Hiệu quả và tính an toàn của huyết tương giàu tiểu cầu tự thân trong điều trị nội mạc tử cung mỏng ở các bệnh nhân thụ tinh trong ống nghiệm
Nội dung chính của bài viết
Tóm tắt
Nghiên cứu nhằm đánh giá tính an toàn và hiệu quả của liệu pháp bơm huyết tương giàu tiểu cầu (PRP) tự thân vào buồng tử cung trên 50 bệnh nhân thụ tinh trong ống nghiệm có tiền sử nội mạc tử cung (NMTC) mỏng đáp ứng kém với phác đồ hormone thay thế. Kết quả cho thấy chế phẩm PRP đạt nồng độ tiểu cầu trung bình 1247,53×106/mL (gấp 5,07 lần máu ngoại vi). Về tính an toàn, không ghi nhận biến cố bất lợi nào được xác định liên quan trực tiếp đến thủ thuật. Về hiệu quả, liệu pháp giúp cải thiện độ dày NMTC có ý nghĩa thống kê từ 5,98 ± 0,72mm ở các chu kỳ trước lên 7,19 ± 0,99mm sau can thiệp (p < 0,001), giúp 70% (35/50) bệnh nhân đủ điều kiện chuyển phôi. Tỷ lệ thai lâm sàng trong nhóm chuyển phôi đạt 37,1% (13/35). Kết luận, bơm PRP tự thân là phương pháp an toàn và hiệu quả, giúp cải thiện độ dày NMTC và mang lại cơ hội có thai cho nhóm bệnh nhân NMTC mỏng kháng trị.
Chi tiết bài viết
Từ khóa
Huyết tương giàu tiểu cầu, PRP, nội mạc tử cung mỏng, thụ tinh trong ống nghiệm, thất bại làm tổ
Tài liệu tham khảo
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2. Yang Y, Zhang X, Zhang Y. Platelet-rich plasma therapy for thin endometrium: a comprehensive review. Arch Gynecol Obstet. 2025; 312(3): 745-753. doi:10.1007/s00404-025-08077-5.
3. Eftekhar M, Neghab N, Naghshineh E, Khani P. Can autologous platelet rich plasma expand endometrial thickness and improve pregnancy rate during frozen-thawed embryo transfer cycle? A randomized clinical trial. Taiwan J Obstet Gynecol. 2018; 57(6): 810-813. doi:10.1016/j.tjog.2018.10.007.
4. Aghajanova L, Zhang A, Lathi RB, Huddleston HG. Platelet-rich plasma infusion as an adjunct treatment for persistent thin lining in frozen embryo transfer cycles: first US experience report. J Assist Reprod Genet. 2024; 41(2): 483-491. doi:10.1007/s10815-023-02993-8.
5. Salman MM, Zaki AM, El-Gamal HH, Gomaa MF, Osman AA, Farid LA. Effect of intrauterine infusion of autologous platelet-rich plasma in patients with refractory thin endometrium undergoing in vitro fertilization. Prz Menopauzalny. 2023; 22(2): 77-82. doi:10.5114/pm.2023.128814.
6. Russell SJ, Kwok YSS, Nguyen TTTN, Librach C. Autologous platelet-rich plasma improves the endometrial thickness and live birth rate in patients with recurrent implantation failure and thin endometrium. J Assist Reprod Genet. 2022; 39(6): 1305-1312. doi:10.1007/s10815-022-02505-0.
7. Dogra Y, Singh N, Vanamail P. Autologous platelet-rich plasma optimizes endometrial thickness and pregnancy outcomes in women with refractory thin endometrium of varied aetiology during fresh and frozen-thawed embryo transfer cycles. JBRA Assist Reprod. 2022; 26(1): 13-21. doi:10.5935/1518-0557.20210037.
8. Shufaro Y, Simon A, Laufer N, Fatum M. Thin unresponsive endometrium—a possible complication of surgical curettage compromising ART outcome. J Assist Reprod Genet. 2008; 25(8): 421-425. doi:10.1007/s10815-008-9245-y.
9. Zheng Y, Chen B, Dai J, et al. Thin endometrium is associated with higher risks of preterm birth and low birth weight after frozen single blastocyst transfer. Front Endocrinol (Lausanne). 2022; 13: 1040140. doi:10.3389/fendo.2022.1040140.
10. Mouhayar Y, Franasiak JM, Sharara FI. Obstetrical complications of thin endometrium in assisted reproductive technologies: a systematic review. J Assist Reprod Genet. 2019; 36(4): 607-611. doi:10.1007/s10815-019-01407-y.
