P–312 Clinical applications of platelet-rich plasma in poor endometrium patients with adenomyosis
Authors: Feskov O , Feskova I , Zhylkova Y , Bezpechna I , Osovskiy I , Feskova A 
Published: August 2021

Abstract

Study question
Does the intrauterus application of platelet-rich plasma (PRP) allow improving the thickness of endometrium in patients with adenomyosis: comparative characteristics of the PRP-techniques?

Summary answer
The endometrial thickness in poor-endometrium-patients is increased after subendometrial PRP- injection comparing with the endometrium size after PRP- irrigation of the uterine cavity (P &lt; 0.05).

What is known already
The endometrium plays an important role in achieving optimal outcomes of assisted reproductive technologies. PRP is a novel method that is used in reproductive medicine to improve the IVF outcome. The mechanisms of PRP have not been completely elucidated, but laboratory studies have shown that the high concentration of growth factors in PRP can potentially speed up the healing process. Recently, the intrauterine PRP-infusion and the subendometrial PRP-injection during the hysteroscopy have been described as a way to promote endometrial growth and receptivity.

Study design, size, duration
Totally 64 patients with adenomyosis and poor endometrium (≤ 6 mm) were divided into three experimental groups depending on PRP administration: intrauterine PRP-infusion, subendometrial PRP-injection and standard hormonal therapy of adenomyosis without PRP application. The period of study – December 2019 – November 2020. The study’s protocol was approved by the Center’s IRB.

Participants/materials, setting, methods
Intrauterine PRP-infusion was performed for 23 patients with age 34.2±3.6 y.o. (Group 1). Subendometrial PRP-injection was applied for 16 patients with the middle age 32,6±2,4 y.o. (Group 2). Additional hormonal therapy was carried out for patients from Groups 1, 2. The third control Group 3 consisted of 25 adenomyosis women with the middle age 35.7±4.1 y.o. Only the hormonal therapy was performed for patients of the control group.

Main results and the role of chance
The procedure of intrauterine PRP-infusion was done using the intrauterine catheter on the 8th and 12th days of the f hormone replacement therapy. Subendometrial PRP-injection was performed during the hysteroscopy on the 8th–10th day of the previous menstrual cycle. The control of the endometrium size was done by ultrasound examination. T-test was used for data analysis. P &lt; 0.05 was considered statistically significant. After subendometrial PRP-injection, the average endometrium thickness was significantly higher comparing with the control (8.7±1.1mm vs. 5.8±0.8mm) (Student t-test t = 2.13, P = 0.04). PRP-infusion also showed significantly strong positive result comparing with the control group (8.3±0.9mm vs. 5.8±0.8mm) (Student t-test t = 2.08, P = 0.043). There is the tendency that subendometrial PRP-has a greater impact on endometrium size comparing with the PRP-infusion. Further investigations should be done.

Limitations, reasons for caution
Patients with Asherman’s syndrome were excluded from experiment.
Wider implications of the findings: It is not clear how the intrauterine administration of PRP may act to affect endometrial thickness. Results from studies on the role of endometrial thickness on implantation and live births are contradictory. There is the urge for well-designed randomized studies to improve our knowledge on PRP in reproductive medicine.

Trial registration number
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