Evaluation of the efficacy and safety of autologous platelet-rich plasma in the treatment of refractory thin endometrium
Main Article Content
Abstract
This study aimed to evaluate the safety and efficacy of intrauterine infusion of autologous platelet-rich plasma (PRP) in 50 in-vitro fertilization (IVF) patients with a history of refractory thin endometrium unresponsive to standard hormone protocols. Results showed that the standardized PRP preparation yielded a mean platelet concentration of 1247.53×106/mL (a 5.07-fold increase from baseline). Regarding safety, no adverse event directly related to the procedure was recorded. In terms of efficacy, the therapy significantly improved endometrial thickness from 5.98 ± 0.72mm pre-intervention to 7.19 ± 0.99mm post-intervention (p < 0.001), enabling 70% (35/50) of patients to proceed to embryo transfer. The clinical pregnancy rate among transferred patients was 37.1% (13/35). In conclusion, autologous PRP infusion is a safe and effective method for improving endometrial thickness and offering pregnancy chances for patients with refractory thin endometrium.
Article Details
Keywords
Platelet-Rich Plasma, PRP, Thin Endometrium, In-Vitro Fertilization, Implantation Failure
References
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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.
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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.