Discussion
ovarian follicular degeneration, diabetes
MISCARRIAGE, DIABETES
This study suggests a novel, simple, and safe treatment for poor ovarian reserve. In such patients, G-CSF priming in 2 consecutive cycles preceding ART significantly improved fertilization and embryonic development attained by ART, increasing clinical and ongoing pregnancy rates following fresh ET. The cumulative live birth rate was significantly higher in the G-CSF group than in controls. G-CSF priming also significantly increased serum AMH, suggesting enhancement of preantral follicle growth. As G-CSF priming improved oocyte developmental competence without significantly increasing numbers of growing follicles and retrieved oocytes, G-CSF appeared to improve preantral follicle growth in terms of quality rather than quantity. This mechanism clearly differs from those previously suggested for improvement of implantation by G-CSF. We observed no effects of G-CSF priming on miscarriage rates or any association of G-CSF efficacy with KIR genotype.A variety of clinical effects of G-CSF have been reported. Administration of G-CSF accompanying ET was found to increase implantation rates and clinical pregnancy in ART patients with repeated implantation failure or endometrial thinning [An important difference in our therapeutic use of G-CSF from other reports involves the timing of the result. Previously reported effects of G-CSF occurred promptly, affecting the cycle in which G-CSF was administered. In contrast, we found that G-CSF priming showed novel delayed effects on embryonic development and pregnancy rate in a subsequent cycle. The significant increase in serum AMH and improvement of follicular development in our G-CSF group suggest preantral follicle growth enhancement as an underlying mechanism.In animal studies, G-CSF attenuated ovarian follicular degeneration and decrements of serum AMH in rats with experimental diabetes [G-CSF also promotes egress of bone marrow stem cells (BMSC) into peripheral blood [Clinical safety and tolerance of G-CSF treatment have been established in healthy bone marrow donors treated for 3 to 5 days [Platelet-rich plasma (PRP) injection into human ovaries has been reported to improve ovarian reserve markers and clinical pregnancy rates [