11. Berrigan WA, Bailowitz Z, Park A, Reddy A, Liu R, Lansdown D. A Greater Platelet Dose May Yield Better Clinical Outcomes for Platelet-Rich Plasma in the Treatment of Knee Osteoarthritis: A Systematic Review. Arthroscopy. 2025; 41(3): 809-817.e2. doi:10.1016/j.arthro.2024.03.018.
12. Chang Y, Li J, Chen Y, et al. Autologous platelet-rich plasma promotes endometrial growth and improves pregnancy outcome during in vitro fertilization. Int J Clin Exp Med. 2015; 8(1): 1286-1290.
13. Liu X, Qian C, Jiang X, et al. Efficacy of platelet-rich plasma in the treatment of thin endometrium: a meta-analysis of randomized controlled trials. BMC Pregnancy Childbirth. 2024; 24(1): 567. doi:10.1186/s12884-024-06741-3.
14. Efendieva Z, Vishnyakova P, Apolikhina I, et al. Hysteroscopic injections of autologous endometrial cells and platelet-rich plasma in patients with thin endometrium: a pilot randomized study. Sci Rep. 2023; 13(1): 945. doi:10.1038/s41598-023-27982-w.
15. Aghajanova L, Houshdaran S, Balayan S, et al. In vitro evidence that platelet-rich plasma stimulates cellular processes involved in endometrial regeneration. J Assist Reprod Genet. 2018; 35(5): 757-770. doi:10.1007/s10815-018-1130-8.
16. King WJ, Krebsbach PH. Growth factor delivery: how surface interactions modulate release in vitro and in vivo. Adv Drug Deliv Rev. 2012; 64(12): 1239-1256. doi:10.1016/j.addr.2012.03.004.
17. Hajipour H, Farzadi L, Latifi Z, et al. An update on platelet-rich plasma (PRP) therapy in endometrium and ovary related infertilities: clinical and molecular aspects. Syst Biol Reprod Med. 2021; 67(3): 177-188. doi:10.1080/19396368.2020.1862357.
18. Jang HY, Myoung SM, Choe JM, et al. Effects of Autologous Platelet-Rich Plasma on Regeneration of Damaged Endometrium in Female Rats. Yonsei Med J. 2017; 58(6): 1195-1203. doi:10.3349/ymj.2017.58.6.1195.
19. Zadehmodarres S, Salehpour S, Saharkhiz N, Nazari L. Treatment of thin endometrium with autologous platelet-rich plasma: a pilot study. JBRA Assist Reprod. 2017; 21(1): 54-56. doi:10.5935/1518-0557.20170013.
20. Chang Y, Li J, Wei LN, Pang J, Chen J, Liang X. Autologous platelet-rich plasma infusion improves clinical pregnancy rate in frozen embryo transfer cycles for women with thin endometrium. Medicine (Baltimore). 2019; 98(3): e14062. doi:10.1097/MD.0000000000014062.
21. Nazari L, Salehpour S, Hoseini S, Zadehmodarres S, Azargashb E. Effects of autologous platelet-rich plasma on endometrial expansion in patients undergoing frozen-thawed embryo transfer: A double-blind RCT. Int J Reprod Biomed. 2019; 17(6): 443-448. doi:10.18502/ijrm.v17i6.4816.
2. Yang Y, Zhang X, Zhang Y. Platelet-rich plasma therapy for thin endometrium: a comprehensive review. Arch Gynecol Obstet. 2025; 312(3): 745-753. doi:10.1007/s00404-025-08077-5.
3. Eftekhar M, Neghab N, Naghshineh E, Khani P. Can autologous platelet rich plasma expand endometrial thickness and improve pregnancy rate during frozen-thawed embryo transfer cycle? A randomized clinical trial. Taiwan J Obstet Gynecol. 2018; 57(6): 810-813. doi:10.1016/j.tjog.2018.10.007.
4. Aghajanova L, Zhang A, Lathi RB, Huddleston HG. Platelet-rich plasma infusion as an adjunct treatment for persistent thin lining in frozen embryo transfer cycles: first US experience report. J Assist Reprod Genet. 2024; 41(2): 483-491. doi:10.1007/s10815-023-02993-8.
5. Salman MM, Zaki AM, El-Gamal HH, Gomaa MF, Osman AA, Farid LA. Effect of intrauterine infusion of autologous platelet-rich plasma in patients with refractory thin endometrium undergoing in vitro fertilization. Prz Menopauzalny. 2023; 22(2): 77-82. doi:10.5114/pm.2023.128814.
