The receptivity and thickness of the endometrium (uterine wall) plays a crucial role in achieving pregnancy. intrauterine (intrauterine) autologous (patient's own) PRP (platelet rich plasma) infusion can be used in patients diagnosed with infertility with recurrent implantation failure and thin endometrium.
PRP is prepared by centrifuging the patient's blood.
PRP is a treatment proven to accelerate cell growth, synthesis of regenerating hormones and cell migration in a laboratory environment.
In a controlled study, intrauterine administration of PRP was shown to increase uterine wall thickness, implantation and clinical pregnancy rates. The information on this subject is not clear and no consensus has been reached as a result of different studies.
Approximately 13% of the world's population is currently unable to achieve pregnancy for various reasons. The intrauterine cavity and endometrium (uterine wall) are vital for the success of pregnancy. In a natural cycle, the time when the endometrium is most suitable for implantation is 5-7 days after ovulation. During this period, the embryo enters the blastocyst phase.
Many factors can influence the receptivity of the endometrium. These can be anomalies such as polyps, fibroids, adhesions or the thickness of the uterine wall.
In assisted reproductive treatment, uterine wall thickness can be easily measured with transvaginal ultrasound. The thickness of the uterine wall is one of the factors affecting the success of pregnancy after embryo transfer.
A thin uterine wall (less than 7 mm) often leads to undesirable results. It is responsible for recurrent IVF transfer failures, decreased pregnancy success rates and increased rates of cancelled embryo transfer.
Approximately 3% of frozen embryo transfer (FET) cycles (treatments) are associated with thin uterine walls. Different forms of estrogen hormone support (oral, skin, vaginal or injection), vasoactive drugs such as low-dose aspirin, tocopherol (vaginal sindenafil), tamoxifen, granulocyte colony-stimulating factor (G-CSF) intrauterine infusion and stem cell therapy are supportive therapies that have been used in an attempt to thicken the uterine wall and/or increase the receptivity of the uterus. Despite these supportive therapies, the problem that causes the most distress to the doctor and the patient in frozen embryo treatments is the low receptivity of the uterine wall and the uterine wall that does not thicken.
Platelet-rich plasma (blood clotting cells) is used in numerous medical fields. These include plastic surgery, dermatology, orthopaedics and heart diseases. The cytokines and growth factors contained in platelet alpha-granules give PRP the chance to have a regenerative (healing) effect on damaged tissues. In recent years, PRP has also been used in assisted reproductive treatments to activate dormant eggs in patients with low ovarian reserve by administering it into the ovary.
Interest has now shifted to endometrial PRP in patients with thin endometrium and recurrent implantation failures.
Platelet-derived factors in PRP act on cells of the endometrium with growth potential. Platelet-derived growth factors also have an effect on stromal (peripheral) cell development, cell migration and contractile function of the endometrium.
When platelet-rich concentrate is injected into the endomethrium (uterine cavity), large amounts of cytokines and chemokines trigger immune mechanisms, local homeostasis (bleeding-coagulation) balance, regeneration and healing.
Endometrial PRP is applied 10 days after the first administration of the oestrogen hormone to thicken the uterine wall or on day 12-13 of menstruation.
In recurrent implantation failures, intrauterine administration of PRP in a volume of 0.5 mL 2 days before the transfer can increase pregnancy success.
Some studies conclude that administrating PRP 3 times a day starting from the 10th day significantly increases the success of ongoing pregnancy in cases with recurrent implantation failure.
Calcium or thrombin can be administered into the PRP to activate platelets. In addition, the centrifuge itself causes platelet activation with traumatic effect.
Endometrial PRP can increase pregnancy rates where assisted reproductive technologies such as other supportive therapies fail.
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