Platelet-rich plasma (PRP) has become a novel treatment in various aspects of medicine including orthopedics, cardiothoracic surgery, plastic surgery, dermatology, dentistry, and diabetic wound healing. PRP is now starting to become an area of interest in reproductive medicine more specifically focusing on infertility. Poor ovarian reserve, menopause, premature ovarian failure, and thin endometrium have been the main areas of research. The aim of this article is to review the existing literature on the effects of autologous PRP in reproductive medicine providing a summation of the current studies and assessing the need for additional research.
Methods
A literature search is performed using PubMed, MEDLINE, and CINAHL Plus to identify studies focusing on the use of PRP therapy in reproductive medicine. Articles were divided into 3 categories: PRP in thin lining, PRP in poor ovarian reserve, and PRP in recurrent implantation failure.
Results
In women with thin endometrium, the literature shows an increase in endometrial thickness and increase in chemical and clinical pregnancy rates following autologous PRP therapy. In women with poor ovarian reserve, autologous intraovarian PRP therapy increased anti-Mullerian hormone (AMH) levels and decreased follicle-stimulating hormone (FSH), with a trend toward increasing clinical and live birth rates. This trend was also noted in women with recurrent implantation failure.
Conclusions
Limited literature shows promise in increasing endometrial thickness, increasing AMH, and decreasing FSH levels, as well as increasing chemical and clinical pregnancy rates. The lack of standardization of PRP preparation along with the lack of large randomized controlled trials needs to be addressed in future studies. Until definitive large RCTs are available, PRP use should be considered experimental.
PMID 33723748 33723748 DOI 10.1007/s10815-021-02146-9 10.1007/s10815-021-02146-9
Cite this article
Sharara, F. I., Lelea, L., Rahman, S., Klebanoff, J. S., & Moawad, G. N. (2021). A narrative review of platelet-rich plasma (PRP) in reproductive medicine. Journal of assisted reproduction and genetics, 38(5), 1003-1012. https://doi.org/10.1007/s10815-021-02146-9
Sharara FI, Lelea L, Rahman S, Klebanoff JS, Moawad GN. A narrative review of platelet-rich plasma (PRP) in reproductive medicine. J Assist Reprod Genet. 2021;38(5):1003-1012. doi:10.1007/s10815-021-02146-9
Sharara, Fady I., et al. "A narrative review of platelet-rich plasma (PRP) in reproductive medicine." Journal of assisted reproduction and genetics, vol. 38, no. 5, 2021, pp. 1003-1012.
Malcom CA et al., 2025·Journal of assisted reproduction and genetics
Prior studies in fresh embryo transfer IVF cycles have associated elevated serum progesterone level on day of ovulatory trigger, particularly if ≥ 1.5 ng/ml, with decreased pregnancy rates. A similar association has been found in intrauterine insemination (IUI) cycles using gonadotropins for ovulation induction. The purpose of this study was to evaluate the association of trigger-day progesterone level with pregnancy rates in IUI cycles using oral ovulation induction agents. A retrospective cohort study was conducted at a multicenter private practice. 4,866 IUI cycles using letrozole or clomiphene were analyzed from January 1, 2017, to December 31, 2023. The primary outcome measure was ongoing pregnancy per cycle as a function of the serum progesterone level obtained on the day of ovulatory trigger. Secondary outcome measures were positive pregnancy, clinical pregnancy, and pregnancy loss. When compared to cycles with trigger-day progesterone < 1 ng/ml, ongoing pregnancy was significantly lower when progesterone was ≥ 1.5 ng/ml (11.9% versus 5.6%; Risk Ratio (RR) 0.46 (95% CI 0.25-0.84)). Ongoing pregnancy was comparable when progesterone was < 1 ng/ml or 1-1.49 ng/ml (11.9% versus 9.2%; (RR 0.75 (95% CI 0.55-1.03)). Positive pregnancy and clinical intrauterine pregnancy outcomes were also significantly lower in the ≥ 1.5 ng/ml versus < 1 ng/ml group, but comparable in the < 1 ng/ml and 1-1.49 ng/ml groups. Pregnancy loss was not significantly different between groups. Pregnancy outcomes are optimized when trigger-day progesterone level is < 1.5 ng/ml in IUI cycles using oral ovulation induction agents, highlighting the value of obtaining a progesterone level on the day of ovulatory trigger.
To determine the effect of luteinized unruptured follicle (LUF) cycles on frozen thawed embryo transfer (FET).
A retrospective analysis comparing the clinical outcomes after FET among 144 cases of luteinized unruptured follicle (LUF) cycles and 866 cases of ovulation cycles.
Reproductive medical center, Beijing China. Chinese infertile women who underwent FET. None. Clinical pregnancy rate (PR), implantation rate. The implantation rate, clinical pregnancy rate, on-going pregnancy rate and live birth rate in LUF group were 12.76% (49/384), 27.78% (40/144), 24.31% (35/144) and 19.44% (28/144), respectively, and in ovulation group, 14.74% (332/2251), 31.29% (271/866), 28.29% (245/866) and 22.23% (193/866), respectively (p > 0.05). LUF does not affect the clinical outcomes of FET. Patients of LUF should be included in FET treatment.
