Combined intrauterine and subcutaneous rhG-CSF boosts live birth rates in persistent chronic endometritis

Recurrent pregnancy failure, including implantation failure and recurrent miscarriage, is a devastating challenge for many couples, often linked to underlying endometrial issues. Chronic endometritis (CE), characterized by persistent inflammation of the uterine lining, is a frequently overlooked cause, affecting a significant portion of women experiencing these failures. Current standard-of-care often involves antibiotic therapy, but a substantial number of patients experience persistent CE, indicating a need for more effective adjunctive treatments. Granulocyte colony-stimulating factor (G-CSF) and its recombinant human form, rhG-CSF, are known for their roles in immune modulation, cell proliferation, and angiogenesis, making them promising candidates to improve endometrial receptivity and resolve inflammation in cases of persistent CE.

This retrospective study analyzed 125 patients diagnosed with chronic endometritis (CE), of whom 90 had persistent CE and a history of pregnancy failure. Patients were divided into three treatment groups: Group A received antibiotic therapy only; Group B received antibiotic therapy plus intrauterine infusion of recombinant human granulocyte colony-stimulating factor (rhG-CSF); and Group C received antibiotic therapy plus both intrauterine infusion and subcutaneous injection of rhG-CSF. Primary outcome measures focused on various pregnancy outcomes, including total pregnancy rate, clinical pregnancy rate, spontaneous abortion rate, live birth rate, and preterm birth rate. Secondary outcomes included histological cure rate of CE, adverse reactions, and adverse events. Biochemical and clinical pregnancy rates were calculated based on all patients in each group, while spontaneous abortion and live birth rates were calculated based on clinical pregnancies.

The study revealed significant differences in pregnancy outcomes across the treatment groups. Group C, receiving combined intrauterine and subcutaneous rhG-CSF alongside antibiotics, demonstrated a higher total pregnancy rate compared to Group A (antibiotics only), with no significant difference observed between Groups B and C. Similarly, the clinical pregnancy rate was higher in Group C than in Group A, with comparable rates between Group B and Group C. Notably, Group C exhibited the most favorable outcomes regarding pregnancy maintenance and live births. Preterm birth rates were also lower in both Group B and Group C compared to Group A, with no significant difference between the two rhG-CSF-treated groups. The abstract did not provide specific numerical percentages or p-values for these comparisons, but emphasized the relative improvements. While biochemical pregnancy rate was higher in Group B than Group C, this did not translate to superior clinical outcomes. The findings strongly suggest a benefit from rhG-CSF supplementation, particularly when administered via both routes. The abstract did not detail specific adverse reactions or events, or the histological cure rates for CE.

Group C, treated with combined intrauterine and subcutaneous rhG-CSF plus antibiotics, achieved the lowest spontaneous abortion rate and the highest live birth rate among all groups.