Autologous Platelet-rich Plasma Injection Research Articles

7967 Hysteroscopic Subendometrial PRP Injection in Cases of Infertility

<h3>Study Objective</h3> To determine the efficacy of Hysteroscopic subendometrial Platelet Rich Plasma (PRP) injection in improving endometrial thickness and pregnancy rates in IVF cases. <h3>Design</h3> Case-control Study. <h3>Setting</h3> Patients had hysteroscopy under general anesthesia or office settings according to their preference, in the dorsal lithotomy position. <h3>Patients or Participants</h3> 51 patients with history of recurrent IVF failure or thin endometrium (<7mm). <h3>Interventions</h3> Hysteroscopic subendometrial injection of autologous PRP using a wallace needle through the hysteroscope's operating channel to inject the PRP beneath the superficial endometrium in novel technique. <h3>Measurements and Main Results</h3> Endometrial thickness was measured sequentially post-operative and pregnancy rates following embryo transfer recorded. <h3>Conclusion</h3> PRP injection significantly improves endometrial thickness, and more studies are needed to ascertain pregnancy rates and live birth rates.

The effect of platelet-rich plasma on the improvement of pregnancy results in repeated implantation failure: A randomized controlled trial

The success rate of infertility treatment depends on many different factors. This study aimed to determine the effect of platelet-rich plasma (PRP) on the improvement of pregnancy outcomes in participants with repeated implantation failure. The study is a randomized triple-blind clinical trial. The study population was 118 women with repeated implantation failure during assisted reproductive technology treatment at Tabriz Jihad-e Daneshgahi ART Center from May 2017 to December 2019. Intervention: Intrauterine injection of autologous PRP. Standard treatment of fetal transfer to the uterine cavity was performed without intrauterine PRP injection in the control group: After 4 wk, the level of β-human chorionic gonadotropin hormone in participants' blood was measured. Comparing the effect of intrauterine injection of PRP in 2 groups showed the level of β-human chorionic gonadotropin positive in the intervention group was 21 (43.8%), in the control group was 12 (26.1%), odds ratio = 2.20 (0.92-5.26) and p = 0.073. The therapeutic effect in the intervention group compared to the control regarding the outcome of a successful pregnancy showed that intrauterine injection of PRP can be effective in improving pregnancy outcomes, although this improvement is not significant.

Autologous Fat and Platelet-Rich Plasma Injections in Trapeziometacarpal Osteoarthritis: A Systematic Review and Meta-Analysis.

For the treatment of carpometacarpal arthritis of the thumb, various therapies are used. Infiltration therapy with autologous substances such as platelet-rich plasma and autologous fat have recently gained increasing attention because of beneficial pain-reducing effects in arthritis and the associated regenerative potential. However, the extent of clinical evidence in this area and how well autologous substances work in terms of pain reduction and improvements in hand function remain unclear. A systematic review and meta-analysis were conducted to evaluate the current evidence and to provide more insight into pain reduction and improvement in hand function after infiltration of autologous substances. The authors identified 11 clinical trials, of which we included eight in the meta-analysis. Autologous substances achieved a good and long-lasting pain reduction, which may also be accompanied by corresponding improvement in hand function. Autologous substances appear to be more effective than corticoid infiltrations. The infiltration of autologous fat seems to be particularly promising in more advanced stages of carpometacarpal arthritis of the thumb. Our meta-analysis showed a mean pain reduction of 2.4 to 3 in visual analogue scale score and a reduction of 18 to 19 points in the Disabilities of the Arm, Shoulder, and Hand questionnaire after infiltration with autologous substances. Both platelet-rich plasma and autologous fat infiltration offer an efficient and long-lasting, minimally invasive therapy option in the treatment of carpometacarpal arthritis of the thumb.

PLANTAR FASCIITIS TREATMENT WITH PLATELET-RICH PLASMA INJECTION VERSUS STEROID INJECTION

Objective: Plantar fasciitis is characterized by heel pain that worsens when you bear weight after a long period of rest. Injections of steroids are one of the numerous therapeutic techniques that are frequently used to control plantar fasciitis. Numerous studies demonstrate that short-term pain alleviation with steroid injections is not long-lasting. According to recent studies, autologous platelet-rich plasma (PRP) injections encourage healing, which improves both short- and long-term pain alleviation. To compare the effects of local PRP injection and corticosteroid in the management of chronic plantar fasciitis, the current study was conducted. Methods: Sixty patients who met the criteria for this prospective double-blind trial were randomly assigned to one of two groups. Patients in Group I received an injection of steroid, whereas those in Group II received an injection of PRPs. The PNS numerical pain score (NPS) and a visual analog scale (VAS) were used to evaluate the patients. An evaluation was conducted before the injection as well as at 6 weeks, 3 months, and 6 months after the injection. Results: The mean VAS in Group I reduced from 7.00 before injection to 2.31 and that in Group II decreased from 7.81 before injection to 1.12. At the 6-month follow-up, the mean NPS score in Group I increased from 7.05 to 1.41 and in Group II from 7.86 to 1.02. The VAS and NPS improvements were statistically significant. In both groups, the plantar fascia thickness had decreased at the conclusion of the 6-month follow-up period (5.88 mm in Group I to 4.03 mm and 5.96 mm to 3.27mm in Group II), and the difference was statistically significant. Conclusion: When compared to steroid injection, local PRP injection is an excellent therapeutic option for persistent plantar fasciitis with long-lasting positive effects.

