CC BY-NC-ND 4.0 · Geburtshilfe Frauenheilkd 2023; 83(04): 453-462
DOI: 10.1055/a-1963-7459
GebFra Science
Meta-Analysis/Systematic Review

Effects of Intrauterine Infusion of Autologous Platelet-Rich Plasma in Women Undergoing Treatment with Assisted Reproductive Technology: a Meta-Analysis of Randomized Controlled Trials

Auswirkungen einer intrauterinen Infusion von autologem plättchenreichem Plasma bei mit assistierter Reproduktionstechnologie behandelten Frauen: eine Metaanalyse randomisierter kontrollierter Studien
Shifu Hu‡
1   Obstetrics and Gynecology Department, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
,
Zhishan Jin‡
1   Obstetrics and Gynecology Department, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
,
Qianqian Tang
1   Obstetrics and Gynecology Department, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Abstract

Purpose This meta-analysis was conducted to systematically retrieve relevant randomized controlled trials (RCTs) and evaluate the effects of intrauterine infusion of autologous platelet-rich plasma (PRP) in women with thin endometrium, implantation or pregnancy failure undergoing treatment with assisted reproductive technology (ART).

Methods We conducted a systematic review and meta-analysis of the retrieved RCTs. Studies on the intrauterine infusion of PRP in women undergoing treatment with ART that were published in PubMed, the Cochrane library, Web of Science, and Embase from inception until June 2022 were included. The data were extracted and analyzed independently using the fixed-effects or random-effects model according to heterogeneity.

Results Seven RCTs involving 861 patients (435 in the intervention group and 426 in the control group) were included. The rates of clinical pregnancy (risk ratio [RR]: 2.51; 95% confidence interval [CI]: 2.0–3.13; P < 0.00001), chemical pregnancy (RR: 1.96; 95% CI: 1.58–2.45; P < 0.00001), live births (RR: 7.03; 95% CI: 3.91–12.6; P < 0.00001), and implantation (RR: 3.27; 95% CI: 1.42–7.52; P = 0.005) were significantly higher in the women who received PRP infusion than in the control group. No significant differences were noted in the miscarriage rate (RR: 0.98; 95% CI: 0.39–2.42; P = 0.96) between the two groups.

Conclusion In summary, intrauterine infusion of PRP may be an effective therapy for women with thin endometrium and recurrent implantation failure (RIF) undergoing treatment with ART. More population-based RCTs are warranted to verify the efficacy of our evidence.

Zusammenfassung

Zielsetzung Bei dieser Metaanalyse wurden die Daten von randomisierten kontrollierten Studien (RCTs) systematisch gesammelt, um die Auswirkungen einer intrauterinen Infusion von autologem plättchenreichem Plasma (PRP) auszuwerten bei Frauen mit dünner Gebärmutterschleimhaut, Implantationsversagen oder Schwangerschaftsmisserfolg, die sich einer Behandlung mit assistierter Reproduktionstechnologie (ART) unterziehen.

Methoden Wir haben eine systematische Auswertung und Metaanalyse der gefundenen relevanten RCTs durchgeführt. Die in PubMed, der Cochrane-Datenbank, Web of Science und Embase von Anbeginn bis Juni 2022 veröffentlichten Studien zur intrauterinen Infusion von PRP bei mit ART behandelten Frauen wurden in unsere Analyse aufgenommen. Die Daten wurden entnommen und, je nach Heterogeneität, einer unabhängigen Analyse mithilfe des Fixed-Effects- oder Random-Effects-Modell zugeführt.

Ergebnisse Sieben RCTs mit 861 Patientinnen (435 in der Interventionsgruppe und 426 in der Kontrollgruppe) wurden in unsere Metaanalyse aufgenommen. Die klinische Schwangerschaftsrate (Risikoquote [RR]: 2,51; 95%-Konfidenzintervall [KI]: 2,0–3,13; p < 0,00001), Anzahl chemischer Schwangerschaften (RR: 1,96; 95%-KI: 1,58–2,45; p < 0,00001), Zahl der Lebengeburten (RR: 7,03; 95%-KI: 3,91–12,6; p < 0,00001) sowie Implantationsraten (RR: 3,27; 95%-KI: 1,42–7,52; p = 0,005) waren signifikant höher in der Gruppe der Frauen, die eine PRP-Infusion erhielten, verglichen mit der Kontrollgruppe. Es gab keine signifikante Unterschiede in den Fehlgeburtenraten (RR: 0,98; 95%-KI: 0,39–2,42; p = 0,96) zwischen den beiden Gruppen.

