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Meta-Analysis
. 2024 Apr 29;4(4):CD013875.
doi: 10.1002/14651858.CD013875.pub2.

Autologous platelet-rich plasma for assisted reproduction

Affiliations
Meta-Analysis

Autologous platelet-rich plasma for assisted reproduction

Dennis Vaidakis et al. Cochrane Database Syst Rev. .

Abstract

Background: Autologous platelet-rich plasma (PRP) consists of plasma and a concentrate of platelets extracted from fresh whole blood of the person being treated. Research has suggested that intrauterine or intraovarian infusion/injection of PRP before embryo transfer may improve endometrial receptivity and response to ovarian stimulation in women undergoing assisted reproduction. We compared these interventions to standard treatment, placebo, or other interventions (mechanical or pharmacological).

Objectives: To assess the effectiveness and safety of intrauterine and intraovarian infusion/injection of platelet-rich plasma in infertile women undergoing assisted reproductive technology cycles.

Search methods: We searched the Cochrane Gynaecology and Fertility Group's Specialised Register, CENTRAL, MEDLINE, Embase, and the Epistemonikos database in January 2023. We also searched the reference lists of relevant articles and contacted the trial authors and experts in the field for any additional trials.

Selection criteria: We included randomized controlled trials (RCTs) that evaluated the application of PRP in the uterine cavity, ovaries, or both versus no intervention, placebo, or any other intervention (either mechanical or pharmacological) in women undergoing in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) cycles.

Data collection and analysis: We followed standard methodological procedures recommended by Cochrane, including use of the updated risk of bias tool (RoB 2). The primary outcomes were live birth (or ongoing pregnancy) and miscarriage. The secondary outcomes were clinical pregnancy, complications of the procedure, multiple pregnancy, ectopic pregnancy, fetal growth restriction, preterm delivery, and fetal abnormality. We estimated the average effect of the interventions by fitting a Der Simonian-Laird's random-effects meta-analysis model. We reported pooled odds ratios (ORs) with 95% confidence intervals (CIs). We restricted the primary analyses to trials at low risk of bias for the outcomes and performed sensitivity analyses that included all studies.

Main results: We included 12 parallel-group RCTs that recruited a total of 1069 women. We identified three different comparison groups. Using GRADE, we assessed the certainty of evidence as very low for almost all outcomes. Intrauterine injection/infusion of platelet-rich plasma versus no intervention or placebo Nine studies evaluated intrauterine PRP versus no intervention or placebo. Eight included women with at least two or three previous implantation failures. Only one was assessed at low risk of bias for each outcome. This study provided very low-certainty evidence about the effect of intrauterine PRP injection versus no intervention on live birth (OR 1.10, 95% CI 0.38 to 3.14; 94 women) and miscarriage (OR 0.96, 95% CI 0.13 to 7.09; 94 women). If the likelihood of live birth following no intervention is assumed to be 17%, then the likelihood following intrauterine PRP would be 7% to 40%; and if the risk of miscarriage following no intervention is 4%, then the risk following intrauterine PRP would be 1% to 24%. When we analyzed all studies (regardless of risk of bias), we found very low-certainty evidence about the effect of intrauterine PRP compared with placebo or no intervention on live birth or ongoing pregnancy (OR 2.38, 95% CI 1.16 to 4.86; I² = 54%; 6 studies, 564 women) and miscarriage (OR 1.54, 95% CI 0.59 to 4.01; I² = 0%; 5 studies, 504 women). The study at low risk of bias provided very low-certainty evidence about the effect of intrauterine PRP compared with no intervention on clinical pregnancy (OR 1.55, 95% CI 0.64 to 3.76; 94 women) and ectopic pregnancy (OR 2.94, 95% CI 0.12 to 73.95; 94 women). The synthesis of all studies provided very low-certainty evidence about the effect of intrauterine PRP compared with placebo or no intervention on clinical pregnancy (OR 2.22, 95% CI 1.50 to 3.27; I² = 24%; 9 studies, 824 women), multiple pregnancy (OR 2.68, 95% CI 0.81 to 8.88; I² = 0%; 2 studies, 240 women), and ectopic pregnancy (OR 2.94, 95% CI 0.12 to 73.95; 1 study, 94 women; very low-certainty evidence). Intrauterine infusion of PRP may increase the risk of preterm delivery compared with no intervention (OR 8.02, 95% CI 1.72 to 37.33; 1 study, 120 women; low-certainty evidence). No studies reported pain, infection, allergic reaction, fetal growth restriction, or fetal abnormality. Intrauterine infusion of platelet-rich plasma versus intrauterine infusion of granulocyte colony-stimulating factor Two RCTs evaluated intrauterine PRP versus intrauterine granulocyte colony-stimulating factor (G-CSF); both included women with thin endometrium, and neither was judged at low risk of bias for any outcome. We are uncertain about the effect of intrauterine PRP compared with intrauterine G-CSF on live birth (OR 0.88, 95% CI 0.43 to 1.81; 1 study, 132 women; very low-certainty evidence), miscarriage (OR 1.94, 95% CI 0.63 to 5.96; 1 study, 132 women; very low-certainty evidence), and clinical pregnancy (OR 1.24, 95% CI 0.66 to 2.35; 2 studies, 172 women; very low-certainty evidence). Neither study reported adverse outcomes other than miscarriage. Intraovarian injection of platelet-rich plasma versus no intervention One RCT evaluated PRP injection into both ovaries versus no intervention; it was judged at high risk of bias for the two outcomes it reported. We are uncertain about the effect of intraovarian PRP injection compared with no intervention on ongoing pregnancy (OR 1.09, 95% CI 0.33 to 3.63; 73 women; very low-certainty evidence) and clinical pregnancy (OR 0.90, 95% CI 0.31 to 2.60; 73 women; very low-certainty evidence). The study examined no safety outcomes.

