Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Stanford School of Medicine, 1195 West Fremont Avenue, MC 7717, Sunnyvale, CA, 94087, USA.
Quantitative Sciences Unit, Department of Medicine, Stanford School of Medicine, Stanford, CA, USA.
J Assist Reprod Genet. 2024 Feb;41(2):483-491. doi: 10.1007/s10815-023-02993-8. Epub 2023 Nov 24.
To study effect of intrauterine infusion of platelet-rich plasma (PRP) on endometrial growth in the setting of thin endometrial lining in patients with prior cancelled or failed frozen embryo transfer (FET) cycles.
Single-arm cohort study of forty-six patients (51 cycles) with endometrial lining thickness (EMT) < 6 mm in prior cancelled or failed FET cycles requesting intrauterine PRP treatment in upcoming FET cycle. The primary outcomes were final EMT in FET cycle and change in EMT after PRP. The secondary outcomes were overall pregnancy rate, clinical pregnancy rate, miscarriage rate, ongoing pregnancy, and live birth rates.
The mean pre-PRP EMT in all FET cycles was 4.0 ± 1.1 mm, and mean post-PRP EMT (final) was 7.1 ± 1.0 mm. Of 51 cycles, 33 (64.7%) reached ≥ 7 mm after PRP administration. There was a significant difference between pre-PRP EMT and post-PRP EMT in all FET cycles, with mean difference of 3.0 ± 1.5 mm. Three cycles were cancelled for failure to reach adequate lining. Total pregnancy rate was 72.9% in our cohort of 48 cycles that proceeded to transfer. Clinical pregnancy rate was 54.2% (26/48 FET cycles); clinical miscarriage rate was 14.3% (5/35 pregnancies). Twenty six women had live birth (18 with EMT ≥ 7 mm and 8 with EMT < 7 mm). Response to PRP was not correlated with any pre-cycle characteristics.
We demonstrate a significant improvement in lining thickness and pregnancy rates in this challenging cohort of women after PRP infusion, with no adverse events. Cost-effectiveness of PRP with benefits and alternatives should be carefully considered.
研究在既往取消或失败的冷冻胚胎移植（FET）周期中存在薄子宫内膜的情况下，宫腔内注射富血小板血浆（PRP）对子宫内膜生长的影响。
这是一项单臂队列研究，共纳入 46 名（51 个周期）既往 FET 周期中子宫内膜厚度（EMT）<6mm 且要求在即将到来的 FET 周期中进行宫腔内 PRP 治疗的患者。主要结局是 FET 周期中的最终 EMT 和 PRP 后 EMT 的变化。次要结局是总妊娠率、临床妊娠率、流产率、持续妊娠率和活产率。
所有 FET 周期的平均 PRP 前 EMT 为 4.0±1.1mm，平均 PRP 后 EMT（最终）为 7.1±1.0mm。在 51 个周期中，有 33 个（64.7%）在 PRP 给药后达到≥7mm。所有 FET 周期中，PRP 前 EMT 与 PRP 后 EMT 之间存在显著差异，平均差异为 3.0±1.5mm。由于未能达到足够的内膜，有 3 个周期被取消。在继续进行移植的 48 个周期中，总妊娠率为 72.9%。我们的队列中有 54.2%（26/48 FET 周期）获得临床妊娠；临床流产率为 14.3%（5/35 例妊娠）。26 名妇女活产（18 名 EMT≥7mm，8 名 EMT<7mm）。PRP 反应与任何周期前特征均无相关性。
我们在接受 PRP 输注的这一具有挑战性的患者队列中证明了子宫内膜厚度和妊娠率的显著改善，且无不良事件。PRP 的成本效益以及替代方案应仔细考虑。
