Abstract
In patients whose embryo transfer has been previously canceled due to a thin endometrium, the injection of platelet-rich plasma (PRP) guided by hysteroscopy into the endomyometrial junction improves endometrial thickness and vascularity. This may well serve as a novel approach for the management of these patients. In this study, 32 patients aged between 27 and 39 years, suffering from primary or secondary infertility, were selected for hysteroscopic instillation of PRP. This cross-sectional study included a retrospective assessment of the improvement of endometrial thickness (>7 mm) on the commencement of progesterone treatment in 24 of 32 patients (75%) after hysteroscopy-guided injections of PRP into the subendometrial zone. After PRP instillation, the endometrium was 7 mm or thicker in 24 of 32 patients, and all 24 patients underwent frozen embryo transfer. Moreover, 12 of 24 patients who underwent embryo transfer conceived, whereas 10 had a clinical pregnancy with visualization of cardiac activity at 6 weeks and two had a biochemical pregnancy. Our approach of PRP injection into the subendometrial region is consistent with the histologically proven regeneration of the endometrium from the endomyometrial junction. We observed an improvement of endometrial thickness and higher pregnancy rates in cases of previously canceled embryo transfer due to a thin endometrium.
Highlights
The optimal endometrial thickness for embryo transfer is assumed to be about 7 mm or more [1,2,3]
A thin endometrium has been identified as an important factor in implantation failure [4,5,6] because it is marked by high blood flow impedance of radial arteries of the uterine vasculature, poor epithelial growth, reduced expression of vascular endothelial growth factor (VEGF), and poor vascular development [7]
Some studies have shown better endometrial thickness (ET) after intrauterine platelet-rich plasma (PRP) [3], which prompted us to use this novel approach in patients who were unresponsive to the aforementioned modalities
Summary
The optimal endometrial thickness for embryo transfer is assumed to be about 7 mm or more [1,2,3]. Various studies have shown the improvement of endometrial thickness with the use of prolonged estradiol valerate, aspirin, sildenafil citrate, L-arginine, and pentoxifylline, but no consensus has been achieved yet in this regard [8,9,10]. Some studies have shown better endometrial thickness (ET) after intrauterine platelet-rich plasma (PRP) [3], which prompted us to use this novel approach in patients who were unresponsive to the aforementioned modalities. Stem or progenitor cells seem to be responsible for this regeneration process. The contribution of stem cells to endometrial regeneration was first described in 2004 [13,14]. Both progenitor cells within the endometrium and multipotent cells from bone marrow were shown to contribute to endometrial growth [15]. CD140b+, CD146+, or SUSD2+ endometrial mesenchymal stem cells (eMSCs) and N-cadherin+ endometrial epithelial progenitor cells (eEPs) are just a few examples concerning types of stem/progenitor cells that have been identified [16]
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