Fertility Center, CHA Bundang Women's Medical Center, CHA University Bundang Medical Center, Seongnam, Republic of Korea.
Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Front Endocrinol (Lausanne). 2024 Sep 3;15:1431453. doi: 10.3389/fendo.2024.1431453. eCollection 2024.
A beneficial effect on endometrial thickness (EMT) and improvement of pregnancy outcome after intrauterine infusion of platelet-rich plasma (PRP) has been suggested. This study assessed the effect of intrauterine PRP infusion on live birth rate and obstetrical outcomes and analyzed cytokines that can potentially improve pregnancy outcomes through PRP.
This study was a prospective cohort study conducted in a university hospital fertility center. The study included ninety-one patients who had a history of two or more failed fertilization (IVF) attempts and refractory thin endometrium that remained unresponsive after at least two conventional treatments for thin endometrium. Patients were treated with an intrauterine infusion of autologous PRP between days 7 and 14 of their hormone replacement therapy-frozen embryo transfer (HRT-FET) cycle. PRP was administered at 3-day intervals until their EMT reached 7mm. After a maximum of three PRP administrations, embryo transfer (ET) was performed. The primary outcome was the live birth rate. Secondary outcomes included the implantation rate and increase in EMT compared to the previous cycle. We compared the cytokines related to angiogenesis in a patient's whole blood (WB) and PRP by utilizing a commercial screening kit.
The live birth rate in the PRP treatment cycle was 20.9% (19 of 91 patients), significantly superior to the previous cycle without PRP infusion (p < 0.001). The implantation rate was also significantly higher during the PRP treatment cycle (16.4%) compared to the previous cycle (3.1%) (p < 0.001). The mean EMT post-PRP treatment was 6.1 mm, showing a significant increase of 0.8 mm (p < 0.001). Nonetheless, an increase in EMT was also observed in the non-pregnancy group. No adverse effects were reported by patients treated with autologous PRP. Cytokine array analysis confirmed marked increases in well-known pro-angiogenic factors such as Ang-1, EGF, LAP (TGF-b1), MMP-8, PDGF-AA, and PDGF-AB/PDGF-BB.
Intrauterine PRP infusion offers a safe and effective treatment for patients with refractory thin endometrium and implantation failures. The angiogenic cytokines present in PRP are the primary drivers of this improvement.
已有研究表明，富血小板血浆（PRP）宫腔内输注可改善子宫内膜厚度（EMT）并提高妊娠结局。本研究评估了宫腔内 PRP 输注对活产率和产科结局的影响，并分析了通过 PRP 提高妊娠结局的潜在细胞因子。
这是一项在大学医院生育中心进行的前瞻性队列研究。研究纳入了 91 例曾经历两次或两次以上受精（IVF）失败且经至少两种常规薄型子宫内膜治疗后仍无反应的患者。患者在激素替代疗法-冻融胚胎移植（HRT-FET）周期的第 7 至 14 天行宫腔内 PRP 输注治疗。PRP 每 3 天输注一次，直至 EMT 达到 7mm。最多进行 3 次 PRP 给药后进行胚胎移植（ET）。主要结局为活产率。次要结局包括与前一周期相比，着床率和 EMT 的增加。我们利用商业筛选试剂盒比较了患者全血（WB）和 PRP 中与血管生成相关的细胞因子。
PRP 治疗周期的活产率为 20.9%（91 例患者中的 19 例），明显高于无 PRP 输注的前一周期（p<0.001）。PRP 治疗周期的着床率也明显高于前一周期（16.4% vs. 3.1%）（p<0.001）。PRP 治疗后 EMT 的平均值为 6.1mm，增加了 0.8mm，差异具有统计学意义（p<0.001）。然而，在非妊娠组中也观察到 EMT 的增加。接受自体 PRP 治疗的患者未报告不良反应。细胞因子阵列分析证实了众所周知的促血管生成因子如 Ang-1、EGF、LAP（TGF-b1）、MMP-8、PDGF-AA 和 PDGF-AB/PDGF-BB 的显著增加。
宫腔内 PRP 输注为薄型子宫内膜和种植失败患者提供了一种安全有效的治疗方法。PRP 中存在的促血管生成细胞因子是改善这一结果的主要驱动因素。
