Effect of autologous platelet-rich plasma on clinical outcome in patients with suboptimal endometrium in fresh ICSI/FET cycle − an interventional prospective study

Abstract

Context: Endometrial receptivity (ER) is crucial for implantation rate and clinical pregnancy rate in ET-IVF. Endometrial receptivity is affected independently by endometrial thickness, vascularity and pattern. Aims: To evaluate the efficacy of autologous platelet-rich plasma in improving the endometrial parameters in patients with suboptimal endometrium in fresh ICSI/FET cycle. To evaluate pregnancy outcome in FET/ICSI cycles after intrauterine instillation of PRP. Settings and Design: Interventional prospective study conducted in tertiary infertility centre. Methods and Material: 30 patients with suboptimal endometrium undergoing IVF-ICSI/FET cycle with failed implantation/history of previous cycle cancellations/intrauterine adhesions on hysteroscopy were included. Patients with poor embryo quality, Bleeding dyscracias, Low platelet counts or active infections were excluded. All patients with any compromised endometrial parameter were offered intra-uterine PRP infusion. Statistical analysis used: Categorical data were presented as frequency and percentage; for comparison Chi square and McNemar tests were used wherever applicable for calculation of P-value. P-value < 0.05 was considered significant. Results: Endometrial thickness showed good response to PRP therapy and the mean increase in endometrial thickness was 1.33mm. PRP therapy significantly changed the endometrial pattern from Type A to Type B in more than half the patients (P-value = 0.001). PRP was instrumental in improving the sub-endometrial flow (22/30 patients, 73.3%) and uterine artery resistance (16/20, 80%), more so in subgroup of patients suffering from Intrauterine adhesions (P-value = 0.004 and 0.001 respectively). 43.3% (13/30) showed positive β-hCG. A clinical pregnancy rate of 30% (9/30) was seen. Conclusions: PRP has promising results in patients with suboptimal endometrium by increasing endometrial thickness, ameliorating pattern and improving vascularity with reduced cancellation rate.