Authors' conclusions: We are uncertain about the effect of intrauterine or intraovarian administration of PRP on outcomes of assisted reproduction technology in infertile women. The pooled results should be interpreted with caution. Only one of the 12 included studies was judged at low risk of bias. Other limitations of the included trials were failure to report live birth, poor reporting of methods, lack of prospective protocol registration, low precision due to the small number of enrolled participants, indirectness due to the specific subpopulations and settings studied, and insufficient or absent safety data.

PubMed Disclaimer

Conflict of interest statement

MP has received grants from the World Health Organization (WHO Reg. Nos. 2021/1110248 & 2022/1270903‐0) outside the submitted work. DV and CSS have no conflicts of interest to disclose.

Figures

1
1
PRISMA flow diagram illustrating the study selection process.
2
2
Risk of bias summary.
3
3
Risk of bias graph.
4
4
Comparison 1: Endometrial injection of platelet‐rich plasma (PRP) versus no intervention or placebo; Outcome 1: Live birth (or ongoing pregnancy) – low risk of bias.
5
5
Comparison 1: Endometrial injection of platelet‐rich plasma (PRP) versus no intervention or placebo; Outcome 2: Live birth (or ongoing pregnancy) – all studies.
6
6
Comparison 1: Endometrial injection of platelet‐rich plasma (PRP) versus no intervention or placebo; Outcome 5: Miscarriage – low risk of bias.
7
7
Comparison 1: Endometrial injection of platelet‐rich plasma (PRP) versus no intervention or placebo; Outcome 6: Miscarriage – all studies.
8
8
Comparison 1: Endometrial injection of platelet‐rich plasma (PRP) versus no intervention or placebo; Outcome 9: Clinical pregnancy – low risk of bias.
9
9
Comparison 1: Endometrial injection of platelet‐rich plasma (PRP) versus no intervention or placebo; Outcome 10: Clinical pregnancy – all studies.
10
10
Comparison 2: Endometrial injection of platelet‐rich plasma (PRP) versus endometrial injection of granulocyte colony‐stimulating factor (G‐CSF); Outcome 1: Live birth.
11
11
Comparison 2: Endometrial injection of platelet‐rich plasma (PRP) versus endometrial injection of granulocyte colony‐stimulating factor (G‐CSF); Outcome 3: Miscarriage.
12
12
Comparison 2: Endometrial injection of platelet‐rich plasma (PRP) versus endometrial injection of granulocyte colony‐stimulating factor (G‐CSF); Outcome 6: Clinical pregnancy.
13
13
Comparison 3: Ovarian injection of platelet‐rich plasma (PRP) versus no intervention; Outcome 1: Ongoing pregnancy.
14
14
Comparison 3: Ovarian injection of platelet‐rich plasma (PRP) versus no intervention; Outcome 3: Clinical pregnancy.
1.1
1.1. Analysis
Comparison 1: Intrauterine infusion/injection of platelet‐rich plasma (PRP) versus no intervention or placebo, Outcome 1: Live birth (or ongoing pregnancy) – low risk of bias
1.2
1.2. Analysis
Comparison 1: Intrauterine infusion/injection of platelet‐rich plasma (PRP) versus no intervention or placebo, Outcome 2: Live birth (or ongoing pregnancy) – all studies
1.3
1.3. Analysis
Comparison 1: Intrauterine infusion/injection of platelet‐rich plasma (PRP) versus no intervention or placebo, Outcome 3: Live birth (or ongoing pregnancy) – sensitivity analysis (risk ratio)
1.4
1.4. Analysis
Comparison 1: Intrauterine infusion/injection of platelet‐rich plasma (PRP) versus no intervention or placebo, Outcome 4: Live birth (or ongoing pregnancy) – sensitivity analysis (live birth only)
1.5
1.5. Analysis
Comparison 1: Intrauterine infusion/injection of platelet‐rich plasma (PRP) versus no intervention or placebo, Outcome 5: Miscarriage – low risk of bias
1.6
1.6. Analysis
Comparison 1: Intrauterine infusion/injection of platelet‐rich plasma (PRP) versus no intervention or placebo, Outcome 6: Miscarriage – all studies
1.7
1.7. Analysis
Comparison 1: Intrauterine infusion/injection of platelet‐rich plasma (PRP) versus no intervention or placebo, Outcome 7: Miscarriage – sensitivity analysis (risk ratio)
1.8
1.8. Analysis
Comparison 1: Intrauterine infusion/injection of platelet‐rich plasma (PRP) versus no intervention or placebo, Outcome 8: Miscarriage – sensitivity analysis (per clinical pregnancy)