CHARACTERIZATION OF THE PROTEIN CONTENT OF PLATELET RICH PLASMA (PRP) AND A COMPARATIVE ANALYSIS OF DIFFERENCES AMONG TWO STRAINS OF MICE: IMPLICATIONS FOR REGENARATIVE STUDIES

Platelet Rich Plasma (PRP) is the plasma portion of the blood rich in platelets. Platelets produce a large number of clotting factors, cytokines, growth factors, and enzymes, which play key roles in the healing processes of the body. PRP has been utilized as a regenerative substance in orthopaedics and plastic surgery. Injection of autologous PRP has been studied as a potential stimulating agent for follicular growth in women with the poor ovarian response (POR) and primary ovarian insufficiency (POI), and to induce endometrial growth in women with endometrial hypoproliferation.

Platelet-Rich Plasma, an Innovative and Noninvasive Technique for Closure of Tracheoesophageal Fistula After Laryngectomy, Report of 2 Cases.

An innovative and noninvasive technique for closure of persistent tracheoesophageal fistula after total laryngectomy is described. In our preliminary study, two patients were included. No clinical and radiological signs of locoregional recurrence prior to treatment were diagnosed. We performed local injections of autologous platelet-rich plasma (PRP) according to our protocol. Complete closure of the fistula was observed in both patients who were able to take normal feeding. No side effects associated with the procedure were observed. These preliminary results are encouraging to consider PRP injection before more invasive surgical techniques in the treatment of persistent tracheoesophageal fistulas after total laryngectomy.

Serial Platelet-Rich Plasma Intra-articular Injections in Kellgren and Lawrence Grade IV Knee Joint Osteoarthritis: A Prospective Blinded Placebo-Controlled Interventional Study.

The purpose of this study was to evaluate whether serial intra-articular (IA) Platelet-Rich Plasma (PRP) injections improve pain and function in patients of Kellgren-Lawrence (K-L) Grade IV primary knee osteoarthritis (KOA), not willing for arthroplasty or having relative contraindications to surgery. 90 patients (84 available at final follow-up) of Grade IV KOA were given 3 PRP or NormalSaline injections at 1-month interval. Pain and functional assessment was done with Visual analog scale (VAS) and Western Ontario and McMaster universities osteoarthritis index (WOMAC) respectively, at baseline and then at three and six months of follow-up. Both groups were homogenous with similar baseline characteristics. Both groups showed statistically significant improvements in the outcome scores but only PRP showed minimal clinically important difference (25% in WOMAC and > 2cm difference of mean in VAS at follow-up). For inter-group comparison, PRP showed better results as there was statistically significant difference in WOMAC at 3months (Difference = - 9.220, 95% CI = - 13.1945 to - 5.2455, P < 0.0001) and at 6months (Difference = - 10.360, 95% CI = - 14.5358 to - 6.1842, P < 0.0001). Similar results were seen for VAS also (Difference = - 0.580, 95% CI = - 1.1412 to - 0.0188, P = 0.04 at 3months, Difference = - 0.870, 95% CI - 1.3993 to - 0.3407, P = 0.001 at 6months). Outcome scores significantly correlated with age and sex but not with body mass index (BMI). Serial Intra-articular Injections of autologous PRP mildly improve short-term subjective pain and knee function scores in patients of Grade IV KOA without any major complications.