6. Russell SJ, Kwok YSS, Nguyen TTTN, Librach C. Autologous platelet-rich plasma improves the endometrial thickness and live birth rate in patients with recurrent implantation failure and thin endometrium. J Assist Reprod Genet. 2022; 39(6): 1305-1312. doi:10.1007/s10815-022-02505-0.
7. Dogra Y, Singh N, Vanamail P. Autologous platelet-rich plasma optimizes endometrial thickness and pregnancy outcomes in women with refractory thin endometrium of varied aetiology during fresh and frozen-thawed embryo transfer cycles. JBRA Assist Reprod. 2022; 26(1): 13-21. doi:10.5935/1518-0557.20210037.
8. Shufaro Y, Simon A, Laufer N, Fatum M. Thin unresponsive endometrium—a possible complication of surgical curettage compromising ART outcome. J Assist Reprod Genet. 2008; 25(8): 421-425. doi:10.1007/s10815-008-9245-y.
9. Zheng Y, Chen B, Dai J, et al. Thin endometrium is associated with higher risks of preterm birth and low birth weight after frozen single blastocyst transfer. Front Endocrinol (Lausanne). 2022; 13: 1040140. doi:10.3389/fendo.2022.1040140.
10. Mouhayar Y, Franasiak JM, Sharara FI. Obstetrical complications of thin endometrium in assisted reproductive technologies: a systematic review. J Assist Reprod Genet. 2019; 36(4): 607-611. doi:10.1007/s10815-019-01407-y.
11. Berrigan WA, Bailowitz Z, Park A, Reddy A, Liu R, Lansdown D. A Greater Platelet Dose May Yield Better Clinical Outcomes for Platelet-Rich Plasma in the Treatment of Knee Osteoarthritis: A Systematic Review. Arthroscopy. 2025; 41(3): 809-817.e2. doi:10.1016/j.arthro.2024.03.018.
12. Chang Y, Li J, Chen Y, et al. Autologous platelet-rich plasma promotes endometrial growth and improves pregnancy outcome during in vitro fertilization. Int J Clin Exp Med. 2015; 8(1): 1286-1290.
13. Liu X, Qian C, Jiang X, et al. Efficacy of platelet-rich plasma in the treatment of thin endometrium: a meta-analysis of randomized controlled trials. BMC Pregnancy Childbirth. 2024; 24(1): 567. doi:10.1186/s12884-024-06741-3.
14. Efendieva Z, Vishnyakova P, Apolikhina I, et al. Hysteroscopic injections of autologous endometrial cells and platelet-rich plasma in patients with thin endometrium: a pilot randomized study. Sci Rep. 2023; 13(1): 945. doi:10.1038/s41598-023-27982-w.
15. Aghajanova L, Houshdaran S, Balayan S, et al. In vitro evidence that platelet-rich plasma stimulates cellular processes involved in endometrial regeneration. J Assist Reprod Genet. 2018; 35(5): 757-770. doi:10.1007/s10815-018-1130-8.
16. King WJ, Krebsbach PH. Growth factor delivery: how surface interactions modulate release in vitro and in vivo. Adv Drug Deliv Rev. 2012; 64(12): 1239-1256. doi:10.1016/j.addr.2012.03.004.
17. Hajipour H, Farzadi L, Latifi Z, et al. An update on platelet-rich plasma (PRP) therapy in endometrium and ovary related infertilities: clinical and molecular aspects. Syst Biol Reprod Med. 2021; 67(3): 177-188. doi:10.1080/19396368.2020.1862357.
18. Jang HY, Myoung SM, Choe JM, et al. Effects of Autologous Platelet-Rich Plasma on Regeneration of Damaged Endometrium in Female Rats. Yonsei Med J. 2017; 58(6): 1195-1203. doi:10.3349/ymj.2017.58.6.1195.
19. Zadehmodarres S, Salehpour S, Saharkhiz N, Nazari L. Treatment of thin endometrium with autologous platelet-rich plasma: a pilot study. JBRA Assist Reprod. 2017; 21(1): 54-56. doi:10.5935/1518-0557.20170013.
20. Chang Y, Li J, Wei LN, Pang J, Chen J, Liang X. Autologous platelet-rich plasma infusion improves clinical pregnancy rate in frozen embryo transfer cycles for women with thin endometrium. Medicine (Baltimore). 2019; 98(3): e14062. doi:10.1097/MD.0000000000014062.
21. Nazari L, Salehpour S, Hoseini S, Zadehmodarres S, Azargashb E. Effects of autologous platelet-rich plasma on endometrial expansion in patients undergoing frozen-thawed embryo transfer: A double-blind RCT. Int J Reprod Biomed. 2019; 17(6): 443-448. doi:10.18502/ijrm.v17i6.4816.