Network meta-analysis on the efficacy of different interventions for treating thin endometrium

Feng K; Wu L; Zhang Z; Luo Y; Li X; Li D; Zhong J; Lan L; Zhu L

doi:10.3389/fendo.2025.1575248

Therapeutics · Hormonal Agents

Network meta-analysis on the efficacy of different interventions for treating thin endometrium

Feng K, Wu L, Zhang Z, Luo Y, Li X, Li D, Zhong J, Lan L, Zhu L

Frontiers in Endocrinology, 2025

DOI 10.3389/fendo.2025.1575248 PMID 40909225 PMC PMC12406221

RRM Academy Synopsis

PRP ranks highest for pregnancy in thin endometrium treatment trials

The 2025 study pooled 18 trials of 2,152 women with a thin uterine lining. It compared six treatments, including aspirin and PRP (platelet-rich plasma). In this analysis, platelet-rich plasma ranked highest for helping women get pregnant.

Key Findings

18 RCTs across six interventions were pooled: 1,088 women received a treatment and 1,064 were in a control group.
For lining thickness versus no treatment, aspirin, G-CSF, and PRP each showed a significant increase (95% credible intervals did not cross zero).
Ding Kun Dan, electrical stimulation, and growth hormone did not significantly increase thickness; their credible intervals crossed zero.
For clinical pregnancy rate, PRP showed the largest effect versus no treatment (OR 2.77, 95% CrI 1.86 to 4.32), ahead of aspirin, Ding Kun Dan, and G-CSF.
On SUCRA (an overall ranking score), G-CSF ranked first for thickness (78.48%) and PRP ranked first for pregnancy rate (80.12%).

Interpretation

The paper is a network meta-analysis. It estimates how treatments compare using statistical modeling, even though each treatment was tested only against a control group. The rankings are a statistical estimate. The treatments were not tested head-to-head. The authors report no significant difference between PRP and aspirin for lining thickness. Trial sizes ranged from 28 to 307 participants; several were quite small. The herbal formula and electrical stimulation each came from just one study, so those results are less certain. Most trials were done in China, which may limit how the findings apply elsewhere. Blinding is hard for these treatments, and the authors note this as a limitation.

RRM Context

A thin uterine lining is a sign of a deeper problem. It can come from low estrogen receptor activity, poor blood flow in the small uterine arteries, low growth factor levels, or scarring that blocks normal growth. The treatments compared here, aspirin, growth-factor infusion, and PRP, target that downstream problem. The cause itself stays unaddressed. Restorative reproductive medicine looks for why one woman's lining is not growing well, since a thin lining can trace back to different causes.

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

Abstract

Background

The incidence of thin endometrium in assisted reproductive technology (ART) is between 1% and 2.5%, yet its treatment options are varied and often show limited efficacy. There is an urgent need to delineate the relative effectiveness of various interventions to guide clinical practice.

Objective

This study aims to systematically compare the efficacy of different interventions for treating thin endometrium via a network meta-analysis, focusing on improvements in endometrial thickness and clinical pregnancy rates.

Methods

A systematic search was conducted in PubMed, The Cochrane Library, EMBASE, CBM, and CNKI databases, covering literature until December 31, 2024. Randomized controlled trials (RCTs) evaluating treatments for thin endometrium were included and assessed for quality using the Cochrane Risk of Bias Tool. Stata 17.0 software was used for the network meta-analysis, employing Bayesian methods to construct network diagrams and calculate the surface under the cumulative ranking curve (SUCRA).

Results

Eighteen RCTs involving six interventions (oral aspirin, Ding Kun Dan, intrauterine infusion of platelet-rich plasma [PRP], intrauterine infusion of granulocyte-macrophage colony-stimulating factor [G-CSF], intramuscular injection of recombinant human growth hormone [rhGH], and neuromuscular electrical stimulation [NMES]) were included. The network meta-analysis revealed: 1) Endometrial thickness: All intervention groups showed varying degrees of effectiveness in increasing thickness compared to the control group. The top three ranked in effectiveness were G-CSF (SUCRA = 78.48%), aspirin (SUCRA = 70.89%), and PRP (SUCRA = 68.14%). 2) Clinical pregnancy rate: PRP ranked highest in improving pregnancy rates (SUCRA = 80.12%), followed by aspirin (SUCRA = 70.29%) and Ding Kun Dan (SUCRA = 62.79%). Overall, PRP showed significant advantages in both increasing endometrial thickness and improving clinical pregnancy rates, making it the most promising intervention.

Conclusion

PRP demonstrates the best clinical application potential in treating thin endometrium, particularly in improving clinical pregnancy rates. Future high-quality RCTs are necessary to further validate and optimize intervention strategies.

Topics

Therapeutics › Hormonal Agents › Estrogen Preparations · Infertility › Uterine Factor › Endometrial Receptivity

Lin Wu

L Wu

PMID 40909225 40909225 DOI 10.3389/fendo.2025.1575248 10.3389/fendo.2025.1575248 Feng et al. 2025, Feng 2025

Network meta-analysis on the efficacy of different interventions for treating thin endometrium

PRP ranks highest for pregnancy in thin endometrium treatment trials

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

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