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Title

THE ROLE OF G-CSF IN RECURRENT IMPLANTATION FAILURE: A RANDOMIZED DOUBLE BLIND PLACEBO CONTROL TRIAL

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 Start Page 737 | End Page 742

Abstract

 Background: Recurrent IMPLANTATION FAILURE (RIF) is the absence of IMPLANTATION after three consecutive In Vitro Fertilization (IVF) cycles with transferring at least four good quality embryos in a minimum of three fresh or frozen cycles in a woman under 40 years. The definition and management of RIF is under constant scrutiny.Objective: To investigate the effects of Granulocyte colony stimulating factor (GCSF) on RIF, PREGNANCY RATE, abortion rate and IMPLANTATION rates.Materials and Methods: A double blind placebo controlled randomized trial was conducted at two tertiary university based hospitals. One hundred patients with the history of RIF from December 2011 until January 2014 were recruited in the study.G-CSF 300μg/1ml was administered at the day of oocyte puncture or day of progesterone administration of FET cycle. Forty patients were recruited at G-CSF group, 40 in saline and 20 in placebo group.Results: The mean age for whole study group was 35.3±4.2 yrs (G-CSF 35.5±4.32, saline 35.3±3.98, placebo 35.4±4.01, respectively). Seventeen patients had a positive pregnancy test after embryo transfer [10 (25%) in G-CSF; 5 (12.5%) in saline; and 2 (10%) in placebo group]. The mean of abortion rates was 17.6% (3), two of them in G-CSF, one in saline group. The IMPLANTATION rate was 12.3% in G-CSF, 6.1% in saline and 4.7% in placebo group.Conclusion: G-CSF may increase chemical pregnancy and IMPLANTATION rate in patients with recurrent IMPLANTATION FAILURE but clinical PREGNANCY RATE and abortion rate was unaffected.Many studies have focused on male infertility. There is limited evidence about the influence of nutrition on quality of semen. Approximately, 30-80% of infertility cases are caused by oxidative stress and decreased level of seminal total antioxidant capacity. This study was aimed to review the effects of oral antioxidant supplements on improving major semen parameters such as sperm concentration, motility, morphology, DNA damage, and fertility rate. Data were extracted from PubMed and Google scholar database by using the terms "antioxidant", "multivitamin", "carnitine", "CoQ10", "vitamin C", "vitamin E", "zinc", "folic acid", "N-acetyl cysteine" and "selenium" combined with "male infertility", "semen", and "sperm" to generate a set of relevant citations. Supplements such as CoQ10 and alpha-tocopherol significantly improve sperm count. Also, carnitine has positive effects on sperm motility and morphology. Simultaneous administration of vitamin E and vitamin C reduces the sperm DNA damage. However, in some studies, one or more factors have not changed substantially. In most of the studies, antioxidant supplementation improved the number, motility, morphology and sometimes DNA integrity of sperm. The present study showed that antioxidant supplements, especially a combination of antioxidants such as vitamin C, vitamin E, and CoQ10 intake can effectively improve semen parameters in infertile men.

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