1.9
1.9. Analysis
Comparison 1: Intrauterine infusion/injection of platelet‐rich plasma (PRP) versus no intervention or placebo, Outcome 9: Clinical pregnancy – low risk of bias
1.10
1.10. Analysis
Comparison 1: Intrauterine infusion/injection of platelet‐rich plasma (PRP) versus no intervention or placebo, Outcome 10: Clinical pregnancy – all studies
1.11
1.11. Analysis
Comparison 1: Intrauterine infusion/injection of platelet‐rich plasma (PRP) versus no intervention or placebo, Outcome 11: Clinical pregnancy – sensitivity analysis (risk ratio)
1.12
1.12. Analysis
Comparison 1: Intrauterine infusion/injection of platelet‐rich plasma (PRP) versus no intervention or placebo, Outcome 12: Clinical pregnancy – sensitivity analysis (full text only)
1.13
1.13. Analysis
Comparison 1: Intrauterine infusion/injection of platelet‐rich plasma (PRP) versus no intervention or placebo, Outcome 13: Multiple pregnancy – all studies
1.14
1.14. Analysis
Comparison 1: Intrauterine infusion/injection of platelet‐rich plasma (PRP) versus no intervention or placebo, Outcome 14: Multiple pregnancy – sensitivity analysis (risk ratio)
1.15
1.15. Analysis
Comparison 1: Intrauterine infusion/injection of platelet‐rich plasma (PRP) versus no intervention or placebo, Outcome 15: Ectopic pregnancy – low risk of bias
1.16
1.16. Analysis
Comparison 1: Intrauterine infusion/injection of platelet‐rich plasma (PRP) versus no intervention or placebo, Outcome 16: Ectopic pregnancy – sensitivity analysis (risk ratio)
1.17
1.17. Analysis
Comparison 1: Intrauterine infusion/injection of platelet‐rich plasma (PRP) versus no intervention or placebo, Outcome 17: Preterm delivery
1.18
1.18. Analysis
Comparison 1: Intrauterine infusion/injection of platelet‐rich plasma (PRP) versus no intervention or placebo, Outcome 18: Preterm delivery – sensitivity analysis (risk ratio)
2.1
2.1. Analysis
Comparison 2: Intrauterine infusion of platelet‐rich plasma (PRP) versus intrauterine infusion of granulocyte colony‐stimulating factor (G‐CSF), Outcome 1: Live birth
2.2
2.2. Analysis
Comparison 2: Intrauterine infusion of platelet‐rich plasma (PRP) versus intrauterine infusion of granulocyte colony‐stimulating factor (G‐CSF), Outcome 2: Live birth – sensitivity analysis (risk ratio)
2.3
2.3. Analysis
Comparison 2: Intrauterine infusion of platelet‐rich plasma (PRP) versus intrauterine infusion of granulocyte colony‐stimulating factor (G‐CSF), Outcome 3: Miscarriage
2.4
2.4. Analysis
Comparison 2: Intrauterine infusion of platelet‐rich plasma (PRP) versus intrauterine infusion of granulocyte colony‐stimulating factor (G‐CSF), Outcome 4: Miscarriage – sensitivity analysis (risk ratio)
2.5
2.5. Analysis
Comparison 2: Intrauterine infusion of platelet‐rich plasma (PRP) versus intrauterine infusion of granulocyte colony‐stimulating factor (G‐CSF), Outcome 5: Miscarriage – sensitivity analysis (per clinical pregnancy)
2.6
2.6. Analysis
Comparison 2: Intrauterine infusion of platelet‐rich plasma (PRP) versus intrauterine infusion of granulocyte colony‐stimulating factor (G‐CSF), Outcome 6: Clinical pregnancy
2.7
2.7. Analysis
Comparison 2: Intrauterine infusion of platelet‐rich plasma (PRP) versus intrauterine infusion of granulocyte colony‐stimulating factor (G‐CSF), Outcome 7: Clinical pregnancy – sensitivity analysis (risk ratio)
2.8
2.8. Analysis
Comparison 2: Intrauterine infusion of platelet‐rich plasma (PRP) versus intrauterine infusion of granulocyte colony‐stimulating factor (G‐CSF), Outcome 8: Clinical pregnancy – sensitivity analysis (full text only)
3.1
3.1. Analysis
Comparison 3: Intraovarian injection of platelet‐rich plasma (PRP) versus no intervention, Outcome 1: Ongoing pregnancy
3.2
3.2. Analysis
Comparison 3: Intraovarian injection of platelet‐rich plasma (PRP) versus no intervention, Outcome 2: Ongoing pregnancy – sensitivity analysis (risk ratio)
3.3
3.3. Analysis
Comparison 3: Intraovarian injection of platelet‐rich plasma (PRP) versus no intervention, Outcome 3: Clinical pregnancy
3.4
3.4. Analysis
Comparison 3: Intraovarian injection of platelet‐rich plasma (PRP) versus no intervention, Outcome 4: Clinical pregnancy – sensitivity analysis (risk ratio)

