Effect of Colony Stimulating Factor on Poor Endometrial Development During IVF

Study Overview
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Brief Summary
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The purpose of this study is to investigate the effect of G-CSF on endometrial thickness in women who have failed reaching minimal endometrial thickness by standard treatments, to assess how many reach embryo transfer and what implantation and pregnancy rates are in comparison to control patients. The study will be conducted in women undergoing transfer of previously cryopreserved embryos or undergoing transfer of embryos from donor eggs.

Detailed Description
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Objective: To investigate the effect of treatment with CSF : A placebo controlled double blinded crossover study. Design: Crossover Randomized Control Trial Setting: Academically affiliated private infertility centers Subjects: Female IVF patients of all ages who are willing to be randomized to treatment and, in either IVF treatment, frozen embryo cycles (FET) or donor IVF cycles (D-IVF), 5 days before ET, have inadequate endometrial thickness. Interventions: Subjects receive transvaginally, utilizing an insemination catheter, 2 slow intrauterine lavages with CSF-1 (Neupogen or generic, 300ug in 1 ml) 5 and 3 days, respectively, before embryo transfer and controls receive 1 ml of saline instead. Patients who do not become pregnant will after one month washout times continue treatment in the opposite study arm if they so choose and if they have remaining embryos. Main Outcome Measures: Number of patients reaching embryo transfer with adequate endometrial thickness of at least 7mm. Second Outcome Measures: Implantation and pregnancy rates.. Statistical and Power considerations: This is a Randomized Controlled Trial (RCT) with two study arms and panned crossover. Patients will be randomly assigned to Study group A or B according to a computer generated randomization table with 50:50 distributions. The study will test the null hypothesis that there is no difference in the transfer rates between the two groups. Transfer is only possible if the endometrial thickness reaches 7 mm or more. Order of treatment ab v ba will be added to the models as a separate factor and each phase will be analyzed as separate treatment strata. The investigators are planning a study of independent cases and controls with 1 control per case. Prior data indicate that the transfer rate among controls is < 1%. If the true transfer rate for experimental subjects is 25%, the investigators will need to study 38 experimental subjects and 38 control subjects to be able to reject the null hypothesis that the transfer rates for experimental and control subjects are equal with probability (power) 0.8. The Type I error probability associated with this test of this null hypothesis is 0.05. We will use a continuity-corrected chi-squared statistic or Fisher's exact test to evaluate this null hypothesis. There will be a planned interim analysis after 20 participants have completed the trial and if significant effects are observed the trial may be terminated at that time. The power to detect a difference in this interim analysis is only 42.6%.

Official Title
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G-CSF and Endometrial Growth, Embryo Implantation and Pregnancy Following FET or Donor ET

Conditions
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Infertility, Female

Intervention / Treatment
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* Drug: G-CSF
* Drug: Saline


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patient's preparing for invitro fertilization and embryo transfer with endometrial growth of less than 7 mm, unresponsive to standard treatment Exclusion Criteria: Sickle Cell disease Renal insufficiency Upper respiratory infection or Pneumonia Chronic Neutropenia Known Past or present malignancy

Ages Eligible for Study
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Minimum Age: 21 Years
Maximum Age: 45 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: G-CSF<br>G-CSF 300 units administered by trans-cervical infusion one time on day of hCG trigger for Ovulation | Drug: G-CSF<br>* One infusion of G-CSF 300 units administered by intrauterine infusion<br>* Other names: NEUPOGEN (Filgrastim);|
| Placebo Comparator: Saline<br>Saline administered by trans-cervical infusion one time on day of hCG trigger for ovulation | Drug: Saline<br>* One intrauterine saline infusions of 1 cc<br>* Other names: 0.91% w/v of NaCl, about 300 mOsm/L;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Endometrial Thickness | Thickness of the endometrium on the day of embryo transfer | Day of embryo transfer | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Implantation Rate | Number of gestational sacs per number of embryos transferred in each treatment group | 28 days after embryo transfer | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Thin Endometrium, Asherman's Syndrome, Endometrial Scarring