PRP and the thin endometrium
PRP, which stands for Platelet Rich Plasma, is a novel and promising treatment.
Recurrent implantation failure (RIF) associated with a thin endometrium (womb lining) is a difficult condition to treat in IVF.
Recurrent implantation failure may be caused by poor endometrial quality and reduced receptivity impeding a good embryo from implanting.
However, other RIF causes may have little or nothing to do with endometrial receptivity such as poor blastocyst quality and competence.
A further cause of implantation failure can be asynchronicity (poor communication/co-ordination) of embryos and the endometrium. In some cases, these cells can be out of synch with each other and not speaking the same language at the normal IVF implantation time.
Endometrial quality is of paramount importance for successful embryo implantation.
The endometrium is a delicate tissue and can be damaged and assaulted by infection or after surgery, causing scarring such as in Asherman’s syndrome.
Studies demonstrate a positive correlation between endometrial thickness and IVF pregnancy rates. Poorer IVF success rates are observed when the endometrium is < 7mm in total thickness before IVF embryo transfer.
PRP, which stands for Platelet Rich Plasma, is a novel and promising treatment. Intrauterine infusion of PRP can help thicken your uterine lining and potentially improve your chance of getting pregnant following an IVF embryo transfer.
For PRP therapy, whole blood is drawn and PRP is separated and concentrated via a technique of centrifugation.
PRP is then infused into the uterine cavity to encourage endometrial growth and repair at least 5 days before an embryo transfer.
Studies usinf intrauterine PRP have shown significant improvements in endometrial thickness, embryo implantation, and clinical pregnancy rates in both cases of a thin endometrium as well as cases of recurrent implantation failure in general. Most studies have looked at a PRP infusion occurring once during a menstrual cycle. In theory however, the technique could be repeated with the potential for even better results.
PRP applies concentrated growth factors and cytokines to the endometrium. Stimulatory factors in PRP include platelet-derived growth factor (PDGF), transforming growth factor (TGF), interleukins (IL), vascular endothelial growth factor (VEGF), epidermal growth factor (EGF), and insulin-like growth factor (IGF).
PRP has gained traction in various areas of medicine, due to demonstrated benefits in many contexts including alopecia, osteoarthritis, cosmetic medicine as well as gynaecological disorders.
Adequate endometrial health and thickness is a critical factor fo establishing a pregnancy in IVF. For pregnancy to occur, an embryo must be of sufficient quality and behave correctly for attachment and implantation to occur.
A known fact is that older eggs create poorer quality embryos. Many embryos are at a high risk of random DNA errors preventing IVF success (Aneuploidy). Over 35 years, aneuploidy is known to affect 50% or more of a woman’s embryos. Failed IVF embryo implantation or early miscarriage in this group of patients is sadly very common.
We need the right embryo, the right endometrium and synchrony and a little bit of magic for pregnancy to successfully happen in IVF. PRP is a promising treatment to improve a thin endometrium to help create this combination of aligning stars.
Written by Dr Raelia Lew
RANZCOG Board Certified CREI Fertility specialist, Gynaecologist and the Director of Women’s Health Melbourne.
Co-host of the Knocked Up Podcast, Co-founder of Lovers intimate wellness solutions. Raelia has a PhD in Preconception Health Promotion and Genetic Screening. Raelia is a leading Australian expert in IVF and egg freezing, pioneering a bespoke model of care.