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Use of Intra-uterine Injection of Platelet-rich Plasma (PRP) for Endometrial Receptivity and Thickness: a Literature Review of the Mechanisms of Action

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Abstract

Endometrial receptivity and thickness play an important role in achieving a pregnancy. Intrauterine autologous platelet-rich plasma (PRP) infusion has been used in infertile women with recurrent implantation failure (RIF) and thin endometrial lining thickness (EMT). Literature search was performed in PubMed for studies including in vitro, animal, and human studies as well as in abstracts presented at national conferences. Animal studies demonstrated a decrease in the expression of inflammatory markers and fibrosis, and increased endometrial proliferation rate, increased expression of proliferative genes, and increased pregnancy rates. The in vitro studies showed that PRP was associated with increased stromal and mesenchymal cell proliferation, increased expression of regenerative enzymes, and enhancement in cell migration. In infertile women undergoing assisted reproductive technology, one randomized clinical trial showed that PRP intrauterine infusion improved EMT, implantation rate, and clinical pregnancy rate (CPR) in patients with thin EMT, while 3 other trials involving subjects with RIF showed conflicting results related to CPR. Case series and cohort studies showed conflicting results pertaining to CPR. Data to date suggest that PRP may be beneficial in improving endometrial thickness and endometrial receptivity. However, further large prospective and high-quality trials are needed to assert its effect and to identify the population of patients that would benefit the most.

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Abbreviations

PRP:

Platelet-rich plasma

RIF:

Recurrent implantation failure

EMT:

Endometrial thickness

CPR:

Clinical pregnancy rate

IVF:

In vitro fertilization

FBS:

Fetal bovine serum

FET:

Frozen embryo transfer

Fresh ET:

Fresh embryo transfer

ICSI:

Intracytoplasmic sperm injection

G-CSF:

Granulocyte colony-stimulating factor

VEGF:

Vascular endothelial growth factor

TGF-β:

Tumor growth factor-β

FGF:

Fibroblast growth factor

PDGF:

Platelet-derived growth factor

EGF:

Endothelial growth factor

HGF:

Hepatocyte growth factor

CXCL12:

C-X-C motif chemokine 12

CCL5:

C-C motif chemokine ligand 5

AFC:

Antral follicle count

FSH:

Follicle-stimulating hormone

PMIE:

Persistent mating-induced endometritis

IL:

Interleukins

CDE:

Chronic degenerative endometritis

ER:

Estrogen receptor

TP53:

Tumor protein 53

COX2:

Cyclo-oxygenase 2

PR:

Progesterone receptor

iNOS:

Inducible nitric oxide synthase

HOXA10:

Homeobox A10

MBSC:

Menstrual blood-stromal cells

SDF-1:

Stromal cell-derived factor 1

TSP-1:

Thrombospondin 1

MenSC:

Menstrual stem cells

COL1A1:

Collagen Type I Alpha 1 Chain

TIMP:

Tissue inhibitors of metalloproteinase

PPP:

Platelet-poor plasma

MMP:

Metalloproteinases

HCG:

Human chorionic gonadotropin

non-RCT:

Non-randomized clinical trial

RCT:

Randomized clinical trial

LBR:

Live birth rate

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Authors and Affiliations

  1. Rejuvenating Fertility Center, New York, NY, USA

    Marco Mouanness & Zaher Merhi

  2. Department of Obstetrics and Gynecology, Brooklyn Hospital Center, Brooklyn, NY, USA

    Shelena Ali-Bynom

  3. Department of Minimally Invasive & Robotic Surgery, Camran Nezhat Institute, Palo Alto, CA, USA

    Janelle Jackman

  4. Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, SUNY Downstate Health Sciences University & RFC (Rejuvenating Fertility Center), 315 West 57th Street, Suite 208, New York, NY, 10019, USA

    Serin Seckin & Zaher Merhi

  5. Department of Biochemistry, Albert Einstein College of Medicine, Bronx, NY, USA

    Zaher Merhi

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Mouanness, M., Ali-Bynom, S., Jackman, J. et al. Use of Intra-uterine Injection of Platelet-rich Plasma (PRP) for Endometrial Receptivity and Thickness: a Literature Review of the Mechanisms of Action. Reprod. Sci. 28, 1659–1670 (2021). https://doi.org/10.1007/s43032-021-00579-2

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