G CSF to help endometrium thickness

annarosie

1 Posts
Reply Posted on: Jan 16, 2012 at 11:50am
Dear Dr Braverman,

I am interested in your views on what could be a beneficial treatment for me since I have a problematic thin endometrium whilst having Donor Egg IVF.

My diagnosis in May 2011 was Premature menopause after 5 months of no period after coming off the pill (Microgynon) in January 2011.I had previously taken Microgynon for 6 years approx. from 2005 – to 2011

From age 15 to age 16 had first year of periods. Very heavy bleeding and not 28 day cycle. My Doctor put me onto the pill to regulate cycle for 6 months. I came off the pill until 2005 and had 2 years of 'healthy' lighter bleeds every 28 days approx..

1st DE IVF Cycle at Instituto Marques – End September/October 2011.
Dosage – Oestrogen patches, 100mg x 2 . changed every 72 hours.
Increased to 3x patches changed every 72 hours.
My endometrium thickness on Day 14 – 4.9mm

2nd DE IVF Cycle at Serum – November 2011.
Dosage – (Day 2 – 6) – 6mg Oestrogen tablets
(Day 7 – 9) – 12mg Oestrogen tablets
(Day 9 – 12) – 16mg Oestrogen tablets
400mg follic acid and 75mg baby aspirin. Per day
Lining thickness on (Day 12) – 6.8mm
Lining thickness at transfer (after 2.5 days of progesterone pessaries) – 6.4mm

Implantation did occur – appears only partial
Results. A slowly increasing Beta HCG from day 8 post transfer to day 16 post transfer. Deemed a non-viable pregnancy.

HysteroscopyOn 10th December 2011
Results : My lining seemed very fragile and thin.
There was a lot of 'old lining tissue'
There was no evidence of infection.
The uterus was atrophic.
Implantation cuts were made.

Immune tests carried out.
Bacterial InfectionSome non-identifiable vaginal infection exists - this result was from test for Gardnerella vaginalis and Atopobium vaginae which were not detected but there was identified to be a change in vaginal flora composition indicating vaginal infection.

Blood clotting factors
Result was a relatively increased genetic predisposition to thrombophilia compared to the general population.

Hidden C – Chlamydia in menstrual blood
Negative

Mycoplasma in menstrual blood
Negative

NK Cells
A normal range of overall % but CD4+/CD8+ ratio is higher than the desired value for ivf.

Partner Sperm fragmentation
Suggested normal level of DNA fragmentation


1st Mock Cycle – December 2011
This cycle was useless as I took progesterone by accident instead of oestrogen through half of cycle.
Endometrium of 3.2mm on day 12.


2nd Mock Cycle – January 2012

(Day 2 –Day 5) 3 white cyclacur orally and 2 vaginally
(Day 6- Day 12) 5 white cyclacur orally and 3 vaginally

1 VIAGRA cream (100mg) in the morning and 1 at night

400mg follic acid and 75mg baby aspirin. Per day

Lining thickness on (Day 12) – 4.6mm

History Of Partner's Fertility
July 2011 – Semen Analysis showed 6% Normal Morphology
November 2011 – Semen Analysis showed 14% Normal Morphology.



In considering all of this history, what do you think the problem could be?
Does it appear I have a lower number of oestrogen receptors? Could these receptors now be blocked?
Could decreasing/stopping oestrogen treatment for a time period 'UN-block' receptors?

Do you think G CSF treatment with you could help to thicken my lining?

If so does it appear that Intra-Uterine treatment would be more beneficial than injections only?

My endometrium lining thickness appears to be our main obstacle at present. We have not had any other issues preventing us pursuing further Donor Egg IVF cycles.


Thankyou AR

Dr. Braverman

1999 Posts
RE: G CSF to help endometrium thickness Posted on: Jan 16, 2012 at 9:45pm
I believe I answered an email from you as well. I think you have to consider immune issues as well as implantation issues here. the early POF is a signal we may be dealing with both. I would be happy to help you , and yes neupogen may help you with both problems if we find an immune issue as well. but you may need subcutaneous injections along with a flush. Please call my office and we can arrange a skype consultation.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.