Masiello Francesca, Pati Ilaria, Piccinini Vanessa, Pupella Simonetta, De Angelis Vincenzo, Cruciani Mario
National Blood Centre, Italian National Institute of Health, Rome, Italy.
Blood Transfus. 2025 Jul-Aug;23(4):322-337. doi: 10.2450/BloodTransfus.937. Epub 2025 Apr 15.
In recent years, platelet-rich plasma (PRP) has been used to improve endometrial receptivity in infertile women undergoing assisted reproduction. This article aims to review the literature and critically appraise the available evidence regarding the efficacy of PRP for assisted reproduction.
An overview of systematic reviews (SRs) (umbrella review) of PRP use for assisted reproduction. The methodological quality of the SRs was assessed using the AMSTAR-2 checklist; quality of the evidence from the trials included in each SR was appraised following the GRADE approach.
Twenty-five SRs published between 2020 and 2024 were included in this overview. The SRs reported data from 306 overlapping reports based on 112 individual primary studies. The overlap among primary studies was slight across all reports included (CCA index 1.9%). With the AMSTAR 2 tool, the SRs showed only some non-critical weakness, but no critical flaws. Thus, confidence in the results of the SRs can be considered high or moderate. Clinical pregnancy rate was reported in 17 SRs, chemical pregnancy in 8, implantation rate in 8, and live birth rate in 16 SRs. Almost uniformly the SRs showed increased rates of positive outcomes in PRP recipients compared to controls (from very low to high certainty of evidence). Miscarriage rate, ectopic pregnancy and multiple pregnancy, reported in some of the SRs, resulted uncertainty about the effect of PRP infusion compared with no intervention on these outcomes (no statistically significant differences between groups).
The evidence from SRs shows beneficial effects of PRP compared to controls in terms of clinical and chemical pregnancy rates, implantation rates and live birth rates. The level of evidence varied from very low to high (more commonly low or moderate) in relation to methodological flaws and clinical heterogeneity of primary studies included in the SRs.
近年来，富血小板血浆（PRP）已被用于改善接受辅助生殖的不孕女性的子宫内膜容受性。本文旨在回顾文献并批判性地评估关于PRP在辅助生殖中疗效的现有证据。
对PRP用于辅助生殖的系统评价（SRs）（伞状评价）进行概述。使用AMSTAR-2清单评估SRs的方法学质量；按照GRADE方法评估每个SR中纳入试验的证据质量。
本概述纳入了2020年至2024年发表的25篇SRs。这些SRs报告了基于112项个体原始研究的306份重叠报告的数据。所有纳入报告中原始研究之间的重叠很小（一致性系数指数1.9%）。使用AMSTAR 2工具，SRs仅显示出一些非关键的弱点，但没有关键缺陷。因此，可以认为对SRs结果的信心较高或中等。17篇SRs报告了临床妊娠率，8篇报告了化学妊娠率，8篇报告了着床率，16篇SRs报告了活产率。几乎一致地，与对照组相比，SRs显示PRP接受者的阳性结果发生率增加（证据确定性从非常低到高）。一些SRs报告的流产率、异位妊娠和多胎妊娠，与未干预相比，PRP输注对这些结局的影响存在不确定性（组间无统计学显著差异）。
SRs的证据表明，与对照组相比，PRP在临床和化学妊娠率、着床率和活产率方面具有有益效果。由于SRs中纳入的原始研究存在方法学缺陷和临床异质性，证据水平从非常低到高不等（更常见的是低或中等）。