956 Patient-Reported Outcomes After Platelet Rich Plasma Injections for Elbow Tendinopathies

Abstract Introduction Elbow tendinopathies affect 1–3% of the population, with 35–50 years old most commonly being affected. It is work-related as such can lead to significant morbidity, time off work, and affect the income of patients as well as daily activities. Non-operative management is the recommended first step however, success is influenced by patient compliance. Autologous platelet-rich plasma injections are a novel approach to managing tendinopathies however, evidence of efficacy was determined by NICE to be inadequate as such recommended more research into its use. Aim Assess patient-reported outcomes after PRP injections for management of elbow tendinopathies. Method Retrospective study of 28 patients with chronic elbow tendinopathies treated with PRP injections between 2018–2020. Pre-and Post-procedure outcomes were measured using the Oxford Elbow Score questionnaire. Average f/u duration-234 days. Results 27 patients answered the questionnaire out of 28 total patients that underwent the procedure. Of the 27 patients, 20 patients (74%) reported improvement in symptoms and were satisfied with their outcomes after one injection. Conclusions This study shows PRP injections are reasonable and efficient management for elbow tendinopathies in patients not managed medically. This helps strengthen arguments for PRP injections over steroids for tendinopathies as studies have shown that steroids have potential side effects, usually requires more than 1 injection for symptomatic relief and despite being beneficial in short term, is worse than other treatment options in the intermediate and long term for patients with tendinopathies. Our numbers also coincide with previous larger studies that showed ∼70% of patients reported symptoms improving after 1 injection.

Leukocyte-Rich Platelet-Rich Plasma as an Effective Source of Molecules That Modulate Local Immune and Inflammatory Cell Responses.

Autologous platelet-rich plasma (PRP) injection is a safe biological method used to treat various musculoskeletal diseases. By downregulation of inflammatory cytokines and stimulation of synovial fibroblasts, PRP injection is a promising adjunctive treatment for patients with chronic autoimmune inflammatory diseases such as rheumatoid arthritis. A major problem in comparing the results of clinical trials in this area is the considerable variability in the cytokine content of PRP. We presented the profile of selected growth factors and inflammatory cytokines in the obtained PRP samples and compared them with baseline serum levels to assess the efficacy of PRP as a source of those paracrine molecules. Additionally, we wanted to determine whether the difference is only quantitative, which would suggest the use of a cheaper alternative by injecting a large amount of autologous serum. For this purpose, we analyzed whole blood and PRP samples prepared using the Mini GPS III Platelet Concentration System (Biomet Inc., USA) in 31 subjects aged 35-60 years. Cellular content, seven selected growth factors, and 13 human inflammatory cytokines were evaluated. Multiplex bead immunoassays that use fluorescence-encoded beads LEGENDplex™ (BioLegend, USA) and flow cytometer measurements were used. As a result, we found a statistically significant increase in four of the growth factors tested and eight of the inflammatory cytokines tested in PRP compared to blood serum. The difference is not only quantitative but also in the composition of paracrine molecules. In conclusion, the study confirmed that PRP is an efficient source of several growth factors and some inflammatory cytokines. These data provide additional insight into the potential mechanisms of PRP's effects on cellular metabolism and inflammatory response and may contribute to a better understanding of its clinical efficacy.

EFFECTIVENESS OF AUTOLOGUS INJECTION PLATELET RICH PLASMA IN MANAGEMENT OF LATERAL EPICONDYLITIS AND TO MEASURE THE OUTCOMES IN A SHORT TERM FOLLOW UP

Introduction: An inflammatory disorder known as lateral epicondylitis develops where the common extensor tendon of the forearm originates over the lateral epicondyle. It is the most prevalent chronic, debilitating, and painful elbow condition. 1 to 3 percent of the overall population experiences symptoms. Aim And Objectives: to assess the results of a brief follow-up study after a single dose of autologous platelet-rich plasma injection for the treatment of lateral epicondylitis. Materials And Methods:This is a prospective study of about 25 patients includes 17 females and 8 males who were diagnosed as lateral epicondylitis. Platelet rich plasma group was injected with 3-4 ml platelet rich plasma, using a “peppering” technique in a clock wise manner to better cover the affected area of lateral epicondyle. Results: All the relevant data were analysed. The average Visual Analogue Scale (VAS) and Disabilities of the Arm, Shoulder and Hand (DASH) scores of pre injection, 4th week, 8th week and 12th week post injection Discussion: Currently, platelet rich plasma (PRP) is considered as the optimal biological component produced from autologous blood. In addition, platelet rich plasma has high antimicrobial potency and this property may prevent infections. Conclusion: Pain and decreased functional activities in lateral epicondylitis are significantly improved by a single autologous platelet-rich plasma injection.

