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International Journal of Endocrinology
Volume 2013, Article ID 704967, 6 pages
Review Article

Granulocyte Macrophage Colony Stimulating Factor Supplementation in Culture Media for Subfertile Women Undergoing Assisted Reproduction Technologies: A Systematic Review

1Assisted Reproduction Unit, Third Department of Obstetrics and Gynecology, University of Athens, Rimini 1, Chaidari, 12642 Athens, Greece
2Second Department of Obstetrics and Gynecology, Aretaieion Hospital, University of Athens, Vas Sofias 76, 11528 Athens, Greece
3Médico Especialista en Medicina Reproductiva (SAMeR), Especialista Universitario en Ginecología y Obstetricia, Magíster en Efectividad Clínica, Viamonte 1432, Buenos Aires, Argentina
4Third Department of Obstetrics and Gynecology, University of Athens, Attikon Hospital, Rimini 1, Chaidari, 12642 Athens, Greece

Received 19 November 2012; Revised 9 January 2013; Accepted 26 January 2013

Academic Editor: Jack R. Wall

Copyright © 2013 Charalampos Siristatidis et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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.