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Thin Endometrium In Ivf Treatment Cycles.Can Prp Be A Solution?

 

Endometrial receptivity is probably one of the most important factors for a successful IVF. Since it is not easy to assess the real receptivity, we, clinicians mostly use endometrial thickness in daily practice. Thin endometrium, in other words, inadequate endometrial growth, is one of the significant problems that may be responsible for unsuccessful IVF trials.

Thin endometrium in assisted reproduction is often defined as endometrial thickness <7 mm during trigger and/or embryo transfer day. The incidence of thin endometrium in ovarian stimulation cycles can be as high as 30–60%. In several studies, the minimum desired endometrium thickness for embryo transfer was reported to be 7 mm. We know from the literature that patients who have thinner than 7mm endometrium at the embryo transfer date have significantly lower chances of pregnancy.

Although with some cases, there seems no reason, common causes of thin endometrium are previous uterine surgery, chronic infection and radiation and endometrial curettage.

Extended estrogen treatment, low dose aspirin, vaginal sildenafil, pentoxifylline, intrauterine perfusion of granulocyte-colony stimulating factor (G-CSF) have been used for treatment. However, there is still no established protocol for this condition.

PRP (autologous platelet-rich plasma) treatment may be a new procedure for these patients. It has been used for some time as a growing therapeutic option in musculoskeletal medicine, It may also promise better results to the patients who suffer from endometrial pathology.

It is actually a simple procedure. Platelet rich plasma is prepared in the laboratory from autologous blood samples. Then it is given to the intrauterine cavity two or three times before the embryo transfer via embryo transfer catheter. There is no reported complication from PRP treatment except for very low infection risk. Due to that risk, antibiotic medication can be given for 2 days as prophylaxis.

PRP contains various growth factors and cytokines to promote cell proliferation and regeneration. The therapeutic mechanism is mainly based on the capacity of different growth factors to provide a regenerative stimulus for promoting repair in tissues such as endometrium. 

There is much scientific research in current literature about PRP.

The first study on PRP for treating human thin endometrium in vivo was published in 2015. Other studies followed and concluded that autologous PRP can promote endometrial growth and improve pregnancy outcomes. For some cases, it increases endometrial thickness, for some cases it just enhances pregnancy chances without changing the endometrial thickness significantly. It may improve endometrial receptivity and capacity enabling capture and development of the embryo.

Before further discussion on the exact effectivity of PRP treatment, we certainly need further studies and extended, randomised controlled researches to determine its benefits for IVF patients. For now, we can say that PRP treatment might be effective in improving the endometrial growth and pregnancy chances in women with a thin endometrium and recurrent failure cases.

References

Liu et al., 2018Liu, K.E., Hartman, M., Hartman, A., Luo, Z.C., and Mahutte, N. The impact of a thin endometrial lining on fresh and frozen-thaw IVF outcomes: an analysis of over 40 000 embryo transfers. Hum. Reprod. 2018331883–1888.

Shahrzad Zadehmodarres, Saghar Salehpour, [...], and Leila Nazari, Treatment of thin endometrium with autologous platelet-rich plasma: a pilot study, JBRA Assist. Reprod. 2017, Jan-Mar; 21(1):54-56

Hounyoung Kim, Ji Eun Shin, [...], and Ji Hyang Kim, Effect of Autologous Platelet-Rich Plasma Treatment on Refractory Thin Endometrium During the Frozen Embryo Transfer Cycle: A Pilot Study, Front Endocrinol (Lausanne) 2019;10:61

Author links open overlay panel

Maryam Eftekhara, Nosrat Neghaba, Elham Naghshinehb, Parisa Khania , Can autologous platelet rich plasma expand endometrial thickness and improve pregnancy rate during frozen-thawed embryo transfer cycle? A randomized clinical trial, Taiwanese Journal of Obstetrics and Gynecology , Volume 57, Issue 6, December 2018, Pages 810-813

Siddhartha Nagireddy, et al. Autologous PRP for the management of thin endometrium in frozen embryo transfer cycles: would it improve the outcome? Fertility and Sterility, September 2019 Volume 112, Issue 3, Supplement, Pages e418–e419.

Maleki-Hajiagha A1Razavi M2Rouholamin S3Rezaeinejad M4Maroufizadeh S5Sepidarkish M6.

Intrauterine infusion of autologous platelet-rich plasma in women undergoing assisted reproduction: A systematic review and meta-analysis. J Reprod Immunol. 2020 Feb;137:103078.

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