The number of previous implantation failures is a critical determinant of intrauterine autologous platelet-rich plasma infusion success in women with recurrent implantation failure

Abstract

Purpose: We aimed to identify factors influencing the reproductive outcomes of frozen-thawed embryo transfer (FET) with intrauterine autologous platelet-rich plasma (PRP) infusion in patients with either a thin endometrium or recurrent implantation failure (RIF) despite a normal endometrial appearance.

Methods: In this retrospective study of women who underwent PRP-FET, factors influencing PRP-FET outcomes were identified using multivariate logistic regression analysis.

Results: We enrolled 111 patients (70 with refractory thin endometrium and 41 with RIF but no thin endometrium). For 99 completed FET cycles, the β-hCG positivity rate was 46.7%, clinical pregnancy rate (CPR) was 41.0%, and live birth rate (LBR) was 36.2%. PRP treatment was associated with significant improvements over previous cycles, and participants with thin endometria demonstrated thickening. Multivariate logistic regression analysis showed that the number of previous implantation failures in women with RIF was a significant factor affecting the PRP-FET outcomes. The CPR and LBR of women with RIF were lower when there had been ≥3 previous implantation failures occurred.

Conclusions: Intrauterine PRP infusion improves the pregnancy outcomes of patients with RIF or a thin endometrium. The number of previous implantation failures is a critical determinant of successful intrauterine PRP infusions in women with RIF.

Keywords: embryo implantation; embryo transfer; endometrium; infertility; platelet‐rich plasma.

FIGURE 1

Diagram showing the participation of patients throughout the study. The numbers of participants are shown. Intrauterine PRP infusion was administered to 111 participants. No one met the exclusion criteria. FET cancellation occurred in six patients. Among 105 cycles of FET, biochemical pregnancies occurred in six cycles and clinical pregnancies occurred in 43 cycles, of which five resulted in clinical abortions, and 38 live births were achieved. FET, frozen–thawed embryo transfer; PRP, platelet‐rich plasma; RIF, recurrent implantation failure; TEM, thin endometrium; β‐hCG, beta‐human chorionic gonadotropin.

FIGURE 2

Decreases in the prevalence of successful PRP‐FET alongside increases in the number of previous implantation failures. The graphs depict the relationships of the number of previous implantation failures with the β‐hCG positivity rate (A), clinical pregnancy rate (B), and live birth rate (C) of the TEM (upper) and RIF (lower) groups. Each dot‐plotted graph on the left of the panels represents the outcome of a single logistic regression analysis of the relationship of the number of previous implantation failures with therapeutic outcomes. The colored areas represent the calculated prevalence of positive outcomes. Each bar graph on the right side represents the results of a Cochran–Armitage trend test for the relationship between the number of previous implantation failures and the therapeutic outcome, and the width of each bar indicates the number of participants. The p‐values represent the results of Wald tests.