Clinical use of colony-stimulating factor-1 in ovulation induction for poor responders.

摘要

OBJECTIVE: To evaluate the benefit of colony-stimulating factor-1 (CSF-1) adjuvant therapy to poor responders during a controlled ovarian hyperstimulation (COH) cycle. DESIGN: Prospective clinical study. SETTING: University hospital, general hospital, and private IVF clinic in Japan. PATIENT(S): Thirty normogonadotropic patients who did not respond to conventional COH protocols. INTERVENTION(S): Eight million units of recombinant human CSF-1 were administered IV every other day during ovarian stimulation using FSH or hMG to 30 normogonadotropic poor responders. Serum CSF-1 concentrations were assayed on day 3. Additional studies were performed in a private IVF clinic on 27 poor responders with low serum CSF-1 levels. MAIN OUTCOME MEASURE(S): Pregnancy rates (PR). In addition, number of mature follicles, cycle cancellations, amount of required gonadotropins were documented. RESULT(S): Significantly more mature follicles, fewer cycle cancellations, and lower amounts of required gonadotropins were seen inthe group treated with CSF-1. Five (16.7%) pregnancies were achieved. The CSF-1-effective patients displayed significantly lower serum CSF-1 concentrations. In a private IVF clinic, CSF-1 treatment increased the number of mature oocytes, fertilized eggs, and transferred embryos. Cycle cancellations decreased from 18.5%-3.7%; 11 pregnancies (40.7%) resulted from treatment. CONCLUSION(S): Concomitant administration of CSF-1 and hMG improved follicle developments, especially in patients with low serum CSF-1 levels in the early follicular phase.