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

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 in the 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.

Key Words: CSF-1, macrophage, follicle development, ovulation induction, poor responder