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.