Document Type : Original Article
Authors
1
Mansoura Integrated Fertility Center, Mansoura
2
Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Zagazig
3
Department of Zoology, Faculty of Science, Mansoura University
10.21608/mjb.2021.460022
Abstract
Several studies in both animals and humans indicate that supplementation of in vitro culture media with cytokines and growth factors can improve pre-implantation embryo development, blastocyst formation rates, ongoing pregnancy rates and reduce pregnancy loss as well. Objective: This study was designed to evaluate the impact of adding combination of three cytokines (granulocyte-macrophage colony-stimulating factor GM-CSF, heparin-binding epidermal growth factor-like growth factor HB-EGF, and leukemia inhibitory factor LIF) into human embryo in vitro culture medium on preimplantation embryo development, embryo quality and pregnancy outcomes after intracytoplasmic sperm injection (ICSI) in patient with history of recurrent pregnancy loss (RPL).
Study design, size, duration: This is a subgroup analysis of a prospective RCT (trial registration no:NCT04547699) including 136 women with a previous history of recurrent pregnancy loss (RPL) and treated by ICSI for other indications between September 2019 and August 2021 at Mansoura Integrated Fertility Center (MIFC), Mansoura, Egypt; and Rahem Fertility Center (RFC), Zagazig, Egypt.
Patients were randomized, and the culture medium were supplemented with three main protocols; group A, culture media prepared with the standard single step culture media (SSCM) plus 5 mg/ml HSA without CYK supplementation, group B prepared with (SSCM) supplemented by cytokines plus high protein (HSA) concentration (5 mg/ml) and the third group C, supplemented by cytokines plus low protein concentration (2.5 mg/ml HSA).
All women were followed-up to primary outcome, Ongoing pregnancy ≥ 12 weeks of gestation which was 25.5% (12/47) in group A of standard single step culture media (SSCM) combined with 5mg/ml HSA, without CYK supplementation, 39.1% (18/46) in group B prepared with (SSCM) supplemented by CYK plus (5mg/ml) HSA, and 51.1% (22/43) in the group C, (SSCM) supplemented by CYK plus (2.5mg/ml) HSA, giving a significant difference in group C when compared with group A (P =0.048). while comparable differences between grouops A vs B and B vs C, p = 0.29 and 0.18 respectively. Pregnancy loss rate (PLR) was significantlly lower in group C when compared with group A, p =0.009. PLR was comparable between group A vs B (p =0.186) and B vs C (p =0.104). Our results indicated that, integration of cytokines and growth factors combined with low HSA concentration into ICSI culture media has significant benefical effect on cycle outcome in cases with history of RPL
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