Efficacy of Autologous Intra-articular Platelet Rich Plasma Injection as a Biological Adjuvant in Early Primary Osteoarthrosis Knee—A Prospective Study

Introduction Classical characteristics of osteoarthrosis are reduction or loss of articular cartilage, new bone formation, accompanied by synovial proliferation resulting in pain, loss of joint function, and disability. Platelet rich plasma (PRP) has been used to provide stimulus for local regeneration and healing. The present study was conducted with the aim of evaluating the clinical outcome and efficacy of injecting PRP intra-articularly in early primary osterarthrosis knee. Objective Prospective study was conducted with the aim of evaluating the clinical outcome of efficacy of injection of PRP in early primary osteoarthrosis knee with respect to pain, stiffness, function and quality of life, in short-term follow-up. Attempt was made to standardize protocol and formulate PRP. Materials and Methods Patients were divided into two groups: one treated with two autologous PRP injections at 2 weeks interval and second received symptomatic treatment with physiotherapy. Patients were prospectively evaluated at baseline and then at 1 month, 3 months, and 6 months of follow-up using the visual analog scale (VAS) score, Western Ontario and McMaster Universities osteoarthritis index (WOMAC) score, and range of movements. Results There was reduction in VAS score in group 1 patients compared with group 2 patients with the p-value &lt;0.0001 which was highly significant. There was a significant improvement in WOMAC score at 1 month, 3 months, and 6 months in group 1 compared with group 2 patients. Conclusion Autologous PRP in osteoarthrosis of knee has emerged as a simple technique, sensitive procedure, and cost-effective treatment option. Administration of intra-articular PRP injections reduced the VAS score significantly and also a significant improvement in the WOMAC score was observed in patients who were treated with PRP injection. The two doses of injection of PRP were found to give adequate relief in short term of 6 months and further long-term studies are required.

Functional and radiological outcome of autologous platelet rich plasma in chronic plantar fasciitis: A prospective study

Plantar fasciitis is one of the most common causes of foot pain. It results from sustained stress of weight bearing - hopping, jumping, running -which results in micro trauma to plantar fascia which further leads to plantar fasciitis. It constitutes 11% to 15% of all foot symptoms. Its prevalence is 8% to 10% in general population. It commonly affects at the age of 40 to 60 years. Recently platelet rich plasma was used in treating in degeneration, muscle and tendon injuries. Hence, the present study aimed to assess the treatment outcome of autologous platelet rich plasma injection in treatment of plantar fasciitis. In this prospective study, we enrolled 35 patients with plantar fasciitis coming to OPD or casualty. Patients satisfying inclusion criteria were selected based on consecutive sampling. 11 patients responded well to conservative management and 3 patients had loss of follow up. The different scoring systems were adopted such as VAS and AOFAS for pain assessment. The thickness of plantar fascia was determined by ultrasound technique. Autologous platelet rich plasma was prepared and the same was injected. The outcome analysis was done at 2 weeks, 3 months, and 6 months; and compared with pre injection values. From pre-injection to up to post-6 months period, the VAS reduction was statistically significant (P&amp;#60;0.0001). All the time interval, the AOFAS was increased which was statistically significant (P&amp;#60;0.001). The injection was effective in reducing the thickness of plantar fascia, which was found to be statistically significant at all the time intervals (P&amp;#60;0.001). Autologous PRP injection for chronic plantar fasciitis was found to be an effective treatment modality for chronic plantar fasciitis.

P-604 Improving IVF treatment outcomes via intraovarian injection of autologous platelet rich plasma: a prospective clinical trial

