Platelet-rich plasma (PRP)
Abstract: Introduction: We tried to evaluate the effectiveness of autologous PRP in the therapy of infertile women with thin endometrium (or = 7mm) and asherman’s syndrome.
Material and methods: 20 women with documented thin endometrium and/or with asherman’ syndrome were selected. Selection criteria used was faiure of endometrium to grow beyond 6mm in natural as well as HRT cycles inspite of supplementation with heparin, aspirin and sildenafil (1) and /or pts. With hysteroscopic finding of asherman’s syndrome. The patients were recruited for frozen embryo transfer cycles. In addition to HRT, intrauterine infusion of PRP was performed. We stimulated the endometrium with incremental doses of estradiol. Endometrial preparation days ranged from 15 to 30 days. Decision of PRP was taken when endometrial thickness did not respond over 5 days of incremental esttradiol.
PRP preparation: PRP was prepared by autologous blood centrifugation. 0.5 to 1ml of PRP was infused in the uterine cavity. Progesterone support was started from next day. Day 3 ET were done. Result: Successful implantation was observed in _ pts. Biochemical (BHCG) was observed in __ pts. Out of __pts.Actually, over the past years a technique that was invented over 20 years ago as been recovered to better sperm samples the day they are to be used for artificial insemination or IVF. The method is called MACS (Magnetic Activated Cell Sorting).
The major functions of platelets are preventing acute blood loss and repairing vascular walls and adjacent tissues after injury. During wound healing, platelets are activated and aggregate to release granules containing growth factors, such as TGF-β, PDGF, IGF, VEGF, EGF and FGF-2 [10,11], which stimulate the inflammatory cascade and healing process.
PRP is collected from an autologous blood sample that has been enriched with platelets about 4-5 times more than circulating blood. PRP with a large amount of cytokines and growth factors can stimulate proliferation and regeneration. (12, 13-16)
PRP is now a days widely applied in clinical scenarios even in mucous tissues such as eye (17) and mouth (18 )to improve tissue degeneration.
This study was to see the effectiveness of PRP in regenerating endometrium in patients with thin endometrium and/or asherman’s syndrome.
In this study, 6 patients had thin endometrium which didn’t respond to estrogen and four patients had partial asherman’s syndrome. After PRP, endometrial thickness became satisfactory in all patients and 8 out of 10 patients became pregnant after embryo transfer.