Platelet-Rich Plasma Intrauterine Infusion as Assisted Reproduction Technology (ART) to Combat Repeated Implantation Failure (RIF): A Systematic Review and Meta-Analysis

Abstract

Background: Repeated implantation failure (RIF) is considered one of the major challenges facing clinician in assisted reproduction technologies (ART) despite the significant advances that have been made in this field. Platelet rich plasma (PRP), also known as autologous conditioned plasma, is a protein concentrate with anti-inflammatory and pro-regenerative characteristics. The use of PRP in women undergoing ART has been studied in the past, with varying degrees of success. The goal of this trial was to see if injecting PRP into the uterus improves pregnancy outcomes in women receiving ART.

Methods: PubMed, Embase, Scopus, Web of Science, and the Cochrane Database of Clinical Trials were among the databases searched (CENTRAL), from 2015 to 2021. The pooled estimates were calculated using a meta-analysis with a random-effects model. There were 14 studies with a total of 1081 individuals (549 cases and 532 controls).

Results: There was no difference in miscarriage rates between women who got PRP and those who received placebo (P≤0.90). Chemical pregnancy (P≤0.00), clinical pregnancy (P ≤0.001), and implantation rate (P≤ 0.001) were all significantly higher in women. Endometrial thickness increased in women who got PRP vs women who received placebo after the intervention (P ≤0.001).

Conclusion: PRP may be an alternate therapeutic approach for individuals with thin endometrium and RIF, according to the findings of this comprehensive study. To determine the subgroup that would benefit the most from PRP, more prospective, big, and high-quality randomized controlled trials (RCTs) are needed.

Keywords: Clinical pregnancy; Implantation rate; Platelet rich plasma; Randomized controlled trials.

Fig.1:

Flow diagram of the literature search and study selection process

Fig. 2:

Forest plot detailed odds ratio and 95% CI for clinical pregnancy

Fig. 3:

Forest plot showing individual and combined effect size estimates and 95% CI in studies that evaluated the risk of chemical pregnancy in women who received intrauterine platelet rich plasma versus control

Fig. 4:

Forest plot showing individual and combined effect size estimates and 95% CI in studies that evaluated the risk of implantation rate in women who received intrauterine platelet rich plasma versus control

Fig. 5:

Forest plot showing individual and combined effect size estimates and 95% CI in studies that evaluated the risk of miscarriage in women who received intrauterine platelet rich plasma versus control

Fig. 6:

Forest plot showing individual and combined effect size estimates and 95% CI in studies that evaluated the standardized mean difference of endometrial thickness in women who received intrauterine platelet rich plasma versus control