Abstract Study question Does the intraovarian injection of autologous platelet rich plasma (A-PRP) improve the outcomes of subsequent in vitro fertilisation (IVF) treatments. Summary answer Intraovarian injection of A-PRP improves embryological performance and pregnancy outcomes in subsequent IVF treatments, but the beneficial effects may be lost with time. What is known already A-PRP has been widely used in other medical fields to optimise treatment outcomes. In IVF, emerging evidence has shown its potential benefit in promoting endometrial quality via release of a range of growth factors and cytokines. More recently it has been proposed that intraovarian injection of A-PRP may have the potential to “activate” some resting follicles in a selected group of patients. In this registered clinical trial, we aimed to evaluate embryology performance and pregnancy outcomes following ovarian injection of A-PRP in patients with poor ovarian function or premature ovarian failure. Study design, size, duration This is a registered (ID= ACTRN126190012061128) prospective clinical trial with recruitment commencing in November 2019. All participating women undergoing A-PRP treatment due to poor ovarian function or premature ovarian failure were reviewed for eligibility for this study. Inclusion criteria were restricted to women who had completed at least one IVF cycle before and after A-PRP injection as of January 2022. Participants/materials, setting, methods All A-PRP treatments were prepared using a commercial kit (Alocuro) approved by the Australian Therapeutic Goods Agency. Up to 3 subsequent IVF cycles post A-PRP injection were included for analysis. Embryological parameters included numbers of follicles, oocytes and embryos yielded per cycle. Paired comparisons were performed between cycles of the same patients before and after A-PRP injection. Cumulative ongoing pregnancy outcomes were also evaluated up to 3 IVF cycles post A-PRP injection. Main results and the role of chance 36 women were included in the analysis, average age 41.14±3.56 years with 4.61±2.91 unsuccessful previous IVF attempts at the time of A-PRP injection. Their serum FSH was reduced from 13.04±8.97 mIU/mL before A-PRP injection to 11.06±.56 mIU/mL post injection. In reference to the IVF cycle immediately before A-PRP injection, an improving trend in the embryology parameters was identified in the subsequent 1st, 2nd, and 3rd IVF cycles; as demonstrated in the numbers of follicles (2.39±1.76, 2.86±2.06, 2.52±1.65 and 2.46±1.66), oocytes (1.86±1.48, 2.56±2.08, 2.43±1.90 and 2.08±1.93) and embryos (1.30±1.03, 1.45±1.39, 1.80±1.67 and 1.20±1.48). Although the comparisons above did not reach statistical significance, the rise in oocyte numbers in the 1st IVF cycle was close to statistical significance (P = 0.08). It should also be noted that the highest improvement in follicle and oocyte numbers was seen in the 1st IVF cycle after A-PRP injection, while embryo number peaked at the 2nd IVF cycle. Three out of 36 women (P = 0.08) achieved ongoing pregnancies after the 1st round IVF cycles with inclusion of associated frozen embryo transfers as applicable. After the 2nd round, 4 out of the 36 women (P = 0.04) achieved ongoing pregnancy but no additional pregnancies from the 3rd round. Limitations, reasons for caution Comparisons performed in this study were not randomised, with the patients themselves used as their own controls. Therefore cycle associated variations may not be eliminated. Sample size was relatively small, and findings were restricted to a selected patient group. Wider implications of the findings Ovarian injection of A-PRP seems to improve both embryology performance and cumulative pregnancy outcomes. However the beneficial effect post injection seems to fade with time. A further randomised study is warranted to specify the timeframe of this diminishing effect in order to better guide clinical practice. Trial registration number ACTRN126190012061128

P-645 Intra-ovarian injection of autologous platelet-rich plasma (PRP) in poor prognosis IVF patients within 1 year of treatment: a cohort study

Abstract Study question Does intraovarian injection of platelet-rich plasma (PRP) change parameters of ovarian function in patients with evidence of diminished ovarian reserve? Summary answer Over one year of follow-up there was no evidence of a positive effect of PRP treatment on ovarian function. What is known already Several authors have previously reported positive outcomes and improved response in ovarian function after treatment with PRP. However, thus far, no randomized controlled trials and few cohort studies have been published. Study design, size, duration This is a longitudinal cohort study following ovarian response among 80 patients with low functional ovarian reserve (LFOR) defined by AMH &amp;lt; 1.1 ng/mL, FSH &amp;gt; 12 mIU/mL or at least one prior IVF cycle with ≤ 3 oocytes for one year before and one year after intraovarian treatment with PRP. Participants/materials, setting, methods 1.5 cc of PRP was injected into the cortex of ovaries in an average 12 injections per ovary. Beginning one month after their PRP treatment, patients underwent one or more cycles of ovulation induction for IVF. Outcome measures were endocrine response, and numbers of oocytes and embryos produced in by patients in response to a maximal gonadotropin stimulation before and after PRP treatment. Main results and the role of chance In this study women between ages 28 and 54 failed to demonstrate statistically significant outcome benefits from intra-ovarian PRP. Two very poor-prognosis 40-year-old patients with prior failed IVF cycles at other IVF centers that never reached embryo transfer, however, achieved pregnancy in an IVF cycle following PRP treatment for an ongoing pregnancy rate of 4.7% if a patient following PRP achieved retrieval of at least 1 oocyte with IVF. Limitations, reasons for caution This is an observational study of patients who performed poorly in past ovulation induction cycles, thus any improvement observed could have been accounted for by regression to the mean. The occurrence of two pregnancies in this group could be secondary to eventual success following a string of previous failures. Wider implications of the findings Even extremely poor prognosis will occasionally achieve a successful outcome from IVF. Uncontrolled case series cannot provide sufficient evidence to support routine use of an intervention like PRP. Future studies demand the use of well- controlled randomized trials. Trial registration number NCT04275700

