Autologous platelet-rich plasma as a potential new approach in the endometrial response during in vitro fertilization cycle: A pilot study

Infertility is a global health concern, affecting ~13% of couples. Despite assisted reproductive technology (ART) attempts, implantation failure occurs due to inadequate growth of the endometrium. Increasing endometrial thickness (ET) can be increased to improve the rate of pregnancy; implantation necessitates a minimum thickness of 7 mm. Platelet-rich plasma (PRP) is a recommended treatment approach for endometrium and ovarian infertility. This approach minimizes the potential of immunogenic reactions and disease transmission because PRP comes from an autologous source. The purpose of this study was to evaluate the efficacy of PRP intrauterine infusions during the in vitro fertilization (IVF) cycle in patients with thin endometrium. Ten patients with primary infertility (age: 28–40 years) were chosen for intrauterine PRP infusion at the RiSSA IVF Center, Delhi. This study was carried out between June 2020 and January 2022 over a span of 18-month period. Intrauterine infusion of PRP was an additional procedure to hormone replacement therapy (HRT) treatment cycle. PRP was prepared by centrifugation process from autologous blood. On the 10th day of HRT cycle, 2 mL of PRP was infused into the uterine cavity. In each cycle, PRP infusion was administered 1–3 times if there was no increase in ET 72 hours later. Out of ten patients, four patients received a single infusion, two patients received two infusions, and four patients received three infusions. The embryos were transferred when the ET reached ≥7 mm. ET was measured at the uterine longitudinal axis at the thickest point. To determine ET, three measurements were made, and the average of those measures was noted. The primary outcome measure was ET, determined by transvaginal sonography, and the secondary outcome measure was clinical pregnancy following embryo transfer. The mean increase in ET was 1.8–2.25 mm. In 8 (80%) patients, there was an increase of 7–7.5 mm in ET. ET thickness did not improve in 2 patients (20%), and it was <6 mm after three infusions of PRP. Further, of the eight patients who had embryo transfer and became pregnant, six patients had a clinical pregnancy with visible cardiac activity at 6 weeks, while two patients had a missed abortion in the first trimester. Six patients had a successful delivery. This study revealed that PRP could support endometrial growth, improving pregnancy outcomes in patients who have thin endometrium. PRP is a novel treatment option for endometrial thinning and poor response to IVF. The findings of the current pilot study support the need for large-scale, randomized, controlled trials in this field.