restorative-reproductive-medicine/adjunct-and-emerging-therapies/platelet-rich-plasma-and-regenerative-approaches infections-and-microbiome/chronic-endometritis/treatment-of-chronic-endometritisinfertility/uterine-factor/endometrial-receptivity
Chen X et al., 2025 · Frontiers in immunology
[BACKGROUND] Chronic endometritis (CE) has been widely recognized as a potential cause of infertility, however, access to effective treatment is a formidable challenge due to the rudimentary understanding of the pathogenesis of persistent CE. Here, we aimed to analyze the impact of platelet-rich plasma (PRP) treatment on pregnancy outcomes and the endometrial microenvironment in patients with persistent CE. [METHODS] A total of 89 infertility patients were selected, including 56 non-CE (as the control group) and 33 persistent CE. The persistent CE patients received an intrauterine infusion of PRP four times before embryo transfer. Immunohistochemistry staining and transcriptomic sequencing were used to investigate the uterine-specific role of PRP in patients with persistent CE. [RESULTS] The implantation rate and clinical pregnancy rate were significantly increased in the cured CE group compared to the non-cured CE group. After PRP treatment, the proportions of endometrial CD8+ T cells, CD56+ NK cells, Foxp3+ Treg cells, and T-bet+ Th1 cells were significantly decreased in patients with persistent CE. Specifically, DEG analysis showed that genes implicated in endometrial receptivity-related and antimicrobial were upregulated and genes involved in the immune response processes were downregulated in cured CE patients after PRP treatment. Functional enrichment analysis suggested that the effects of changes in leukocyte chemotaxis-related genes played a critical role in the endometrial immune environment. [CONCLUSIONS] Autologous PRP treatment has been shown as a potentially successful therapy for improving pregnancy outcomes by reconstructing the uterine local immune microenvironment to improve endometrial receptivity in patients with persistent CE.
infertility/uterine-factor/endometrial-receptivity restorative-reproductive-medicine/adjunct-and-emerging-therapies/platelet-rich-plasma-and-regenerative-approachesassisted-reproduction/add-ons-and-adjuncts/adjunct-evidence-base
Chen L et al., 2025 · Frontiers in reproductive health
[OBJECTIVE] To analyze the effect of autologous platelet-rich plasma (PRP) intrauterine perfusion on the clinical outcomes of frozen-thawed embryo transfer in patients with chronic endometritis. [METHODS] A retrospective continuous cohort of 219 patients diagnosed with chronic endometritis at the Reproductive Medicine Center of Affiliated Hospital of Putian University between January 2020 and December 2022, undergoing their first frozen-thawed embryo transfer cycle, was included. All patients received standardized oral doxycycline treatment after diagnosis. Based on whether they received PRP intrauterine perfusion prior to embryo transfer, patients were divided into an observation group (PRP group, n=103) and a control group (non-PRP group, n = 116). Outcome measures included live birth rate per transfer cycle, clinical pregnancy rate per transfer cycle, and early miscarriage rate per clinical pregnancy. [RESULTS] All patients underwent endometrial preparation using a hormone replacement therapy (HRT) protocol. Endometrial thickness on the day before transformation was significantly higher in the PRP group compared to the control group (10.58 ± 1.78 mm vs. 9.79 ± 1.58 mm, P = 0.001). The PRP group exhibited significantly higher clinical pregnancy rate per transfer cycle and live birth rate per transfer cycle than the control group (58.25% vs. 40.52%, P = 0.038; 52.43% vs. 34.48%, P = 0.007). The difference in early miscarriage rate per clinical pregnancy between the PRP group and the control group was not statistically significant (8.33% vs. 14.89%, P = 0.86). The live birth rate per transfer cycle in the single-PRP subgroup was significantly lower than in the multiple-PRP subgroup (44.62% vs. 65.79%, P = 0.038). There were no statistically significant differences in clinical pregnancy rate per transfer cycle or early miscarriage rate per clinical pregnancy between the single-PRP and multiple-PRP subgroups (52.31% vs. 68.42%, P = 0.110; 11.76% vs. 3.85%, P = 0.377). [CONCLUSION] For patients diagnosed with chronic endometritis undergoing their first frozen-thawed blastocyst transfer after standardized antibiotic treatment, adjunctive PRP intrauterine perfusion therapy improves pregnancy outcomes.
infertility/uterine-factor/endometrial-receptivity therapeutics/hormonal-agents/estrogen-preparationsrestorative-reproductive-medicine/adjunct-and-emerging-therapies/platelet-rich-plasma-and-regenerative-approaches
Liu X et al., 2024 · BMC pregnancy and childbirth
[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.
infections-and-microbiome/chronic-endometritis/endometritis-and-reproductive-outcomes infertility/uterine-factor/endometrial-receptivityrestorative-reproductive-medicine/adjunct-and-emerging-therapies/platelet-rich-plasma-and-regenerative-approaches
Li J et al., 2023 · Frontiers in cell and developmental biology
Chronic endometritis (CE) has been considered to reduce uterine receptivity and negatively affect reproductive outcomes for in vitro fertilization-embryo transfer (IVF-ET) patients, especially for people undergoing recurrent implantation failure (RIF). To investigate the effects of antibiotic and platelet-rich plasma (PRP) therapy on pregnancy outcomes following frozen-thawed embryo transfer (FET) in RIF patients with CE, endometrial specimens of 327 patients with RIF obtained by endometrial scratching during mid-luteal phase were immunostained by multiple myeloma oncogene-1 (Mum-1)/syndecan-1 (CD138). RIF patients with CE were given antibiotics and PRP treatment. According to the Mum-1+/CD138+ plasmacytes after treatment, patients were divided into persistent weak positive CE (+) group, CE (-) group and non-CE group. FET was performed and the basic characteristics and pregnancy outcomes of patients in three groups were compared. Among 327 RIF patients, 117 patients were complicated with CE, the prevalence was 35.78%. The prevalence of strong positive was 27.22% and that of weak positive was 8.56%. 70.94% patients with CE converted to negative after treatment. There was no significant difference in the basic characteristics, including age, BMI, AMH, AFC, infertility years, infertility types, number of previous transplant cycles, endometrial thickness on transplantation day and number of transplanted embryos (p > 0.05); The positive rate of hCG, clinical pregnancy rate and implantation rate in CE (-) group were significantly increased compared with the weak CE (+) group and non-CE group (p < .01), and the live birth rate also improved (p < .05). Whereas, the rate of early abortion in CE (-) group was 12.70%, which was higher than that in weak CE (+) group and non-CE group (p < .05). After multivariate analysis, number of previous failed cycles and CE remained independent factors associated with live birth rate, while only CE remained to be the independent factor of clinical pregnancy rate. It is recommended to perform CE-related examination for patients with RIF. Antibiotic and PRP treatment can significantly improve pregnancy outcomes of patients with CE negative conversion in FET cycle.