intrauterine GCSF and HCG

carnelian

14 Posts
Reply Posted on: Apr 22, 2012 at 7:43am
Dear Dr Braverman

I asked you previously about using HCG as an intrauterine wash (500IU) 10 minutes before embryo transfer - and you kindly let me know that you were trying it for some of your patients.

I also know about that case study that showed a benefit for 4 patients who had poor lining development using Neupogen 300mcg intrauterine wash 2-9 days before embryo transfer - they showed very fast improvement in lining thickness in only 2 days and achieved pregnancy for all 4 (poor prognosis) participants with lining issues.

I've also seen that there is an ongoing research trial recruiting patients in in New York to use 2 intrauterine washes of Neupogen 300mcg given 2 days apart to see if it improves pregnancy rate. Are you one of the clinics participating in that study? Do you know how many days after the last intrauterine neupogen wash the transfers are being done?

My other question is: if intrauterine GCSF is a can accelerate lining growth so rapidly/effectively, does that imply that temporarily the uterine environment must be subject to quite a powerful boost/disturbance in cytokines? Does that imply that it wouldn't be a good environment to transfer an embryo into immediately i.e., would your gut feeling be that embryo transfer should be delayed for around 2 or more days after intrauterine Neupogen?

The turkish HCG study suggests that an intrauterine infusion of HCG 500IU can safely (and helpfully) be done immediately prior to ET - but is your gut feeling the same as mine, that GCSF should not be used immediately before ET?

Do you think there would be any dis-advantage to adding HCG to the GCSF wash for ladies like me with thin lining providing its done at least 2 days before ET?

I really do appreciate the time you take to help me go through my ideas!

You joked last time that I should come and work for you. It must be a really exciting field/clinic to work in!

C x

Dr. Braverman

2026 Posts
RE: intrauterine GCSF and HCG Posted on: Apr 22, 2012 at 10:08am
G-CSF does not act by activating inflammatory cytokines , there is no evidence that it increases the amount of these cytokines locally . The high cytokines with estrogen stimulation have been shown , one of the reaons why with high responders with immune issues , it is best to transfer on a frozen cycle. I dont think the reason we have been using G-CSF so many days before transfer is due to a concern of cytokines but just the concern of excess fluid in the cavity from the treatment. This does not seem to be the case with HCG however as it has been used day of transfer, but evn when I use it I use it the day before.
I have had very good results with the G-CSF and have not had enough cases yet with HCG. HCG is not for uterine proliferation , only for known (or unknown or suspected) immune issues , here they have a similar mechanism to G-CSF by keeping dendritic cells in their immature state and preventing the message of inflammation to be transported to the lymph nodes(among other actions) .
Braverman Medical Team
Braverman Reproductive Immunology P.C.