The Effect of Intrauterine Autologous Platelet-Rich Plasma Infusion on Endometrial Thickness and Pregnancy Outcomes in Women With Thin Endometrium
INTRAUTERINE PRP INFUSION IN THIN ENDOMETRIUM
Keywords:
Embryo Transfer, Endometrium, Infertility, Platelet-Rich Plasma
Abstract
Aim: To investigate the efficacy of intrauterine administration of platelet-rich plasma (PRP) in a frozen-thawed embryo transfer (FET) cycle with a thin endometrium.
Material and Methods: This prospective cohort study was conducted at Maltepe University, Center for Reproductive Medicine. Intrauterine PRP administration was performed after hormonal therapy in patients whose cycles were previously cancelled due to thin endometrium. A total of 41 women participated in the study. Eighteen of them were in the PRP group (n: 18), and 23 of them formed the control group (n: 23). On the 11th day of hormone replacement therapy (HRT), intrauterine autologous PRP infusion was applied.
Results: At the beginning of the menstrual cycle, the control group's mean endometrial thickness (EMT) was 6.3 ± 0.5 mm, and the mean EMT of the PRP group was 6.2 ± 0.6 mm. Following the HRT, the mean EMT in control and PRP groups were 7.4 ± 0.8 mm and 8.4 ± 0.9 mm, respectively. EMT increased by 1.1 ± 0.7 mm in the control group and 2.2 ± 0.8 mm in the PRP group. The increase in the EMT of the PRP group was statistically significant compared to the control group (p< 0.05). Biochemical, clinical and ongoing pregnancy rates were slightly higher in the PRP group, but this increase was not statistically significant (p= 0.382, p= 0.238, p= 0.237, respectively).
Conclusion: Our study showed that intrauterine PRP administration significantly increases EMT. Moreover, PRP application increases the pregnancy rates in patients with thin endometrium, although this was not statistically confirmed.
Clinical Significance: Intrauterine administration of PRP has increased pregnancy rates in a FET cycle with a thin endometrium.
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References
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21 - Chang Y, Li J, Chen Y, et al. Autologous platelet-rich plasma promotes endometrial growth and improves pregnancy outcome during in vitro fertilization. Int J ClinExp Med. 2015;8(1):1286-1290. Published 2015 Jan 15.
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23 - Eftekhar M, Neghab N, Naghshineh E, Khani P. Can autologous platelet rich plasma expand endometrial thickness and improve pregnancy rate during frozen-thawed embryo transfer cycle? A randomized clinical trial. Taiwan J Obstet Gynecol. 2018;57(6):810-813. doi:10.1016/j.tjog.2018.10.007
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25 - Zadehmodarres S, Salehpour S, Saharkhiz N, Nazari L. Treatment of thin endometrium with autologous platelet-rich plasma: a pilot study. JBRA Assist Reprod. 2017;21(1):54-56. Published 2017 Feb 1. doi:10.5935/1518-0557.20170013
26 - Maleki-Hajiagha A, Razavi M, Rouholamin S, Rezaeinejad M, Maroufizadeh S, Sepidarkish M. Intrauterine infusion of autologous platelet-rich plasma in women undergoing assisted reproduction: A systematic review and meta-analysis. J ReprodImmunol. 2020;137:103078. doi:10.1016/j.jri.2019.103078
27 - Harmon K, Hanson R, Bowen J, Greenberg S, Magaziner E, Vandenbosch J, et al: Guidelines for the use of platelet rich plasma. https://www.scribd.com/document/159334949/206- ICMS-Guidelines-for-the-Use-of-Platelet- Rich-Plasma-Draftob-oasbonasdandbowndoww
28 - Christgau M, Moder D, Hiller KA, Dada A, Schmitz G, Schmalz G. Growth factors and cytokines in autologous platelet concentrate and their correlation to periodontal regeneration outcomes. J ClinPeriodontol. 2006;33(11):837-845. doi:10.1111/j.1600-051X.2006.00991.x
