Use Of Platelet - Rich Plasma In Infertility

In IVF clinical practice, a thin endometrium, unresponsive to conventional therapies, usually results either in a embryo transfer under suboptimal conditions and  cycle failure or cycle cancellation and embryo cryopreservation The evaluation of an adequate endometrial growth is performed using grey-scale ultrasound. The minimal endometrial thickness required for embryo transfer is widely considered about 7 mm at the end of natural or medically induced follicular phase and there is general consensus that  if the endometrial lining is below 7mm the chance of pregnancy is statistically significant reduced.

Thin endometrium is relatively frequent in women with previous trauma of the uterus (cesarean sections, repetitive curettage), patients subjected to antitumoral treatments in childhood (Radiotherapy, Chemotherapy, Surgery), women affected by Asherman's syndrome, chronic infections (endometritis, Pelvic Inflammatory Disease) and inadequate blood flow (stress, malposition of uterus, fibrosis), patients with low estradiol values or excessive use of Clomiphene Citrate.

Several alternative treatments have been proposed over the years to improve the endometrial thickening, then showed themselves to be not considered the answer in many cases: some of them, indeed, require a not damaged endometrium, other act on endometrial blood flow and have no direct proliferative effect on the endometrium.  .

Recently, a new method has shown promising results in inducing endometrial growth.  Hysteroscopic intrauterine infusion of  Platelet-Rich Plasma (PRP) appears to increase proliferation not only on cultured fibroblasts, as currently known but also on mesenchymal cells, which are progenitors of different types of cells, including endometrial cells. There is significant  evidence to support the hypothesis that PRP stimulates some of the cellular processes involved in endometrial regeneration, that can be relevant to the management of a thin lining.

Autologous Platelet-Rich Plasma is prepared from fresh whole blood which is collected from a peripheral vein and processed to separate platelets from the other blood components. PRP contains activating platelets that stimulate the action of cytokines and  several growth factors such as vascular endothelial growth factor (VEGF), epidermal growth factor (EGF), platelet derived growth factor (PDGF), transforming growth factor (TGF).  On the basis of this evidence, local intrauterine infusion of PRP may improve endometrial growth and implantation. Patients with an indication for a PRP application undergo a minor hematologic evaluation to exclude blood disorders or platelet dysfunction. The sample for infusion is prepared through various processing steps from 20 ml of peripheral blood, and injected under direct hysteroscopic visualization in the endometrium via multiple entry points.

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Dr Eleftherios Meridis