Successful Implantation and Live Birth Following Autologous Platelet-rich Plasma Treatment for a Patient with Recurrent Implantation Failure and Chronic Endometritis

Konstantinos Sfakianoudis; Mara Simopoulou; Nikolaos Nitsos; Leandros Lazaros; Anna Rapani; Agni Pantou; Michael Koutsilieris; Yorgos Nikas; Konstantinos Pantos

doi:10.21873/invivo.11504

Assisted Reproduction · Add-Ons and Adjuncts

Successful Implantation and Live Birth Following Autologous Platelet-rich Plasma Treatment for a Patient with Recurrent Implantation Failure and Chronic Endometritis

Sfakianoudis K, Simopoulou M, Nitsos N, Lazaros L, Rapani A, Pantou A, Koutsilieris M, Nikas Y, Pantos K

In vivo (Athens, Greece), 2019

DOI 10.21873/invivo.11504 PMID 30804135 PMC PMC6506282

RRM Academy Synopsis

Chronic endometritis resolved after platelet-rich plasma in one case

In a 2019 case report, chronic endometritis showed no signs after intrauterine platelet-rich plasma in a 35-year-old woman. Six donated embryo transfers had failed, and two antifungal courses had not cleared the condition. Her next transfer of donated embryos led to twins, delivered at the 36th week.

Key Findings

The patient was 35 years old and had premature ovarian insufficiency. Six donated embryo transfers had failed before she was referred to the authors' clinic.
Hysteroscopy, microbiological analysis and scanning electron microscopy diagnosed chronic endometritis, and microbiology found Candida albicans. Two blastocysts graded 5AA were transferred after antifungal treatment, and pregnancy loss followed 20 days after transfer.
After a second antifungal course, all analyses confirmed persistent chronic endometritis. After intrauterine platelet-rich plasma, hysteroscopy, microbiological analysis and scanning electron microscopy showed no signs of it.
Transfer of two donated blastocysts graded 5BB and 5BC in the next cycle produced a twin pregnancy. Delivery came at the 36th week, with babies weighing 2.28 kg and 2.18 kg.

Interpretation

A case report follows one woman and comes from the clinic where she was treated. The authors argue that platelet-rich plasma treated the endometritis and enabled the pregnancy. Their supporting point is that the donated embryos from the transfer that ended in loss were graded higher (5AA) than those that led to birth (5BB and 5BC). The report includes no comparison patient, so it gives no estimate of how often this result occurs. The woman had premature ovarian insufficiency and received donated embryos, which differs from women using their own eggs. The authors state that larger randomized controlled studies would strengthen the finding.

RRM Context

Chronic endometritis is often silent. The authors report that ultrasound and hysterosalpingography cannot detect it. Repeated embryo transfers can go on while the inflamed lining stays unidentified. Restorative reproductive medicine treats failed implantation as a symptom with a findable cause. Here, hysteroscopy with biopsy testing found a uterine condition that coexisted with the failed transfers. The authors note that such maternal causes are usually diagnosed after the fact.

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

Abstract

Background and Aims

Patients diagnosed with chronic endometritis (CE) may fail to respond to standard antibiotic treatment. The driver behind the approach reported here was the imperative need for alternative therapeutic solutions.

Case Report

This case report presents a woman with CE and premature ovarian insufficiency having experienced repeated implantation failures following donated embryo transfers. The patient was diagnosed with CE through hysteroscopy, microbiological analysis and scanning electron microscopy. Following the suggested antibiotic treatment, she underwent a new embryo transfer, but with subsequent pregnancy loss. Following a second antibiotic scheme, all diagnostic procedures certified the persistence of CE. The patient underwent autologous, intrauterine platelet-rich plasma treatment and a subsequent embryo transfer. The diagnostic procedures indicated no signs of CE, while the embryo transfer resulted in a twin pregnancy and birth.

Conclusion

Platelet-rich plasma may be employed as a first-line CE treatment, especially for patients who fail to respond to conventional antibiotic schemes.

Topics

Assisted Reproduction › Add-Ons and Adjuncts › Adjunct Evidence Base · Therapeutics › Emerging Therapies › Platelet-Rich Plasma · Infections and the Reproductive Microbiome › Chronic Endometritis › Treatment of Chronic Endometritis

Konstantinos Sfakianoudis, Mara Simopoulou, Nikolaos Nitsos, Leandros Lazaros, Anna Rapani, Agni Pantou, Michael Koutsilieris, Yorgos Nikas, Konstantinos Pantos

K Sfakianoudis, M Simopoulou, N Nitsos, L Lazaros, A Rapani, A Pantou, Mike Koutsilieris, M Koutsilieris, Y Nikas, K Pantos

PMID 30804135 30804135 DOI 10.21873/invivo.11504 10.21873/invivo.11504 Sfakianoudis et al. 2019, Sfakianoudis 2019

Successful Implantation and Live Birth Following Autologous Platelet-rich Plasma Treatment for a Patient with Recurrent Implantation Failure and Chronic Endometritis

Chronic endometritis resolved after platelet-rich plasma in one case

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

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