29 - Zhuang YW, Zeng YM, Chen YF, Zhang HP, Chen XY, Yang DY, Wu WJ. The effects of different activators on the release curve of human platelet-rich plasma. ZhonghuaJie He He Hu Xi ZaZhi. 2018;41(11):868-872. doi:10.3760/cma.j.issn.1001-0939.2018.11.008
30 - Amable PR, Carias RB, Teixeira MV, et al. Platelet-rich plasma preparation for regenerative medicine: optimization and quantification of cytokines and growth factors. Stem Cell Res Ther. 2013;4(3):67. Published 2013 Jun 7. doi:10.1186/scrt218
31 - Nazari L, Salehpour S, Hosseini MS, HashemiMoghanjoughi P. The effects of autologous platelet-rich plasma in repeated implantation failure: a randomized controlled trial. Hum Fertil (Camb). 2020;23(3):209-213. doi:10.1080/14647273.2019.1569268
32 - Kim H, Shin JE, Koo HS, Kwon H, Choi DH, Kim JH. Effect of Autologous Platelet-Rich Plasma Treatment on Refractory Thin Endometrium During the Frozen Embryo Transfer Cycle: A Pilot Study. Front Endocrinol (Lausanne). 2019;10:61. Published 2019 Feb 14. doi:10.3389/fendo.2019.00061
33 - Tehraninejad ES, Kashani NG, Hosseini A, Tarafdari A. Autologous platelet-rich plasma infusion does not improve pregnancy outcomes in frozen embryo transfer cycles in women with history of repeated implantation failure without thin endometrium. J ObstetGynaecol Res. 2021;47(1):147-151. doi:10.1111/jog.14445
2 - Liu KE, Hartman M, Hartman A, Luo ZC, Mahutte N. The impact of a thin endometrial lining on fresh and frozen-thaw IVF outcomes: an analysis of over 40 000 embryo transfers. Hum Reprod. 2018;33(10):1883-1888. doi:10.1093/humrep/dey281
3 - Jeon YE, Jung JA, Kim HY, et al. Predictive factors for pregnancy during the first four intrauterine insemination cycles using gonadotropin. GynecolEndocrinol. 2013;29(9):834-838. doi:10.3109/09513590.2013.808324
4- Weissman A, Gotlieb L, Casper RF. The detrimental effect of increased endometrial thickness on implantation and pregnancy rates and outcome in an in vitro fertilization program. FertilSteril. 1999;71(1):147-149. doi:10.1016/s0015-0282(98)00413-0
5 - Isaacs JD Jr, Wells CS, Williams DB, Odem RR, Gast MJ, Strickler RC. Endometrial thickness is a valid monitoring parameter in cycles of ovulation induction with menotropins alone. FertilSteril. 1996;65(2):262-266. doi:10.1016/s0015-0282(16)58082-0
6 - Ke H, Jiang J, Xia M, Tang R, Qin Y, Chen ZJ. The Effect of Tamoxifen on Thin Endometrium in Patients Undergoing Frozen-Thawed Embryo Transfer. Reprod Sci. 2018;25(6):861-866. doi:10.1177/1933719117698580
7 - Chen MJ, Yang JH, Peng FH, Chen SU, Ho HN, Yang YS. Extended estrogen administration for women with thin endometrium in frozen-thawed in-vitro fertilization programs. J Assist Reprod Genet. 2006;23(7-8):337-342. doi:10.1007/s10815-006-9053-1
8 - Hurst, BS, Bhojwani JT, Marshburn PB et al. Low-dose aspirin does not improve ovarian stimulation, endometrial response, or pregnancy rates for in vitro fertilization. J ExpClin Assist Reprod 2005; 2: 8. https://doi.org/10.1186/1743-1050-2-8
9 - Lebovitz O, Orvieto R. Treating patients with "thin" endometrium - an ongoing challenge. GynecolEndocrinol. 2014;30(6):409-414. doi:10.3109/09513590.2014.906571
10 - Sher G, Fisch JD. Effect of vaginal sildenafil on the outcome of in vitro fertilization (IVF) after multiple IVF failures attributed to poor endometrial development. FertilSteril. 2002;78(5):1073-1076. doi:10.1016/s0015-0282(02)03375-7
11 - Tehraninejad E, DavariTanha F, Asadi E, Kamali K, Aziminikoo E, Rezayof E. G-CSF Intrauterine for Thin Endometrium, and Pregnancy Outcome. J Family Reprod Health. 2015;9(3):107-112.
