Does Platelet-Rich Plasma Improve Adhesion Recurrence and Pregnancy Outcomes in Women With Intrauterine Adhesions? A Systematic Review and Meta-Analysis.

OBJECTIVE

To determine the role of Platelet-rich plasma (PRP) in improving pregnancy and adhesion recurrence outcomes in women who underwent hysteroscopic treatment of intrauterine adhesions.

DATA SOURCES

A total of 3 databases: Google scholar, PubMed, and clinicaltrials.gov were searched extensively from inception until April 5, 2023, without any language restrictions.

METHODS OF STUDY SELECTION

After the removal of duplicates, studies were first scrutinized on the basis of title/abstract followed by a full-text review to assess for eligibility. Data extraction was carried out in an online Excel sheet. Risk ratio (RR) and mean difference (MD) was used as the outcome measure for dichotomous and continuous outcomes, respectively. Comprehensive meta-analysis software (version 3) was used for statistical analysis. A p-value of .05 was deemed significant throughout the analysis. This meta-analysis was registered on Prospero with the registration number "CRD42024524425."

TABULATION, INTEGRATION, AND RESULTS: This meta-analysis comprised 12 studies: 8 randomized controlled trials (RCTs) and 4 non-RCTs with a total of population of 874 participants: 425 in the PRP group and 449 in the control group. Our meta-analysis showed that the PRP administration significantly improved the recurrence of moderate to severe adhesions (RR: 0.477, p-value: <.001), reduction in American Fertility Score (AFS) score (MD: 0.862, p-value: .043), clinical pregnancy rate (RR: 1.373, p-value = .036), menstruation flow (MD: 2.956, p-value: <.001), change in endometrial thickness (MD: 0.815, p-value <.001), and menstruation duration (MD: 1.132, p-value <.001). However, no significant difference was observed for chemical pregnancy, miscarriage, and live birth rate.

CONCLUSION

PRP shows promising results in reducing adhesion recurrence and has a potential to improve pregnancy outcomes. Further large-scale RCTs, particularly addressing dosage-response relationships, are needed to better understand the efficacy of PRP in preventing the recurrence of intrauterine adhesions.