Salman Mohamed M, Zaki Aya M, El-Gamal Hatem H, Gomaa Mostafa F, Osman Amany A, Farid Laila A
Department of Obstetrics and Gynaecology, Faculty of Medicine, Ain Shams University, Ain Shams, Egypt.
Prz Menopauzalny. 2023 Jun;22(2):77-82. doi: 10.5114/pm.2023.128814. Epub 2023 Jun 5.
Treatment of refractory thin endometrium during IVF is a relatively challenging problem, considering that optimal endometrium thickness is one of the critical factors for successful implantation and pregnancy. Autologous intrauterine platelet-rich plasma (PRP) infusion is an adjuvant therapeutic alternative for enhancing the endometrial thickness (EMT) and echo pattern. It was shown that PRP could expand EMT and improve pregnancy outcomes with its high content of growth factors and cytokines, and its role in the regulation of the immunological interaction between the embryo and the endometrium. The aim of the study is to evaluate the effect of autologous PRP in improving the ongoing pregnancy rate in patients with refractory thin endometrium undergoing IVF.
A prospective study in Ain Shams University Hospital including 66 infertile women with a refractory thin endometrium below 7 mm by ultrasound on the day of human chorionic gonadotropin injection in fresh embryo transfer (ET) cycle, who did not respond to standard medical therapies after more than 2 cycles of previous medical therapy, and who were candidates for IVF cycle were given intrauterine PRP.
A significant increase in EMT was noted and enhancement of endometrial pattern after intrauterine PRP infusion in the days of ovum pick-up and ET. There was also a significant increase in ongoing pregnancy, chemical pregnancy, clinical pregnancy, and implantation rates, while the miscarriage rate decreased after PRP infusion.
Intrauterine PRP infusion improved ongoing pregnancy, chemical pregnancy, clinical pregnancy, and implantation rates, in addition to EMT and pattern on the days of ovum pick-up and ET, while the miscarriage rate significantly decreased.
在体外受精（IVF）过程中，治疗难治性薄型子宫内膜是一个相对具有挑战性的问题，因为最佳的子宫内膜厚度是成功着床和妊娠的关键因素之一。自体宫腔内注射富含血小板血浆（PRP）是一种辅助治疗方法，可增加子宫内膜厚度（EMT）并改善内膜回声。研究表明，PRP因其富含生长因子和细胞因子，以及在调节胚胎与子宫内膜之间免疫相互作用中的作用，能够增加EMT并改善妊娠结局。本研究的目的是评估自体PRP对接受IVF的难治性薄型子宫内膜患者持续妊娠率的影响。
在艾因夏姆斯大学医院进行的一项前瞻性研究，纳入了66例不育女性，她们在新鲜胚胎移植（ET）周期中，人绒毛膜促性腺激素注射日经超声检查显示子宫内膜厚度低于7mm且为难治性薄型，在前两轮以上标准药物治疗后无反应，且符合IVF周期条件，对其进行宫腔内PRP注射。
在取卵日和ET日，宫腔内注射PRP后，EMT显著增加，子宫内膜形态得到改善。PRP注射后，持续妊娠率、生化妊娠率、临床妊娠率和着床率也显著增加，而流产率降低。
宫腔内注射PRP除了在取卵日和ET日改善EMT及内膜形态外，还提高了持续妊娠率、生化妊娠率、临床妊娠率和着床率，同时流产率显著降低。