P-574 Ovarian Revitalisation using Platelet Rich Plasma

Abstract Study question Can we rejuvinate ovaries (with low ovarian reserve) by injecting fresh platelet rich plasma ? Summary answer With ovarian PRP injections, Ovarian reserve will increase and number of follicles increases in treated ovaries . What is known already Till date no definitive treatment is available to restore function of ovaries. Few drugs e.g. granulocyte colony stimulating factor etc tried for the same but no satisfactory result was achieved. Oral ovulogens and gonadotropins cannot produce satisfactory number of ova in these patients. So they were forced to go for donar ova. By using ovarian PRP injections couple can have a chance of their own biological child. Study design, size, duration we conducted the pilot study involving injection of autologous fresh platelet rich plasma injection into the ovaries of subfertile females by comparison of their fertility parameters viz. hormonal profile involving measurements of blood levels of follicular stimulating hormone (FSH), luteinizing hormone (LH), anti-Mullerian hormone (AMH), prostaglandin E2 levels (PGE2); antral follicular count (AFC); number of mature follicles (NMF) and number of retrieved oocytes (NRO) in both pre-PRP and post-PRP states. Participants/materials, setting, methods Forty-five subfertile females of more than 20 years were included in our study . All the patients underwent fresh autologous PRP injection under transvaginal ultrasonographic guidance. Besides the demographic data, each patient’s hormonal profile (including blood levels of AMH, FSH, LH, PGE2), AFC, NMF and NRO in both pre-PRP and post-PRP state were recorded in a predesigned proforma. Statistical evaluation of the recorded data was done using appropriate methods and tools. Main results and the role of chance Mean age, weight, height, body mass index and years of subfertility of the patients in our study was 31.27yrs, 58.38kg, 154.84cm, 24.37kg/m2 and 8.44years respectively. The mean blood levels of AMH increased significantly in post-PRP state (1.6 vs 2.4pg/ml) in contrast to significant decrease in blood level of FSH (21.4 vs 12.5mIU/ml), LH (15.1 vs 5.9mIU/ml) &amp; PGE2 (162.7 vs 66pg/ml). The AFC, NMF &amp; NRO also increased in post-PRP state relative to pre-PRP state. The differences in above levels and numbers were statistically significant. Limitations, reasons for caution Autologous PRP injection into ovaries improves hormonal profile, AFC and number of mature follicles as well as retrieved oocytes. Furthur followup is needed to know weather our patients concieve spontaneously or they will need some kind of assisted tecniques to concieve a pregnency. Wider implications of the findings Autologous PRP injection into ovaries improves hormonal profile, AFC and number of mature follicles as well as retrieved oocytes, it can be utilized as a revitalisation tool to boost fertility. Our study results reinforce the above concept. However, outcome-based studies are needed to further validate the results of our study. Trial registration number TMU/IEC/19-20/0113

P-418 The effect of subendometrial injection of autologous platelet rich plasma treatment on refractive endometrium during frozen embryo transfer

Abstract Study question Will subendometrial injection of autologous platelet rich plasma (PRP) enhance the implantation by improving endometrial thickness (ET) and vascularity in frozen embryo transfers (FET)? Summary answer In this study it was observed that subendometrial injection of autologous PRP enhances implantation by improving ET and vascularity. What is known already Reports on evaluating effectiveness of injecting PRP hysteroscopically at the endomyometrial junction are limited. PRP has more effect on angiogenic growth cells as it contains high concentrations of vascular endothelial growth factor, epidermal growth factor, platelet derived growth factor, leukemia inhibiting factor, beta 3 integrin, transforming growth factor and cytokines which are essential for the endometrial proliferation. Previous reports suggest that these factors are inadequately expressed in a deficient endometrium and they are enhanced after PRP. Study design, size, duration From December 2019 to December 2021, 172 women with ET less than or equal to 7mm were included in the study and underwent PRP instillation. Patients with Asherman’s syndrome were excluded from the study. The endometrial vascularity zone as per Applebaum criteria was noted. Informed written consent obtained from all participants.The comparison of ET and vascularity before and after PRP was carried out by paired t test. This study was approved by Institutional ethical committee. Participants/materials, setting, methods 8 ml of autologous PRP was instilled at the junctional zone hysteroscopically from day 6-10 of menstrual cycle. After allowing 8 weeks for the endometrium to regenerate, ET and vascularity were measured and prepared for FET. The statistical significance was tested by comparing ET and vascularity before and after PRP using Paired T-test at 5% level of significance. FET was done for 109 women and the outcome was analysed. Main results and the role of chance Based on paired ‘t’test, it is concluded that there is statistically significant effective difference on ET after PRP at 0.05 significance level and vascularity following PRP at CI (-0.663± 0.11). T statistic = 1.653813 p value = 0.000282 and CI (-0.33±0.092),T statistic=1.653813, p value= 0.000254 respectively. Out of 172 women, ET increased in 130, decreased in 22 and remained the same in 20. Mean ET before and after PRP were 5.9mm and 6.6mm respectively which showed significant difference. Endometrial vascularity improved for 56 women decreased for 9 remained the same for 107. Of 172 women, 109 had underwent FET 44 showed positive BHCG value (40.3%) and 38 showed a clinical pregnancy rate (CPR) corresponding to 34.8%. Two others are awaited for the first scan Other two had blighted ovum, missed abortion respectively. CPR was observed to be 34.09% in the group with increased and 33.3% in the group with decreased and 44.4% in the group with no change in ET. Similarly the CPR was 30% in women with increased and 50% in those with decreased and 36% in the group with no change in vascularity. Limitations, reasons for caution The embryo quality and synchrony could have an effect on the pregnancy rate. It involves invasive procedure at a higher cost. It can cause infections and anaesthesia related complications. Wider implications of the findings we can assume that subendometrial injection of PRP is effective in improving the ET and vascularity and there by improve the pregnancy outcome. More studies are needed to confirm the effect of PRP in improving the endometrial thickness and vascularity and thereby implantation. Trial registration number N/A

