title: Granulocyte macrophage colony stimulating factor supplementation in culture media for subfertile women undergoing assisted reproduction technologies: a systematic review.
abstract: Granulocyte macrophage colony stimulating factor (GM-CSF) is a cytokine/growth factor produced by epithelial cells that exerts embryotrophic effects during the early stages of embryo development. We performed a systematic review, and six studies that were performed in humans undergoing assisted reproduction technologies (ART) were located. We wanted to evaluate if embryo culture media supplementation with GM-CSF could improve success rates. As the type of studies and the outcome parameters investigated were heterogeneous, we decided not to perform a meta-analysis. Most of them had a trend favoring the supplementation with GM-CSF, when outcomes were measured in terms of increased percentage of good-quality embryos reaching the blastocyst stage, improved hatching initiation and number of cells in the blastocyst, and reduction of cell death. However, no statistically significant differences were found in implantation and pregnancy rates in all apart from one large multicenter trial, which reported favorable outcomes, in terms of implantation and live birth rates. We propose properly conducted and adequately powered randomized controlled trials (RCTs) to further validate and extrapolate the current findings with the live birth rate to be the primary outcome measure.
authors.affiliation: Assisted Reproduction Unit, Third Department of Obstetrics and Gynecology, University of Athens, Rimini 1, Chaidari, 12642 Athens, Greece.
authors.forename: Charalampos
authors.initials: C
authors.lastname: Siristatidis
authors.forename: Paraskevi
authors.initials: P
authors.lastname: Vogiatzi
authors.forename: George
authors.initials: G
authors.lastname: Salamalekis
authors.forename: Maria
authors.initials: M
authors.lastname: Creatsa
authors.forename: Nikos
authors.initials: N
authors.lastname: Vrachnis
authors.forename: Demián
authors.initials: D
authors.lastname: Glujovsky
authors.forename: Zoe
authors.initials: Z
authors.lastname: Iliodromiti
authors.forename: Charalampos
authors.initials: C
authors.lastname: Chrelias