O-221 Regenerative endometrial PRGF (plasma rich in growth factors) treatment in patients with thin endometrium, recurrent implantation failure, and recurrent miscarriages: a retrospective, self-controlled, cohort study
Authors: Bodri D , Rogel S , Abad J L , Paul R , Izquierdo H , Aizpurua J 
Published: June 2023

Abstract

Study question
What reproductive outcomes are observed in patients submitted to endometrial PRGF therapy due to thin endometrium (ThE), recurrent implantation failure (RIF) and recurrent miscarriages (RM)?

Summary answer
Following endometrial PRGF treatment, success rates were significantly increased in ThE and RIF patients, whereas in the RM group pregnancy loss rates were not affected.

What is known already
Adequate development of a functional endometrium is a prerequisite for successful embryo implantation in ART cycles. In contrast, the management of patients with thin endometrial lining or recurrent implantation failure has been an ongoing challenge with none of the proposed surgical, hormonal, and pharmacological interventions achieving satisfactory results. In recent years, the use of plasma rich in growth factors (PRGF) - successfully applied in other medical fields - has become a novel treatment option in reproductive medicine. It was used experimentally both for ovarian follicle activation and to enhance endometrial receptivity although published studies are small with often contradictory results.

Study design, size, duration
All consecutive patients (n = 107) who underwent endometrial PRGF treatment (n = 150) in a single, private centre between 2016-2022 were included in this retrospective analysis. Patients were recruited into ThE (n = 64), RIF (n = 36) and RM (n = 7) groups, respectively. Live birth / ongoing pregnancy rates per embryo transfer were compared to success rates obtained in previous embryo transfers preceding the endometrial PRGF intervention. External Ethics Committee approval was obtained for a comparative pilot study including above patient groups.

Participants/materials, setting, methods
PRGF was obtained by processing the patients’ autologous blood sample in an in-house validated open system. Endometrial PRGF interventions were performed using a thawed PRGF sample with a series of intrauterine instillations (43%) or with a combined approach performing hysteroscopic subendometrial infiltration during early follicular phase (57%). Endometrial preparation was conducted using an artificial hormone replacement protocol with high-dose oral estrogens and vaginal progesterone. Most embryo transfers involved the replacement of a single, vitrified-thawed blastocyst.

Main results and the role of chance
A total of 107 patients underwent 150 endometrial PRGF treatments and 131 subsequent embryo transfers. Altogether 19 (13%) embryo transfers were cancelled, higher in ThE than in the RIF group (16 vs 7.1%). In the ThE group (64 patients, 98 PRGF cycles and 107 controls), positive pregnancy (41 vs 32%, NS), clinical pregnancy (35 vs 22%, p = 0.049) and ongoing pregnancy/live birth rates (24 vs 4.7%, p &lt; 0.0001) per embryo transfer were significantly higher in the endometrial PRGF treatment group compared to previous embryo transfers. In the RIF group (36 patients, 42 PRGF cycles and 101 controls), positive pregnancy (59 vs 20%, p &lt; 0.0001), clinical pregnancy (44 vs 11%, p &lt; 0.0001) and ongoing pregnancy/live birth rates (33 vs 7.9%, p &lt; 0.0001) per embryo transfer were significantly higher in the endometrial PRGF treatment group compared to previous embryo transfers. In the RM group (7 patients, 10 PRGF cycles and 15 controls), positive pregnancy (50 vs 60%), clinical pregnancy (20 vs 27%) and ongoing pregnancy/live birth rates (0 vs 0%) per embryo transfer were not significantly different and no ongoing pregnancies were achieved. So far, 20 singletons and 1 set of twins have been confirmed to be born from the above PRGF cycles (12 pregnancies still ongoing).

Limitations, reasons for caution
Heterogeneity of clinical severity between included ThE patients could affect observed reproductive outcomes. The self-controlled design of the study might have influenced the comparison between pre-, and post-intervention pregnancy rates, although this also highlights the poor-prognostic nature of included participants. RM patients were too few to evaluate pregnancy loss rates.

Wider implications of the findings
This preliminary, retrospective study has shown that regenerative therapy using autologous PRGF is a safe, affordable, and efficient treatment option for ThE and RIF patients. Further randomized studies are warranted, although they are hampered by patient selection issues and the lack of applicable efficient treatment options in the non-intervention group.

Trial registration number
not applicable