The use of Platelet-Rich Plasma in the Gynaecological Clinical Setting. A review

Abstract

Reports on clinical use of platelet-rich plasma (PRP) have dramatically increased in the last decade. PRP is a natural product where a high level of platelets is concentrated with growth factors concentration 3 to 5 times greater than plasma. In their alpha granules, platelets contain a cocktail of chemical mediators that trigger tissue regeneration, both through the promotion of angiogenesis and the initiation of cell regeneration. Such bioactive factors include platelet derived growth factor (PDGF), transforming growth factor-beta (TGF-β), vascular endothelial growth factor (VEGF), epidermal growth factor (EGF), fibroblast growth factor (FGF), insulin growth factor (IGF). In the gynaecological setting, PRP has been shown to facilitate wound healing and has been proposed as an effective treatment for the treatment of disorders such as Lichen Sclerosus (LS) or cervical ectopy. Evidence of PRP effectiveness in conditions of pelvic organ prolapse and urinary incontinence has also been reported. Recent publications have shown its positive effects in promoting endometrial and follicular growth and gestation in assisted reproduction cycles. PRP administration in the ovarian tissue has resulted in rejuvenation as evaluated by the relevant biochemical markers as well as reactivation of folliculogenesis. Other researchers have showed effective use in improving pregnancy outcomes in patients with repeated implantation failure. For managing repeated failures, several methods have been attempted, but recently PRP appears as effective in inducing endometrial development in patients with thin, poor endometrium. Another possible mechanism of PRP to endometrium is through its anti-inflammatory actions. PRP is an innovative therapeutic modality, as it is simple, easily performed, and effective, with minimal risk as it is an autologous product. The employment of regenerative medicine approaches will continue to grow in the gynaecological setting and the future trials should be carefully designed in order to facilitate the clinical translation.