A comparative evaluation of subendometrial and intrauterine platelet-rich plasma treatment for women with recurrent implantation failure

Uterine Biology

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VOLUME 2, ISSUE 3, P295-302, AUGUST 01, 2021

Authors:

Majiyd Abdul Noushin, M.D., M.R.C.P.I., F.R.M., Mohamed Ashraf, M.D., D.G.O., D.P.S., Chaitra Thunga, M.D., D.N.B., F.R.M., Sankalp Singh, M.D., D.N.B., Swati Singh, M.D., D.N.B., Reema Basheer, M.D., F.R.M., Raiza Ashraf, M.B.B.S., M.Sc., F.C.E., Kanna Jayaprakasan, M.D., Ph.D.

Abstract:

Objective

To compare the effectiveness of treatment with autologous activated platelet-rich plasma (PRP), administered to either the subendometrium (SE-PRP) or endometrial surface (intrauterine; IU-PRP), against controls.


Design

Prospective observational cohort study.


Setting

Tertiary fertility unit.


Patients

Women aged <40 years with a history of recurrent implantation failure undergoing frozen embryo transfer (FET) (n = 318).


Interventions

In SE-PRP, PRP was injected into the subendometrial space transvaginally in the luteal phase of the previous cycle of embryo transfer under ultrasound guidance (n = 55). In IU-PRP, PRP was administered during the index FET cycle when the endometrium was approximately 7 mm (n = 109). Both SE-PRP and IU-PRP groups were administered 300 μg of granulocyte colony-stimulating factor (G-CSF) subcutaneously once a day for 3 days to boost white blood cells (WBC) and growth factor production in the PRP sample. The control group consisted of women who did not choose PRP treatment and underwent standard FET with no intervention (n = 154).


Main Outcome Measures

Ongoing pregnancy rate or live birth rate (OPR/LBR) per transfer cycle, clinical pregnancy rate (CPR) per transfer cycle, and miscarriage rate.


Results

As a result, OPR/LBR was higher in the SE-PRP (22/55, 40%) and IU-PRP (45/109, 41.3%) groups than that in the control group (34/154, 22.1%). It was similar between the SE-PRP and IU-PRP groups. Moreover, CPR showed a similar trend with a higher rate in the SE-PRP (28/55, 51%) and IU-PRP (57/109, 52.3%) groups than that in the controls (52/154, 33.8%). No statistical difference in the CPR was noted between the SE-PRP and IU-PRP groups. The miscarriage rate was similar in all three groups (14/55, 25.45%; 25/109, 22.23%; and 34/154, 22.07%, respectively).


Conclusion

In women with a history of recurrent implantation failure, PRP treatment appears to improve FET outcome with an increase in OPR/LBR. However, SE-PRP treatment does not offer any advantage over lesser invasive IU-PRP treatment.

Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders.