P-792 The effect of subendometrial injection of autologous platelet rich plasma (PRP) guided by hysteroscopy in recurrent implantation failure patients - A pilot study
Authors: Gupta G , Sharma G , Raheja A , Sarkar P 
Published: June 2023

Abstract

Study question
Does the subendometrial injection of autologous platelet-rich plasma (PRP) guided by hysteroscopy achieve successful pregnancy outcome in recurrent implantation failure patients?

Summary answer
In this study we observed that subendometrial injection of autologous PRP is associated with higher implantation rates in recurrent implantation failure patients.

What is known already
The key success factors in IVF are to have a good endometrium lining and vascularity for successful implantation. These two factors directly affect the pregnancy outcomes of IVF.
Although several approaches have been attempted to address these factors including estrogen treatment, aspirin, sildenafil, vitamin E, Granulocyte-Colony Stimulating Factor (G-CSF), there is no efficient method described. Additionally, some cases do not show a response to the medical treatment. In those cases, specifically, in previously failed IVF patients autologous Platelet Rich Plasma (PRP) injection into the sub-endometrial cavity with an ovum pick up needle has been preferred, as confirmed by literature.

Study design, size, duration
An open label, single center study. Total 130 women were selected for hysteroscopic instillation of PRP, all patients have previous unsuccessful IVF attempts in our clinic or were referred to our clinic. Study participants are of age 23 to 49 years. Study began in July 2020 and was completed in December 2022.

Participants/materials, setting, methods
2 ml of autologous PRP was instilled in the junctional zone using a wallace needle through the hysteroscope's operating channel to inject the PRP beneath the superficial endometrium from day 6-14 of menstrual cycle. FET preparation was started from Day 2/3 of next menstrual cycle using 6 mg/daily estradiol hemihydrate (EV Active Tab CORONA Remedies).

Main results and the role of chance
Women who received hysteroscopic instillation of PRP in the sub-endometrial junction had higher pregnancy rates (82/130 [63.07%] (P-value = &lt;0.05). In the subsequent cycle monitored to day 15, Endometrial thickness (ET) was 7 mm or thicker in 90 of 130 patients [69.23%] (P-value = &lt;0.05) and 6-7 mm in 8 of 130 patients [6.15%]. Endometrial thickness did not improve in 32 of 130 patients [24.61%] and remained below 6 mm. Subendometrial blood flow increased significantly in 92 of 130 patients [70.76%] (P-value = &lt;0.05). The mean increase in ET was 1.5 to 2 mm.
The instillation of PRP caused no side effects and was well tolerated by all patients. In 47 patients (36.15%) we did not achieve clinical pregnancy while 1 had a biochemical pregnancy
Based on paired ‘t’ test, it is concluded that there is statistically significant improvement in ET, vascularity and successful pregnancy outcome after PRP instillation.

Limitations, reasons for caution
Little is known about the best dosage and time for the instillation of PRP in endometrium. The importance of standard yet simple techniques and a highly repeatable protocol for clinical use is deciding factor which yet to finalize. It involves invasive procedure so may cause infections and anesthesia related complications.

Wider implications of the findings
Although PRP has still not gained universal acceptance in previously failed IVF patients for a variety of reasons, emerging evidences suggests that PRP could be an effective option compared to conventional approach especially, in patients with thin endometrium, advanced maternal age and primary ovarian insufficiency.

Trial registration number
Not applicable