Effectiveness of Lateral Elbow Tendinopathy Treatment Depends on the Content of Biologically Active Compounds in Autologous Platelet-Rich Plasma.

Autologous platelet-rich plasma (PRP) injection is an alternative treatment option for patients with lateral elbow tendinopathy. The treatment is supposed to accelerate tissue regeneration by providing high concentrations of growth factors derived from platelets. The aim of the study was to assess the relationship between the content of biologically active compounds in PRP and the clinical effect of the treatment. Thirty patients with lateral elbow tendinopathy treated with a single PRP injection, were evaluated. The pain intensity (measured by a visual analogue scale (VAS)), the pressure pain threshold (PPT), the grip strength and strength of the main arm and forearm muscle groups, and the functional outcome (measured by the Disability of Arm, Shoulder and Hand (DASH) and Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaires), were assessed before PRP injection and at one- and three-months follow-up. Flow cytometry measurements of the growth factors and inflammatory cytokines in PRP were performed, and the results were used to establish the relationship between those molecules and the clinical outcome. After three months from the intervention, the minimal clinically important difference in pain reduction and functional improvement was observed in 67% and 83% of patients, respectively. Positive correlations were found between the extent of pain reduction after three months and concentrations in the PRP of platelets, epidermal growth factor (EGF), vascular endothelial growth factor, and platelet-derived growth factors. The concentration of EGF in the PRP significantly correlated with an improvement in grip strength, strength of wrist extensors, and the size of functional improvement measured by the PRTEE. The local injection of PRP is a safe and effective treatment option for lateral elbow tendinopathy, and the clinical outcome is correlated with concentrations of its biologically active compounds.

Transforaminal injection of autologous platelet-rich plasma for lumbar disc herniation: A single-center prospective study in Vietnam

ObjectiveLumbar radiculopathy is a major health problem, which often treated by neurosurgery or guided lumbar epidural steroids for pain relief. We used autologous Platelet Rich Plasma (PRP) as a novel pharmaceutical agent that has strongly emerged in recent years to treat patients of lumbar disc herniation. From that, we evaluated the efficacy of PRP via transforaminal route in treatment of radicular pain in patients with lumbar disc herniation. MethodsTwenty-five patients were enrolled and injected with 4 ml of autologous platelet rich plasma under fluoroscopic guidance via transforaminal epidural injection into area of affected nerve root. They were followed using Visual Analogue Scale (VAS), Modified Oswestry Disability Index (ODI) and Straight Leg Raising Test (SLRT) for clinical assessment. ResultsPatients who received transforaminal injections with autologous PRP showed statistically significant improvements on all three evaluation tools (VAS, ODI, SLRT). The improvements were sustained over twelve-month follow-up and there were no associated complications. ConclusionTransforaminal injection with autologous PRP helps patients relieve chronic pains and be able return to work. Besides, autologous PRP can be considered as a good alternative to epidural steroids in management of lumbar disc herniation.

Preliminary report of intraovarian injections of autologous platelet-rich plasma (PRP) in extremely poor prognosis patients with only oocyte donation as alternative: a prospective cohort study.

