A Comparative Study on the Efficacy of Subendometrial versus Intrauterine Platelet-rich plasma Injections for Treating Intrauterine Adhesions: A Retrospective Cohort Study

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ObjectiveComparison of the clinical efficacy of hysteroscopic subendometrial injection of platelet-rich plasma (PRP) and intrauterine instillation of PRP for the treatment of intrauterine adhesions. DesignA Retrospective Cohort Study. SettingUniversity hospital. PatientsPatients who underwent hysteroscopic transcervical excision of adhesions from September 1, 2020, to July 31, 2023, and were treated with PRP in the postoperative period were included. InterventionsSubendometrial PRP injection group (referred to as SE-PRP group) and intrauterine PRP infusion group (referred to as IU-PRP group) Measures and main resultsA total of 299 patients with moderate-to-severe IUA treated with PRP after Transcervical resection of adhesions (TCRA) were included. The primary outcome metric was the clinical pregnancy rate, and the secondary outcome metrics were the rate of menstrual improvement and the AFS score. The results showed that: the AFS reduction scores was greater in the SE-PRP group than in the IU-PRP group (8 vs. 7, P = 0.019); the menstrual improvement rate in the SE-PRP group was higher than that in the IU-PRP group (77.0% vs. 52.9%, P < 0.001); and the clinical pregnancy rate in the SE-PRP group was similar than that in the clinical pregnancy rate in the IU-PRP group (28.4% vs. 20.4%, P = 0.208). The results of multifactorial logistic regression analysis showed that the clinical pregnancy rate in the SE-PRP group was significantly higher than that in the IU-PRP group (OR = 2.020, 95% CI = 1.050-3.889, P = 0.035). The results of the propensity score matching (PSM) analysis showed that: the median postoperative AFS score reduction was significantly higher in the SE-PRP group than in the IU-PRP group (P = 0.015); and the rate of improvement in menstruation was significantly higher in the matched SE-PRP group (75.0% vs. 58.1%, P = 0.027) and clinical pregnancy rates were higher in the SE-PRP group (29.4% vs. 16.2%, P = 0.043). ConclusionsHysteroscopic intrauterine PRP injection is more clinically effective than intrauterine PRP infusion for patients with moderate to severe intrauterine adhesions, resulting in greater reduction in adhesion scores, improvement in menstrual rate, and increased clinical pregnancy rate.