Title: Autologous PRP for the management of thin endometrium in frozen embryo transfer cycles: would it improve the outcome?
Abstract: Autologous platelet rich plasma (PRP) has emerged as a newer modality of treatment to improve endometrial thickness (ET) in cases of thin endometrium. Platelet activation would release growth factors from the alpha granules such as VEGF, EGF, PDGF, TGF and other cytokines, which may facilitate endometrial development. The present study was aimed to study the effect of autologous PRP on endometrial development in cases of thin endometrium in frozen embryo transfer cycles. Non-randomized single arm trial. All women aged 20 - 40 years, presenting with thin endometrium (<7mm) on day 11 of HRT (hormone replacement therapy) for FET (frozen embryo transfer) were included in the study. Patients with previous endometrial disease such as asherman syndrome, tubercular endometritis, mullerian anomalies, and premature ovarian failure were excluded. Endometrial preparation was performed by GnRHa down regulation and HRT by estradiol valerate at 6mg/day. PRP was prepared by two step centrifugation method, and administered intrauterine by IUI catheter. Repeat USG evaluation of endometrium was performed on Day 15 ( 4 days after PRP instillation). Statistical analysis was performed by Paired sample T test and Chi square test through SPSS version 17 software. P<0.05 was considered statistically significant. Of the 28 women who presented with thin endometrium, 20 patients (71.4%) had increased ET to ≥ 7 mm, and underwent frozen embryo transfer. Eight patients (28.6%) had cycle cancellation due to persistent thin ET. There was a significant increase in the ET after PRP instillation: from 6.3 ± 1.0 to 7.0 ± 1.1 mm; P= 0.003. In transferred cycles, the pregnancy rate was 35% and implantation rate was 14.2%. The ongoing pregnancy and live birth rates were 14.2% and 20% respectively.Tabled 1ParameterResultAge32 ± 3.79Male factor13 (46.4%)PCOS03 (10.7%)Tubal factor05 (17.9%)Fibroid uterus01 (3.6%)Endometriosis01 (3.6%)Decreased ovarian reserve03 (10.7%)Unexplained02 (7.1%)Endometrial thickness (ET) before PRP6.3 ± 1.0Endometrial thickness (ET) after PRP7.0 ± 1.1No. of patients with good endometrial vascularity (Grade II & III) before PRP11 (39.3%)No. of patients with good endometrial vascularity after PRP12 (42.8%)No. of patients with improved ET (≥ 7 mm)20 (71.4%)No. of patients with cycle cancellation08 (28.6%)Pregnancy rate in transferred patients35% (7/20)Implantation rate14.2%Miscarriage rate14.2% (1/7)Ongoing pregnancy02 (10.0%)Live birth rate04 ( 20.0%) Open table in a new tab 1. Autologous PRP significantly improves endometrial thickness in cases of thin endometrium in FET cycles.