STUDY QUESTIONDoes intraovarian injection of platelet-rich plasma (PRP) change ovarian function in patients with extremely low functional ovarian reserve (LFOR) who, otherwise, would likely only have a chance of pregnancy through third-party oocyte donation?SUMMARY ANSWERNo clinically significant effects of PRP treatment on ovarian function were observed over 1 year of follow-up.WHAT IS KNOWN ALREADYSeveral investigators have reported improved responses to ovulation induction after treatment with PRP. However, previous published reports have involved, at most, only small case series. Whether PRP actually improves ovarian performance is, therefore, still unknown. PRP is nevertheless widely offered as an ‘established’ fertility treatment, often under the term ‘ovarian rejuvenation’.STUDY DESIGN, SIZE, DURATIONWe are reporting a prospective cohort study of 80 consecutive patients at ages 28–54 with LFOR, defined by anti-Müllerian hormone <1.1 ng/ml, FSH >12 mIU/ml or at least one prior IVF cycle with ≤3 oocytes within 1 year. The women were followed for 1 year after an intraovarian PRP procedure.PARTICIPANTS/MATERIALS, SETTING, METHODSPRP (1.5 ml) was injected into the cortex of ovaries with an average of 12 injections per ovary. Study participants were followed every 3 days for 2 weeks after PRP treatment with estradiol and FSH measurements and vaginal ultrasound to observe follicle growth and thereafter followed weekly. Beginning 1 month after their PRP treatment, participants underwent one or more cycles of ovarian stimulation for IVF. Outcome measures were endocrine response, and numbers of oocytes and embryos produced in response to a maximal gonadotropin stimulation before and after PRP treatment.MAIN RESULTS AND THE ROLE OF CHANCEIn this study, women failed to demonstrate statistically significant outcome benefits from intraovarian PRP. However, two 40-year-old very poor-prognosis patients, with prior failed IVF cycles that never reached embryo transfer at other centers, achieved pregnancy, resulting in an ongoing pregnancy rate of 4.7% among patients who, following PRP, produced at least one oocyte (n = 42).LIMITATIONS, REASONS FOR CAUTIONAs an observational study of patients who performed poorly in past ovarian stimulation cycles, the improvement may be accounted for by regression to the mean. Similar considerations may also explain the occurrence of the two pregnancies.WIDER IMPLICATIONS OF THE FINDINGSThis study demonstrates that, even in extremely poor prognosis patients due to LFOR, sporadic pregnancies are possible. The study, however, does not allow for the conclusion that those pregnancies were the consequence of PRP treatments. A case series, indeed, does not allow for such conclusions, even if results are more suggestive than here. This registered study, therefore, must be viewed as a preliminary report, with further data expected from this study but also from two other prospectively randomized ongoing registered studies with more controlled patient selection.STUDY FUNDING/COMPETING INTEREST(S)This work was supported by intramural funds from The Center for Human Reproduction and the not-for-profit research Foundation for Reproductive Medicine, both in New York, NY, USA. N.G. and D.H.B. are listed as co-inventors on several US patents. Some of these patents relate to pre-supplementation of hypo-androgenic infertile women with androgens, such as dehydroepiandrosterone and testosterone and, therefore, at least peripherally relate to the subject of this manuscript. They, as well as D.F.A., have also received research support, travel funds and speaker honoraria from several pharmaceutical and medical device companies, though none related to the here presented subject and manuscript. N.G. is a shareholder in Fertility Nutraceuticals and he and D.H.B. receive royalty payments from Fertility Nutraceuticals LLC. E.M. has no conflicts of interest to declare.TRIAL REGISTRATION NUMBERNCT04275700

Protective Effects of Autologous ‎Platelet-Rich Plasma (PRP) on the Outcome of ‎Cryopreservation in Rabbit Sperm.

Sperm ‎cryopreservation is a cost-effective means of preserving gene resources and ‎transporting sperm across distant locations. However, due to the ‎general disadvantages of using freeze-thawed sperm, to prevent this irreversible damage, cryopreservation techniques must be ‎improved by the addition of additional cryoprotection agents. ‎This study aims to improve the freezability of buck semen using an ‎‎intratesticular injection of Autologous ‎Platelet-Rich Plasma (‎PRP) and ‎confirm this theory by Casa laboratory analysis and gene ‎expression detection of three genes (CATSPER1‎, SPAG5 and Hsp70). Twenty ‎rabbits a New ‎Zealand ‎healthy male were randomly ‎‎divided into two equal groups; ‎the control and PRP group ‎which enriched with PRP, ‎the semen ‎collection was ‎applied after 10 weeks, then each sample ‎was ‎divided into two ‎‎fractions; ‎First ‎‎fractions ‎‎ we apply the ‎ laboratory semen analysis ‎directly, and the second ‎‎fractions ‎‎were ‎ cryopreservation, then thawed after one ‎month to apply ‎‎the same ‎ laboratory analysis. The ‎results of CASA, DNA fragmentation, and‎ real ‎time-PCR analysis ‎had ‎ ‎‎statistically significant ‎differences (P<0.01) when compartment ‎of these values ‎after and ‎‎before freezing, yet we don't ‎record any statistical ‎differences between the C group ‎and CR ‎group.‎ This study's findings are extremely significant, indicating that intratesticular injection of PRP ‎ is a good method for using in enhancing the rabbit sperm procedure after ‎freeze-thawing.