12 - Azizi R, Aghebati-Maleki L, Nouri M, Marofi F, Negargar S, Yousefi M. Stem cell therapy in Asherman syndrome and thin endometrium: Stem cell- based therapy. Biomed Pharmacother. 2018;102:333-343. doi:10.1016/j.biopha.2018.03.091
13 - Santamaria X, Cabanillas S, Cervelló I, et al. Autologous cell therapy with CD133+ bone marrow-derived stem cells for refractory Asherman's syndrome and endometrial atrophy: a pilot cohort study. Hum Reprod. 2016;31(5):1087-1096. doi:10.1093/humrep/dew042
14 - Ho M, Huang LC, Chang YY, et al. Electroacupuncture reduces uterine artery blood flow impedance in infertile women. Taiwan J Obstet Gynecol. 2009;48(2):148-151. doi:10.1016/S1028-4559(09)60276-X
15 - Hua X, Zeng Y, Zhang R, Wang H, Diao J, Zhang P. Using platelet-rich plasma for the treatment of symptomatic cervical ectopy. Int J Gynaecol Obstet. 2012;119(1):26-29. doi:10.1016/j.ijgo.2012.05.029
16 - Morelli M, Rocca ML, Venturella R, et al. Adjuvant use of platelet gel for wound breakdown prevention in advanced vulvar cancer surgery: a retrospective study. Int J Gynecol Cancer. 2013;23(8):1490-1494. doi:10.1097/IGC.0b013e3182a50517
17 - Behnia-Willison F, Pour NR, Mohamadi B, et al. Use of Platelet-rich Plasma for Vulvovaginal Autoimmune Conditions Like Lichen Sclerosus. PlastReconstrSurg Glob Open. 2016;4(11):e1124. Published 2016 Nov 23. doi:10.1097/GOX.0000000000001124
18 - Shirvan MK, Alamdari DH, Ghoreifi A. A novel method for iatrogenic vesicovaginal fistula treatment: autologous platelet rich plasma injection and platelet rich fibrin glue interposition. J Urol. 2013;189(6):2125-2129. doi:10.1016/j.juro.2012.12.064
19 - Melo P, Navarro C, Jones C, Coward K, Coleman L. The use of autologous platelet-rich plasma (PRP) versus no intervention in women with low ovarian reserve undergoing fertility treatment: a non-randomized interventional study. J Assist Reprod Genet. 2020;37(4):855-863. doi:10.1007/s10815-020-01710-z
20 - Liu KE, Hartman M, Hartman A. Management of thin endometrium in assisted reproduction: a clinical practice guideline from the Canadian Fertility and Andrology Society. Reprod Biomed Online. 2019;39(1):49-62. doi:10.1016/j.rbmo.2019.02.013
21 - Chang Y, Li J, Chen Y, et al. Autologous platelet-rich plasma promotes endometrial growth and improves pregnancy outcome during in vitro fertilization. Int J ClinExp Med. 2015;8(1):1286-1290. Published 2015 Jan 15.
