P-205 Exploring the influence of platelet rich plasma (PRP) versus PRP with hyaluronic acid on endometrial thickness (ET) and IVF outcome: a pilot study
Authors: Dhar A , Gupta G , Gupta S , Raheja A , Sarkar P , Sharma G , Arya M , Sharma S 
Published: July 2024

Abstract

Study question
What is the impact of sub-endometrial instillation of PRP versus PRP with hyaluronic acid on ET and IVF outcome defined by positive and clinical pregnancy

Summary answer
PRP with hyaluronic acid group had more endometrial thickness with better vascularity and better pregnancy outcomes as compared to normal PRP

What is known already
Receptive endometrium is the end result of an interplay of a myriad of cytokines, adhesion molecules growth factors etc. Defect in these can result in thin endometrium. Sub endometrial PRP instillation has been attempted in such cases with promising results and acts by stimulating cell growth and angiogenesis These actions are enhanced by hyaluronic acid along with its antiadhesive effect. PRP with hyaluronic acid has been used previously in orthopedics, dermatology but not documented in thin endometrium. Most of previous studies have focused on endometrial thickness and no comparison has been done between PRP and PRP with hyaluronic acid.

Study design, size, duration
A retrospective observational study was conducted at Gunjan IVF WORLD Ghaziabad, from January 2022 to Dec 2023. Total 215 patients between the age group of 21-50 years with thin endometrium (ET &lt; 7mm) with zone 2 or less vascularity with at least 1 good quality blastocyst for transfer were selected. They were subjected to hysteroscopic sub endometrial PRP instillation or instillation of PRP with hyaluronic acid

Participants/materials, setting, methods
Women with diverse reasons for infertility were divided into 2 groups - those receiving PRP (87 subjects) vs PRP with hyaluronic acid (128 subjects). PRP was activated by adding 0.1 ml of Calcium Chloride in 0.9 ml of PRP. Hyaluronic acid (80IU/ML) was added to PRP in the ratio of 1:5. The two groups were compared for positive pregnancy defined as βhCG &gt;100 mIU/ml, clinical pregnancy defined as visualization of gestational sac and endometrial thickness

Main results and the role of chance
112 of 215 (52.09%) women had positive pregnancy outcomes (βhCG &gt;100 mIU/ml). Of the 112 subjects having positive outcomes, 40 (35.71%) belonged to normal PRP group and 72 (64.28%) belonged to PRP with hyaluronic acid group. Clinical pregnancy was seen in 37 (33.03%) in normal PRP group and 70(62.5%) in PRP with hyaluronic acid group. Mean βhCG was significantly higher in PRP with hyaluronic acid group (p = 0.013). Mean endometrial thickness was also higher in PRP with hyaluronic acid group (p = 0.05). The findings of the study suggest that PRP with hyaluronic acid has much better results in patients with thin endometrium in terms of not only the endometrial thickness but it also translates into better pregnancy rates.

Limitations, reasons for caution
1. Patient pool from limited geographical area.
2. More Randomized controlled trials with larger sample size required to assess efficacy of Platelet rich plasma with hyaluronic acid.
3. The results were analyzed only up to clinical pregnancy and not ongoing pregnancy or live birth rates

Wider implications of the findings
1. PRP with hyaluronic acid can be a boon to patients having thin endometrium who otherwise would have sub optimal IVF outcomes
2. Study can encourage larger randomized controlled trials in this direction especially in cases of intrauterine adhesions.

Trial registration number
not applicable