Uterine washes before transfers

ALI 12

7 Posts
Reply Posted on: Apr 14, 2012 at 4:39am
Hi Dr Braverman,

You recently discussed Neupogen with me as a possible treatment for my IVF cycle.

Over here (UK), there has been news coverage about a 'breakthrough in a fertility switch'. I was wondering what your views were about this?

Perhaps the UK is behind such discoveries and this is been a breakthrough elsewhere previously?!

In the study, it talks about a uterine regulator called SGK1. They discovered it was too high in infertile women/implantation failure women - and too low in RPL. They describe it influencing whether the endometrium allows an embryo to implant and that upregulating/downregulating it at different times in mice affected if implantation could initiate and if so, how well a pregnancy could then succeed.They link it to being regulated by progesterone amoungst other factors and its presence and level seems to affect the window of receptiveness. What caught my eye was their suggestion for treatment is a uterine wash: 'flushing of the uterine cavity with a selective SGK1 inhibitor prior to embryo transfer in IVF patients may faciliate implantation'. They talk about possible SGK1 inhibitors being 'heterocyclic indazole derivatives'.

Is the Neupogen wash one of these derivitives I wondered?!

I was interested to know what your opinion is about this research (I can post the link - the name I recognised is a Professor Quenby) and if the gcsf wash is in any way was like the uterine flush they are proposing?

Thank you in advance

(apologies if this was sent twice, I thought i'd posted/or deleted it at one point).

Dr. Braverman

2027 Posts
RE: Uterine washes before transfers Posted on: Apr 14, 2012 at 5:25am
no neupogen or G-CSF works by a different mechanism of cell proliferation and inhibition of dendritic cell maturation.(although no one has looked at its effect of SGK1) The SGK1 modulation is just one of many avenues being looked at , its never just as simple as looking at just one defect and treating it. We are far away from a therapeutic avenue here as over or under modulation can lead to miscarriage so will need quite some time to sort this out.

Also SGK1 is upregulated as well by progersterone , BHCG, and steroids such as prednisone and may help explain benefits of treatment of these modalities. We have started using intrauterine HCG to improve pregnancy rates but our data is still very limited.

I hope this helps.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.