To evaluate the clinical relevance of serum progesterone levels on the day of frozen embryo transfer (FET) and the dose of vaginal progesterone gel (Crinone) used for early luteal phase support (LPS) in artificial-cycle frozen embryo transfer (AC-FET). This single-center retrospective study analyzed 342 AC-FET cycles in patients aged 18-45 at Changhua Christian Hospital, Taiwan (April 2018-December 2022). Women aged 18-45 years undergoing AC-FET were included; cycles with >3 prior failed FETs, major comorbidities, donor oocytes, or missing outcome data were excluded. Pregnancy outcomes were assessed per cycle. Crinone (90 mg or 180 mg daily) was administered for 5 days after endometrial thickness ≥7 mm and progesterone <1.5 ng/mL. Serum progesterone was measured on the day of FET. Clinical pregnancy rates based on gestational sac (CPR-S), fetal heartbeat (CPR-H), and live birth rate (LBR) were evaluated. Receiver operating characteristic (ROC) evaluated the predictive value of serum progesterone levels. Associations between study variables and pregnancy outcomes were assessed using univariate and multivariable logistic regression. Comparisons of pregnancy outcomes between the high- and low-dose Crinone groups were further conducted using inverse probability of treatment weighting (IPTW) to adjust for baseline differences between dosage groups. Serum progesterone levels demonstrated poor predictive performance for CPR-S, CPR-H, and LBR (AUC 0.541-0.559) and were not independently associated with pregnancy outcomes in multivariable analyses. After adjustment using inverse probability of treatment weighting, a higher Crinone dose (180 mg vs. 90 mg) was significantly associated with higher CPR-S (OR, 1.87; 95% CI, 1.11-3.17; p = 0.020), CPR-H (OR, 2.11; 95% CI, 1.24-3.59; p = 0.006), and LBR (OR, 2.10; 95% CI, 1.31-3.38; p = 0.002). Serum progesterone levels measured on the day of FET did not predict pregnancy outcomes in AC-FET cycles using vaginal progesterone gel. A higher Crinone dose was associated with higher early clinical pregnancy rates compared with a lower dose.
Is there a difference in live birth rates at 24 months between infertile women with polycystic ovary syndrome (PCOS) who have normal versus abnormal glucose metabolism? Abnormal glucose metabolism did not significantly reduce live birth rates but was associated with increased obstetric complications. Women with PCOS are often at increased risk of glucose metabolism disorders. However, evidence about the impact of these disorders on pregnancy outcomes remains limited, particularly in Asian populations. This prospective cohort study was conducted at a reproductive care centre in Vietnam from June 2020 to August 2024. A total of 1208 women were enrolled. PARTICIPANTS/MATERIALS Eligible participants were infertile women aged 18-40 years diagnosed with PCOS (Rotterdam criteria). Comprehensive assessments included medical history, anthropometric measurements, endocrine evaluations, fasting plasma glucose (FPG), glycosylated haemoglobin (HbAlc), and oral glucose tolerance tests (OGTT). Participants were categorized into normal or abnormal glucose metabolism groups and monitored for live birth outcomes at 24 months from the first visit. MAIN Live birth rates at 24 months were comparable between women with normal versus abnormal glucose metabolism (52.7% vs 48.2%, P = 0.12). However, obstetric complications, including gestational diabetes mellitus (15.2% vs 28.0%, P < 0.001) and hypertensive disorders of pregnancy (2.3% vs 9.0%, P < 0.001), were more common in the group with abnormal glucose metabolism. In women who conceived naturally, greater waist circumference and higher Homeostatic Model Assessment of Insulin Resistance index were significantly associated with lower odds of live birth, whereas the presence of hyperandrogenism was associated with higher odds of live birth. No factors were significantly associated with live birth in the group that conceived via ovulation induction plus IUI. In the group that conceived through IVF or IVM, a higher BMI was significantly associated with a lower live birth rate. LIMITATIONS This single-centre study was conducted exclusively on infertile women from South-East Asia who had PCOS, potentially limiting generalizability to other populations. Additionally, metabolic assessments were only performed at baseline, preventing evaluation of longitudinal changes and their dynamic effects on reproductive outcomes. While no significant difference in live birth rates was observed between PCOS women with normal and abnormal glucose metabolism, the abnormal glucose metabolism group experienced higher rates of gestational complications. These findings underscore the importance of preconception metabolic screening and tailored fertility strategies that include targeted interventions to optimize reproductive and maternal outcomes in women with PCOS. This study was supported by My Duc Hospital. Lan N. Vuong reports funding from the Vietnam National Foundation for Science and Technology Development (NAFOSTED; grant number FWO.108-2022.01); Speaker and conference fees; speaker and conference fees as well as a grant; speaker, conference, and scientific board fees outside the submitted work. All other authors declare no conflicts of interest. NCT04364087.