Effect of intrauterine infusion of autologous platelet rich plasma in patients with refractory thin endometrium undergoing in vitro fertilization

Abstract

Background: Since the first introduction of (IVF-ET), the technology has evolved rapidly, and the pregnancy rate with it has significantly increased. However, treatment of refractory thin endometrium during IVF is a relatively challenging problem, considering that optimal endometrium thickness is one of critical factors for successful implantation and pregnancy. Autologous intrauterine PRP infusion is an adjuvant therapeutic alternative for enhancing the EMT and Echo pattern. It was settled that PRP could expand EMT and improve pregnancy outcomes with its high content of growth factors and cytokines in addition to its role in regulation of immunological interaction between embryo and endometrium. Aim of the work: The aim of the study is to evaluate the effect of autologous PRP in improving the ongoing pregnancy rate in patients with refractory thin endometrium undergoing IVF. Patients and Methods: After explanation of the nature of the study, ethical committee approval and written consents would be obtained from patients, this prospective single arm clinical trial was performed on a total number of 85 infertile women with a refractory thin endometrium, characterized by atrophy with endometrial interface measurements below 7 mm by ultrasound on the day of hCG injection in fresh ET cycle, which does not respond to standard medical therapies after more than 2 cycles of previous medical therapy,6 cases were excluded (2 cases declined to participate and 4 cases withdrawn from the study ) and 13 cases were cancelled (6 cases had poor ovarian response, 3 cases had poor quality embryos,1case had degenerated egg, and 3 cases were COVID 19 positive ), who were candidates for IVF cycle at the ART Unit of Ain Shams University Maternity Hospital in a period from January 2021 and August 2021 with the same inclusion and exclusion criteria using long luteal phase GnRHa protocol. Results: There was statistically significant increase in EMT “mm” and enhancement of endometrial pattern after intrauterine PRP infusion with p- value < 0.001 for both of them. Regarding EMT ((6.19±0.34) mean EMT on D1 ( day of hCG injection in fresh IVF cycles & PRP infusion vs, (7.75±0.48) mean EMT on D2 ( the day of OR ), and (8.97±0.65) on D3 ( day of ET)) and according to endometrial patterns on D1 (15.2%, 47% and 37.9%) of patients had patterns A, B and C, respectively vs, D2 (47%,45.5% and 7.6%) of patients had patterns A, B and C, respectively, and D3 (51.5% and 48.5% ) of patients had patterns A, B and C, respectively. Regarding risk factors affecting chemical pregnancy ; multivariate analysis of current study revealed that EMT (mm) and endometrial pattern at D2 and D3 were the best independent predictors of chemical pregnancy, with statistically significant difference between chemical pregnancy (positive and negative) according to EMT and pattern as [OR (C.I.95%), p-value] were [2.452 (0.674- 8.924) 0.037] and [2.869 (0.789-10.441), p-value 0.043] respectively. Regarding outcomes of embryo transferred cycles; statistical analysis of current results showed that there were high positive pregnancy results (implantation, chemical, clinical and ongoing pregnancy and miscarriage rates) as a result of intrauterine PRP infusion. Conclusion: As evident from the current study, Intrauterine PRP infusion as an adjuvant on day of hCG injection, significantly improved EMT and endometrial pattern distribution at the days of OR and ET of infertile women with refractory thin endometrium. EMT (mm) and endometrial pattern at the day of OR and at the day of ET were the most significant independent predictors of chemical pregnancy. Autologous intrauterine PRP infusion had some aspects to restore the damaged endometrium, not only increasing the EMT but also enhancing the endometrial vascularity & receptivity. Implantation rate, chemical, clinical and ongoing pregnancy rates were significantly improved and miscarriage rate was significantly decreased as a result of intrauterine PRP infusion.