Schlußfolgerung Die intrauterine Infusion von PRP könnte sich als effektive Therapie herausstellen bei Frauen mit dünnem Gebärmutterschleimhaut und rezidivierendem Implantationsversagen (RIF), die sich einer ART-Behandlung unterziehen. Mehr populationsbezogene RCTs werden benötigt, um die Aussagekraft unserer Daten zu bestätigen.

Schlüsselwörter

plättchenreiches Plasma (PRP) - assistierte Reproduktionstechnologie - randomisierte kontrollierte Studien (RCTs)

Keywords

platelet-rich plasma (PRP) - assisted reproductive technology - randomized controlled trials (RCTs)


Publication History

Received: 11 July 2022

Accepted after revision: 16 October 2022

Article published online:
13 December 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Aghajanova L, Hoffman J, Mok-Lin E. et al. Obstetrics and Gynecology Residency and Fertility Needs. Reprod Sci 2017; 24: 428-434
    CrossrefPubMedSearch in Google Scholar
  • 2 Craciunas L, Gallos I, Chu J. et al. Conventional and modern markers of endometrial receptivity: a systematic review and meta-analysis. Hum Reprod Update 2019; 25: 202-223
    CrossrefPubMedSearch in Google Scholar
  • 3 Bender Atik R, Christiansen OB, Elson J. et al. ESHRE guideline: recurrent pregnancy loss. Hum Reprod Open 2018; 2018: hoy004
    CrossrefPubMedSearch in Google Scholar
  • 4 Russell SJ, Kwok YSS, Nguyen TTN. et al. Autologous platelet-rich plasma improves the endometrial thickness and live birth rate in patients with recurrent implantation failure and thin endometrium. J Assist Reprod Genet 2022; 39: 1305-1312
    CrossrefPubMedSearch in Google Scholar
  • 5 Magdi Y, El-Damen A, Fathi AM. et al. Revisiting the management of recurrent implantation failure through freeze-all policy. Fertil Steril 2017; 108: 72-77
    CrossrefPubMedSearch in Google Scholar
  • 6 Maleki-Hajiagha A, Razavi M, Rouholamin S. et al. Intrauterine infusion of autologous platelet-rich plasma in women undergoing assisted reproduction: A systematic review and meta-analysis. J Reprod Immunol 2020; 137: 103078
    CrossrefPubMedSearch in Google Scholar
  • 7 Farimani M, Poorolajal J, Rabiee S. et al. Successful pregnancy and live birth after intrauterine administration of autologous platelet-rich plasma in a woman with recurrent implantation failure: A case report. Int J Reprod Biomed 2017; 15: 803-806
    PubMedSearch in Google Scholar
  • 8 Pourmoghadam Z, Abdolmohammadi-Vahid S, Pashazadeh F. et al. Efficacy of intrauterine administration of autologous peripheral blood mononuclear cells on the pregnancy outcomes in patients with recurrent implantation failure: A systematic review and meta-analysis. J Reprod Immunol 2020; 137: 103077
    CrossrefPubMedSearch in Google Scholar
  • 9 Chang Y, Li J, Chen Y. et al. Autologous platelet-rich plasma promotes endometrial growth and improves pregnancy outcome during in vitro fertilization. Int J Clin Exp Med 2015; 8: 1286-1290
    PubMedSearch in Google Scholar
  • 10 Lin Y, Qi J, Sun Y. Platelet-Rich Plasma as a Potential New Strategy in the Endometrium Treatment in Assisted Reproductive Technology. Front Endocrinol (Lausanne) 2021; 12: 707584
    CrossrefPubMedSearch in Google Scholar
  • 11 Bos-Mikich A, Ferreira MO, de Oliveira R. et al. Platelet-rich plasma or blood-derived products to improve endometrial receptivity?. J Assist Reprod Genet 2019; 36: 613-620
    CrossrefPubMedSearch in Google Scholar
  • 12 Cavalcante MB, Cavalcante C, Sarno M. et al. Intrauterine perfusion immunotherapies in recurrent implantation failures: Systematic review. Am J Reprod Immunol 2020; 83: e13242
    CrossrefPubMedSearch in Google Scholar
  • 13 Higgins JP, Altman DG, Gøtzsche PC. et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 2011; 343: d5928
    Search in Google Scholar
