Assisted Reproduction · Add-Ons and Adjuncts
RRM Academy Synopsis
PRP linked to more live births per transfer in chronic endometritis
In a retrospective cohort of 219 women with chronic endometritis, about 5 out of 10 transfers with platelet-rich plasma ended in a live birth. The comparison group had about 3 out of 10. The plasma came from each woman's own blood and was placed in the uterus before a first frozen embryo transfer, after antibiotics, in women 37 or younger.
Key Findings
- Live birth per transfer cycle was 52.43% (54 of 103) in the PRP group and 34.48% (40 of 116) in the control group (P = 0.007).
- Clinical pregnancy per transfer cycle was 58.25% (60 of 103) with PRP and 40.52% (47 of 116) in controls (P = 0.038).
- Early miscarriage per clinical pregnancy was 8.33% (5 of 60) with PRP and 14.89% (7 of 47) in controls, a difference that did not reach statistical significance.
- Within the PRP group, live birth per transfer cycle was 44.62% (29 of 65) after a single session and 65.79% (25 of 38) after multiple sessions (P = 0.038).
- Endometrial compaction, a thinning of the lining after progesterone began, occurred in 32.04% (33 of 103) of the PRP group and 18.10% (21 of 116) of controls (P = 0.017).
Interpretation
The study is a retrospective cohort from one hospital center. Researchers compared records of women who had received PRP with records of women who had not, so the results show an association. Women were 37 or younger, had good-quality blastocysts, and had no history of repeated implantation failure or pregnancy loss. The groups were similar in age, body mass index, infertility duration and causes. The authors note that the retrospective design limits their conclusions and the single-center setting limits generalizability. They call for multicenter prospective randomized trials. The multiple-session subgroup had 38 women. Diagnosis used CD138 staining without routine screening for specific infectious agents.
RRM Context
Chronic endometritis is an inflammation of the uterine lining that can be diagnosed. The paper cites studies associating it with scar tissue in the uterus, polyps and endometriosis. It reports prevalence rates of 2.8% to 56.8% among infertile patients. Restorative reproductive medicine puts the search for causes first, for both partners. Here, the women had the endometritis diagnosed by biopsy and treated with antibiotics before the study's transfers.
Abstract
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.
