Assisted Reproduction Add-Ons and Adjuncts
RRM Academy Synopsis
PRP linked to higher pregnancy rates in recurrent implantation failure
Intrauterine platelet-rich plasma (PRP) infusion was associated with higher pregnancy and live birth rates in a meta-analysis of 12 randomized trials. The trials enrolled 1438 women with recurrent implantation failure after IVF. Preterm birth was also higher with PRP, in the only two trials that reported it. The authors call the benefit potential but inconclusive.
Key Findings
- Ten trials reported clinical pregnancy, which was higher with PRP (OR = 3.18, 95%CI (2.45, 4.14), I2 = 3%).
- Five trials reported live birth, which was higher with PRP (OR=5.10, 95%CI (1.95, 13.37), I2 = 75%).
- Seven trials with 572 patients found no significant difference in miscarriage (OR = 0.56, 95%CI (0.17, 1.89), I2 = 65%).
- Only two trials reported preterm birth, which was higher with PRP (OR = 8.24, 95%CI (2.09, 32.41), I2 = 0%).
- In blastocyst transfers, clinical pregnancy (OR = 3.84, 95%CI (2.82, 5.23)) and live birth (OR = 7.32, 95%CI (3.17, 16.90)) were higher with PRP. Cleavage-stage transfers showed no significant effects.
Interpretation
The study pools 12 randomized trials of IVF embryo transfers in women with recurrent implantation failure. Only two included trials were rated low risk of bias, and eight did not mention allocation concealment. Live birth data came from five trials with high heterogeneity, and preterm birth data from two. Nearly all trials used untreated controls, so the effect of the catheter procedure itself could not be assessed. PRP preparation varied and no trial reported embryo ploidy testing. Higher clinical pregnancy and live birth rates and a lower miscarriage rate appeared only in trials enrolling women with three or more prior failures. All trials enrolled women with endometrial thickness above 7mm.
RRM Context
The authors describe recurrent implantation failure as good-quality embryos that fail to implant after several transfers. They state that about half of cases remain unexplained. IVF goes ahead without finding the reason, and PRP is added to the same transfer. Restorative reproductive medicine treats unexplained infertility as undiagnosed. Restorative care looks for the cause in both partners first.
Abstract
Objective
The role of intrauterine PRP infusion in managing recurrent implantation failure (RIF) remains controversial despite its emerging clinical use. This systematic review aims to evaluate its therapeutic potential in RIF patients and further to investigate variations in outcomes based on transfer cycle type, embryo developmental stage, RIF diagnostic criteria, and endometrial thickness.
Methods
We systematically searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, Scopus, and Web of Science for randomized controlled trials (RCTs) investigating PRP treatment for RIF patients from the beginning of the database to May 2025.
Results
This meta-analysis showed that PRP administration significantly improved clinical pregnancy rate (CPR) [OR = 3.18, 95%CI (2.45, 4.14), I2 = 3%], biochemical pregnancy rate (BPR) [OR = 2.84, 95%CI (2.22, 3.63), I2 = 0%], ongoing pregnancy rate (OPR) [OR = 3.41, 95%CI (2.08, 5.60), I2 = 30%] and live birth rate (LBR) [OR=5.10, 95%CI (1.95, 13.37), I2 = 75%] in women with RIF. However, PRP intrauterine infusion did not reduce miscarriage rate (MR). Notably, the preterm birth rate was significantly higher in the PRP group compared to controls [OR = 8.24, 95%CI (2.09, 32.41), I2 = 0%]. Subgroup analysis demonstrated that PRP improved CPR, BPR and LBR in both the fresh and frozen embryo transfer cycles. Additionally, while PRP increased CPR, LBR and reduced MR in blastocyst transfers [CPR OR = 3.84, 95%CI (2.82, 5.23), I2 = 0%; LBR OR = 7.32, 95%CI (3.17, 16.90), I2 = 63%; MR OR = 0.27, 95%CI (0.07, 0.96), I2 = 54%], these effects were not observed in cleavage-stage embryo transfers. Moreover, PRP administration associated with a higher CPR [OR = 3.84, 95%CI (2.82, 5.23), I2 = 0%], OPR[OR = 4.13, 95%CI (1.79, 9.56), I2 = 48%], LBR [OR = 7.32, 95%CI (3.17, 16.90), I2 = 63%] and a lower MR [OR = 0.27, 95%CI (0.07, 0.96), I2 = 54%] in women with ≥3 prior implantation failure, it did not confer the same benefit to those with a history of ≥2 failed cycles.
Conclusion
These findings suggest a possible beneficial role for PRP on pregnancy outcomes to some extent in women with RIF, particularly in cases with ≥3 prior failed transfers, and blastocyst transfer may increase LBR and reduce miscarriage risk. However, further investigation is warranted to determine whether this treatment may pose an increased risk of preterm birth.
Systematic Review Registration
https://www.crd.york.ac.uk/prospero/, identifier CRD420251061511.