  • 14 Eftekhar M, Neghab N, Naghshineh E. et al. Can autologous platelet rich plasma expand endometrial thickness and improve pregnancy rate during frozen-thawed embryo transfer cycle? A randomized clinical trial. Taiwan J Obstet Gynecol 2018; 57: 810-813
    CrossrefPubMedSearch in Google Scholar
  • 15 Nazari L, Salehpour S, Hoseini S. et al. Effects of autologous platelet-rich plasma on endometrial expansion in patients undergoing frozen-thawed embryo transfer: A double-blind RCT. Int J Reprod Biomed 2019; 17: 443-448
    CrossrefPubMedSearch in Google Scholar
  • 16 Nazari L, Salehpour S, Hosseini MS. et al. The effects of autologous platelet-rich plasma in repeated implantation failure: a randomized controlled trial. Hum Fertil (Camb) 2020; 23: 209-213
    CrossrefPubMedSearch in Google Scholar
  • 17 Nazari L, Salehpour S, Hosseini S. et al. The Effects of Autologous Platelet-Rich Plasma on Pregnancy Outcomes in Repeated Implantation Failure Patients Undergoing Frozen Embryo Transfer: A Randomized Controlled Trial. Reprod Sci 2022; 29: 993-1000
    CrossrefPubMedSearch in Google Scholar
  • 18 Nazari L, Salehpour S, Hosseini S. et al. Effect of autologous platelet-rich plasma for treatment of recurrent pregnancy loss: a randomized controlled trial. Obstet Gynecol Sci 2022; 65: 266-272
    CrossrefPubMedSearch in Google Scholar
  • 19 Zamaniyan M, Peyvandi S, Heidaryan Gorji H. et al. Effect of platelet-rich plasma on pregnancy outcomes in infertile women with recurrent implantation failure: a randomized controlled trial. Gynecol Endocrinol 2021; 37: 141-145
    CrossrefPubMedSearch in Google Scholar
  • 20 Obidniak D, Gzgzyan A, Feoktistov A. et al. Randomized controlled trial evaluating efficacy of autologous platelet – rich plasma therapy for patients with recurrent implantation failure. Fertil Steril 2017; 108: E370
    CrossrefSearch in Google Scholar
  • 21 Stamenov GS, Parvanov DA, Chaushev TA. Mixed double-embryo transfer: A promising approach for patients with repeated implantation failure. Clin Exp Reprod Med 2017; 44: 105-110
    CrossrefPubMedSearch in Google Scholar
  • 22 Kasius A, Smit JG, Torrance HL. et al. , Endometrial thickness and pregnancy rates after IVF: a systematic review and meta-analysis. Hum Reprod Update 2014; 20: 530-541
    CrossrefPubMedSearch in Google Scholar
  • 23 Kusumi M, Ihana T, Kurosawa T. et al. Intrauterine administration of platelet-rich plasma improves embryo implantation by increasing the endometrial thickness in women with repeated implantation failure: A single-arm self-controlled trial. Reprod Med Biol 2020; 19: 350-356
    CrossrefPubMedSearch in Google Scholar
  • 24 Timeva T, Shterev A, Kyurkchiev S. Recurrent implantation failure: the role of the endometrium. J Reprod Infertil 2014; 15: 173-183
    PubMedSearch in Google Scholar
  • 25 Srivastava A, Sengupta J, Kriplani A. et al. Profiles of cytokines secreted by isolated human endometrial cells under the influence of chorionic gonadotropin during the window of embryo implantation. Reprod Biol Endocrinol 2013; 11: 116
    CrossrefPubMedSearch in Google Scholar
  • 26 Ideta A, Sakai S, Nakamura Y. et al. Administration of peripheral blood mononuclear cells into the uterine horn to improve pregnancy rate following bovine embryo transfer. Anim Reprod Sci 2010; 117: 18-23
    CrossrefPubMedSearch in Google Scholar
  • 27 Anitua E, de la Fuente M, Ferrando M. et al. Biological effects of plasma rich in growth factors (PRGF) on human endometrial fibroblasts. Eur J Obstet Gynecol Reprod Biol 2016; 206: 125-130
    CrossrefPubMedSearch in Google Scholar
  • 28 Lee JH, Kim MJ, Ha SW. et al. Autologous Platelet-rich Plasma Eye Drops in the Treatment of Recurrent Corneal Erosions. Korean J Ophthalmol 2016; 30: 101-107
    CrossrefPubMedSearch in Google Scholar
  • 29 Babaei V, Afradi H, Gohardani HZ. et al. Management of chronic diabetic foot ulcers using platelet-rich plasma. J Wound Care 2017; 26: 784-787
    CrossrefPubMedSearch in Google Scholar