Kaur Harpreet, Meenu Meenakshi, Pandey Shivam, Chauhan Anil, Mangla Mishu
Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Bilaspur, Himachal Pradesh, India.
Department of Pharmacology, All India Institute of Medical Sciences, Bilaspur, Himachal Pradesh, India.
J Hum Reprod Sci. 2024 Jan-Mar;17(1):2-15. doi: 10.4103/jhrs.jhrs_166_23. Epub 2024 Mar 28.
Recurrent implantation failure (RIF) is a challenging clinical situation and various strategies have been tried to improve the pregnancy rate in RIF. Platelet-rich plasma (PRP), which is obtained from the autologous blood samples of a person and is multiple times richer in platelets and other growth factors helps improve endometrial receptivity.
This study has been conducted to summarise the evidence and quality of evidence available so far regarding the role of PRP in cases of unexplained RIF.
An electronic database search for randomised clinical trials comparing PRP against routine care in women with unexplained RIF was performed on PubMed, EMBASE, SCOPUS and Cochrane Central. Two independent reviewers conducted a literature search and retrieved data using the predefined eligibility criteria. Bias assessment was done using the Cochrane Collaboration Network Risk of Bias Tool version 2. The quality of evidence was determined and a summary of the findings table was prepared for individual outcomes using GRADEpro software.
We identified 1146 records, and after removing duplicates, 531 records were screened. Out of these, 22 studies reached full-text screening and nine studies were included in the final review. We are uncertain about the effect of PRP due to the very low quality of evidence and we have little confidence that the administration of PRP had any significant effect on improving the live birth rate in women with RIF (odds ratio [OR]: 7.32, 95% confidence interval [CI]: 4.54-11.81, = 40%). Similarly, the quality of evidence was low for the clinical pregnancy rate, so we are uncertain if the administration of PRP had any significant effect on the clinical pregnancy rate (OR: 3.20, 95% CI: 2.38-4.28, = 0%).
The current review suggests that there may be some beneficial effects of PRP in women with RIF, but the quality of evidence is very low and we are uncertain of the benefit and have little confidence in these findings.
Limitations are the small sample size of most studies, a short follow-up period, non-uniformity in the definition of outcomes and very low quality of evidence.
The protocol was registered on PROSPERO (CRD42021292209).
反复种植失败（RIF）是一种具有挑战性的临床情况，人们尝试了各种策略来提高RIF患者的妊娠率。富血小板血浆（PRP）从人的自体血样中获取，其血小板和其他生长因子的含量是普通血液的数倍，有助于提高子宫内膜容受性。
本研究旨在总结目前关于PRP在不明原因RIF病例中的作用的证据及证据质量。
在PubMed、EMBASE、SCOPUS和Cochrane Central上进行电子数据库检索，以查找比较PRP与常规护理对不明原因RIF女性疗效的随机临床试验。两名独立的评审员进行文献检索，并使用预定义的纳入标准检索数据。使用Cochrane协作网偏倚风险工具第2版进行偏倚评估。确定证据质量，并使用GRADEpro软件为各个结局编制结果总结表。
我们识别出1146条记录，去除重复记录后，筛选了531条记录。其中，22项研究进入全文筛选，9项研究纳入最终综述。由于证据质量极低，我们不确定PRP的效果，并且我们几乎不相信PRP的应用对提高RIF女性的活产率有任何显著效果（优势比[OR]：7.32，95%置信区间[CI]：4.54 - 11.81，P = 40%）。同样，临床妊娠率的证据质量较低，所以我们不确定PRP的应用对临床妊娠率是否有任何显著效果（OR：3.20，95%CI：2.38 - 4.28，P = 0%）。
当前综述表明，PRP对RIF女性可能有一些有益效果，但证据质量非常低，我们不确定其益处，对这些结果也缺乏信心。
局限性在于大多数研究样本量小、随访期短、结局定义不统一以及证据质量极低。
该方案已在PROSPERO（CRD42021292209）上注册。
