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PRP and the thin endometrium

Posted on 4 July 2022

IVF


Recurrent implantation failure (RIF) is a difficult condition to treat in IVF.

Recurrent implantation failure may be caused by poor endometrial quality,

However, other causes may have little or nothing to do with endometrial receptivity such as low blastocyst competence,

Another cause of implantation failure is asynchronicity between embryo and endometrium – when these cells are out of synch with each other’s development and are not speaking the same language.

Endometrial quality is of paramount importance for successful embryo implantation.

The endometrium is a delicate tissue and may be damaged by infection or scarring such as in Asherman’s syndrome.

Studies have demonstrated a positive correlation between endometrial thickness and embryo implantation rates with worse implantation rates when the endometrium is < 7mm in total thickness.

One novel and promising treatment is the intrauterine infusion of autologous PRP.

PRP stands for Platelet Rich Plasma.

For this therapy, blood is drawn from the patient and PRP concentrated via a technique of centrifugation.

PRP is then infused into the uterine cavity during the proliferative phase at least 5 days before embryo transfer.

In most studies PRP infusion has occurred once per cycle but in theory the technique could be repeated. Early studies 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.

Autologous PRP infusion is a non-invasive and direct method of applying concentrated growth factors and cytokines to the endometrium. Stimulatory factors in PRP include platelet-derived growth factor (PDGF), transforming growth factor (TGF), a variety of interleukins (IL), vascular endothelial growth factor (VEGF), epidermal growth factor (EGF), and insulin-like growth factor (IGF).

PRP has become popular in various areas of medicine, due to demonstrated benefits in many medical contexts including alopecia, osteoarthritis, cosmetic medicine and various gynaecological disorders.

Adequate endometrial thickness is key for establishing and maintaining a pregnancy in IVF. However, the embryo must also be of sufficient quality for attachment and implantation to occur.

It is a known fact that older women create poorer quality embryos and also embryos at a higher risk of aneuploidy (random DNA errors preventing IVF success). Aneuploidy is known to affect 50% or more of embryos in women over 35, and typically commonly results in failed implantation or early miscarriage in this group of patients.

We need the right embryo, the right endometrial and good synchrony for pregnancy to successful occur in IVF. PRP is a promising treatment to improve a thin endometrium to help create this magical combination of aligning stars, aiming to optimise chances of success in an IVF context.

 


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