Efficacy of platelet-rich plasma in the treatment of thin endometrium: a meta-analysis of randomized controlled trials

Xinyuan Liu; Chengyu Qian; Xiaoyue Jiang; Yue Zhou; Xue Feng; Yinyin Ding; Jing Jin; Minghui Hu; Weiye Zhou; Bei Liu; Huifang Zhou

doi:10.1186/s12884-024-06741-3

Assisted Reproduction · Add-Ons and Adjuncts

Efficacy of platelet-rich plasma in the treatment of thin endometrium: a meta-analysis of randomized controlled trials

Liu X, Qian C, Jiang X, Zhou Y, Feng X, Ding Y, Jin J, Hu M, Zhou W, Liu B, Zhou H

Published August 30, 2024 BMC pregnancy and childbirth

DOI 10.1186/s12884-024-06741-3 PMID 39215227 PMC PMC11363443

RRM Academy Synopsis

Platelet-rich plasma may raise clinical pregnancy in thin endometrium

Clinical pregnancy was about twice as likely after platelet-rich plasma infusion (risk ratio 2.04) in a meta-analysis of eight randomized trials with 678 women who had thin endometrium. Live birth was also higher in the PRP groups (risk ratio 2.46). The trials took place around assisted reproductive technology (ART) cycles.

Key Findings

Seven trials reported endometrial thickness, which was greater after PRP infusion (mean difference 1.23, 95% CI 0.87 to 1.59; 608 women), with wide variation between studies (I2 = 84.0%).
Clinical pregnancy rate: risk ratio 2.04 (95% CI 1.52 to 2.76; seven studies, 603 women). Live birth rate: risk ratio 2.46 (95% CI 1.57 to 3.85; four studies, 362 women).
Embryo implantation rate was higher (risk ratio 2.71, 95% CI 1.91 to 3.84) and cycle cancellation rate was lower (risk ratio 0.46, 95% CI 0.23 to 0.93) with PRP.
Spontaneous abortion rate (risk ratio 0.85, 95% CI 0.40 to 1.78) and chemical pregnancy rate (risk ratio 1.84, 95% CI 0.72 to 4.72) showed no statistically significant difference.
Endometrial vascular improvement rate also showed no statistically significant difference between groups (risk ratio 1.10, 95% CI 0.89 to 1.38; two studies, 227 women).

Interpretation

The authors chose randomized controlled trials because they are widely acknowledged as the best way to evaluate clinical treatment outcomes. Control groups received hormone replacement therapy or a placebo. Only one trial reported double-blinding, and one reported blinding its outcome assessors. Thickness results varied widely. The authors suggest this may reflect differences in how PRP was prepared and given, and in who was enrolled. They list the small number of studies and English-only searching as limitations. No study reported complications or adverse events associated with PRP injection, and nearly half followed women to childbirth. The authors note that the studies did not mention the children's later growth and development.

RRM Context

The authors note that most women with thin endometrium have had repeated uterine procedures. These carry a higher risk of inflammation and fibrosis. The authors also cite meta-analyses showing that some ovulation-inducing drugs can thin the lining. Restorative reproductive medicine starts from causes like these and from the ovulatory cycle, which makes the estrogen and progesterone that prepare the lining. The trials gave PRP inside assisted reproduction cycles. The studies defined a thin lining by ultrasound thickness, with different cut-offs.

Our editorial summary of this paper, not the article's abstract.

Abstract

Background

Thin endometrium (TE) is a common cause of female infertility in clinical practice. Platelet-rich Plasma (PRP) therapy becomes a novel treatment for thin endometrium; however, its clinical application remains controversial. This meta-analysis aims to evaluate the therapeutic effects of intrauterine autologous PRP infusion in women with thin endometrium through relevant randomized controlled trials (RCTs).

Methods

We systematically searched studies published in English from inception until June 2024 in databases such as PubMed, The Cochrane Library, Embase, Web of Science, and MEDLINE. Search terms included "Platelet-Rich Plasma," "thin endometrium," "endometrial thickness," "infertility," "pregnancy," "reproduction," and "adverse reactions". RCTs identified through the search were subjected to systematic review and meta-analysis, and data were analyzed using fixed-effects or random-effects models based on heterogeneity.

Results

Eight RCTs involving 678 patients with thin endometrium were included. Patients receiving PRP infusion demonstrated significantly superior outcomes compared to the control group in endometrial thickness (MD: 1.23, 95%CI: 0.87 to 1.59, P = 0.000), clinical pregnancy rate (RR: 2.04, 95%CI: 1.52 to 2.76, P = 0.000), live birth rate (RR: 2.46; 95%CI: 1.57 to 3.85, P = 0.000), cycle cancellation rate (RR: 0.46, 95%CI: 0.23 to 0.93, P = 0.000), and embryo implantation rate (RR: 2.71; 95%CI: 1.91 to 3.84, P = 0.000). There were no statistically significance in spontaneous abortion rate (RR: 0.85, 95%CI: 0.40 to 1.78, P = 0.659), chemical pregnancy rate (RR: 1.84, 95%CI: 0.72 to 4.72, P = 0.204) and endometrial vascular improvement rate (RR: 1.10; 95%CI: 0.89 to 1.38, P = 0.367) between the two groups. The limitations of this study includes that, we only included single lauguage for literature research, the sample size and heterogeneity which could cause criteria bias.

Conclusion

Intrauterine PRP infusion may be an effective and safe treatment for women with thin endometrium. Further high-quality, large-sample, randomized controlled trials are needed to validate the reliability of our results.

Trial Registration

The review protocol is registered on PROSPERO with registration number CRD42023490421, and no modifications were made to the information provided at registration.

Topics

Assisted Reproduction › Add-Ons and Adjuncts › Adjunct Evidence Base · Therapeutics › Emerging Therapies › Platelet-Rich Plasma · Infertility › Uterine Factor › Endometrial Receptivity

Xinyuan Liu, Chengyu Qian, Xiaoyue Jiang, Yue Zhou, Xue Feng, Yinyin Ding, Jing Jin, Minghui Hu, Weiye Zhou, Bei Liu, Huifang Zhou

X Liu, C Qian, X Jiang, Y Zhou, X Feng, Y Ding, J Jin, M Hu, W Zhou, B Liu, H Zhou

PMID 39215227 39215227 DOI 10.1186/s12884-024-06741-3 10.1186/s12884-024-06741-3 Liu et al. 2024, Liu 2024

Efficacy of platelet-rich plasma in the treatment of thin endometrium: a meta-analysis of randomized controlled trials

Platelet-rich plasma may raise clinical pregnancy in thin endometrium

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

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