22 - Chang Y, Li J, Wei LN, Pang J, Chen J, Liang X. Autologous platelet-rich plasma infusion improves clinical pregnancy rate in frozen embryo transfer cycles for women with thin endometrium. Medicine (Baltimore). 2019;98(3):e14062. doi:10.1097/MD.0000000000014062
23 - Eftekhar M, Neghab N, Naghshineh E, Khani P. Can autologous platelet rich plasma expand endometrial thickness and improve pregnancy rate during frozen-thawed embryo transfer cycle? A randomized clinical trial. Taiwan J Obstet Gynecol. 2018;57(6):810-813. doi:10.1016/j.tjog.2018.10.007
24 - Nazari L, Salehpour S, Hoseini S, ZadehmodarresSh, Azargashb E. “Effects of autologous platelet-rich plasma on endometrial expansion in patients undergoing frozen-thawed embryo transfer: A double-blind RCT,” Int J ReprodBioMed2019; 17: 443–448. https://doi.org/10.18502/ijrm.v17i6.4816
25 - Zadehmodarres S, Salehpour S, Saharkhiz N, Nazari L. Treatment of thin endometrium with autologous platelet-rich plasma: a pilot study. JBRA Assist Reprod. 2017;21(1):54-56. Published 2017 Feb 1. doi:10.5935/1518-0557.20170013
26 - Maleki-Hajiagha A, Razavi M, Rouholamin S, Rezaeinejad M, Maroufizadeh S, Sepidarkish M. Intrauterine infusion of autologous platelet-rich plasma in women undergoing assisted reproduction: A systematic review and meta-analysis. J ReprodImmunol. 2020;137:103078. doi:10.1016/j.jri.2019.103078
27 - Harmon K, Hanson R, Bowen J, Greenberg S, Magaziner E, Vandenbosch J, et al: Guidelines for the use of platelet rich plasma. https://www.scribd.com/document/159334949/206- ICMS-Guidelines-for-the-Use-of-Platelet- Rich-Plasma-Draftob-oasbonasdandbowndoww
28 - Christgau M, Moder D, Hiller KA, Dada A, Schmitz G, Schmalz G. Growth factors and cytokines in autologous platelet concentrate and their correlation to periodontal regeneration outcomes. J ClinPeriodontol. 2006;33(11):837-845. doi:10.1111/j.1600-051X.2006.00991.x
29 - Zhuang YW, Zeng YM, Chen YF, Zhang HP, Chen XY, Yang DY, Wu WJ. The effects of different activators on the release curve of human platelet-rich plasma. ZhonghuaJie He He Hu Xi ZaZhi. 2018;41(11):868-872. doi:10.3760/cma.j.issn.1001-0939.2018.11.008
30 - Amable PR, Carias RB, Teixeira MV, et al. Platelet-rich plasma preparation for regenerative medicine: optimization and quantification of cytokines and growth factors. Stem Cell Res Ther. 2013;4(3):67. Published 2013 Jun 7. doi:10.1186/scrt218
31 - Nazari L, Salehpour S, Hosseini MS, HashemiMoghanjoughi P. The effects of autologous platelet-rich plasma in repeated implantation failure: a randomized controlled trial. Hum Fertil (Camb). 2020;23(3):209-213. doi:10.1080/14647273.2019.1569268
32 - Kim H, Shin JE, Koo HS, Kwon H, Choi DH, Kim JH. Effect of Autologous Platelet-Rich Plasma Treatment on Refractory Thin Endometrium During the Frozen Embryo Transfer Cycle: A Pilot Study. Front Endocrinol (Lausanne). 2019;10:61. Published 2019 Feb 14. doi:10.3389/fendo.2019.00061
33 - Tehraninejad ES, Kashani NG, Hosseini A, Tarafdari A. Autologous platelet-rich plasma infusion does not improve pregnancy outcomes in frozen embryo transfer cycles in women with history of repeated implantation failure without thin endometrium. J ObstetGynaecol Res. 2021;47(1):147-151. doi:10.1111/jog.14445
Published
2023-03-18
How to Cite
1.
Gürsoy A, Sayin EU, Ozekici U. The Effect of Intrauterine Autologous Platelet-Rich Plasma Infusion on Endometrial Thickness and Pregnancy Outcomes in Women With Thin Endometrium. jms [Internet]. 2023Mar.18 [cited 2026Nov.15];26(1):28-4. Available from: https://jmsskims.org/index.php/jms/article/view/1256
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