether G-CSF is effective in improving results for patients with RIF.
Objective |
To describe and summarize current evidence of the effect of the granulocyte colony stimulating factor (G-CSF) in treating RIF.
Method |
Relevant scientific literature was thoroughly searched by computer in domestic and foreign database from the inceptions to November 2019. And relevant randomized controlled trials (RCTs) assessing the efficacy of G-CSF in unexplained RIF were included. The meta-analysis was conducted by Stata 12. 0 software, and we estimated relative risks (RRs) and associated 95 % confidence intervals (CIs) of G-CSF on implantation rate (IR), the clinical pregnancy rate (CPR), the abortion rate (AR) in patients with unexplained RIF using fixed-effect model. Besides, Subgroup analysis was performed according to the different administration methods.
Result |
A total of eleven articles were included for the final meta-analysis with sample sizes ranging from 13 to 107 patients. The G-CSF was associated with an increased IR [RR = 2.346, 95 %CI (1.615–3.409), I2 = 0. 0%] and CPR [RR = 1.910, 95 %CI (1.562–2.337), I2 = 0.0 %] in patients with unexplained RIF. When further stratified by the method of administration, the subgroup analysis revealed that both intrauterine injection and subcutaneous injection are capable of improving IR[subcutaneous injection:RR = 2.400, 95 %CI (1. 268−4. 542), I2 = 0.0 %; intrauterine injection:RR = 2.317, 95 %CI (1.462–3.673), I2 = 0.0 %] and CPR[subcutaneous injection: RR = 2. 022, 95 %CI (1.443–2.832), I2 = 0. 0%; intrauterine injeciton: RR = 1.848, 95 %CI (1.438–2.376), I2 = 0. 0%]. G-CSF was not associated with AR in patients with unexplained RIF [RR = 2.092, 95 %CI (0.815–5.369), I2 = 0.0 %].
Conclusion |
The current evidence support G-CSF’s positive effect on the implantation rate and clinical pregnancy rate of patients with unexplained RIF, especially when administrated by subcutaneous injection. There is no conclusive evidence for the association between G-CSF and the abortion rate. Moreover, few of the included articles reported side effects of G-CSF, so its safety remains to be investigated.Thus, future research should evaluate.
Le texte complet de cet article est disponible en PDF.Abbreviation : RIF, G-CSF, RCT, IR, CPR, AR, IVF-ET, ART
Keywords : Repeated implantation failure, Granulocyte colony stimulating factor, Implantation rate, Clinical pregnancy rate, Abortion rate, Meta-analysis
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