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References

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IRCT2017073034422N {unpublished data only}
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    1. Jackman JM, Ali-Bynom S, Amberg A, Zhang J, Lipkin L, Olcha M, et al. Platelet rich plasma (PRP) can improve pregnancy outcome in patients with recurrent implantation failure (RIF and thin endometrial lining. Fertility and Sterility 2020;114(3):e333.
JPRN‐UMIN000030493 {unpublished data only}
    1. JPRN-UMIN000030493. Clinical study of infertility treatment using platelet rich plasma (PRP) to endometrium [Clinical study of infertility treatment using platelet rich plasma (PRP) to endometrium. - clinical study of infertility treatment using platelet rich plasma (PRP) to endometrium]. trialsearch.who.int/Trial2.aspx?TrialID=JPRN-UMIN000030493 (first received 25 December 2017).
Katakdhond 2019 {published data only}
    1. Katakdhond MS, Deshmukh SD, Khandeparkar SS, Naik NJ, Sanap M, Naik G, et al. Women with previous failed IVF benefit from intrauterine instillation of platelet rich plasma. Fertility and Sterility 2019;112(3):e185.
Kim 2019 {published data only}
    1. Kim JH, Kim E, Kwon H, Choi DH. Effect of autologous platelet-rich plasma treatment on refractory thin endometrium during the frozen embryo transfer cycle. Human Reproduction 2019;34:i314-5. - PMC - PubMed
Kim 2022 {published data only}
    1. KCT0003375. A study about treatment of endometrium using autologous platelet rich plasma in patient suffering repeated implantation failure [A double-blind randomized control trial of autologous platelet-rich plasma in treatment of endometrium in repeated implantation failure patients]. trialsearch.who.int/Trial2.aspx?TrialID=KCT0003375 (first received 25 November 2018).
    1. Kim J, Yoon H, Ko J, Shin SY, Park C, Choi D, et al. Effects of autologous platelet-rich plasma in women with POI and POR. Fertility and Sterility 2022;118(4):e319.
Liu 2021 {published data only}
    1. Liu C, Fang J, Hao C, Xu Y. Platelet-rich plasma intrauterine perfusion combined with hysteroscopic endometrial mechanical stimulation: a new choice for treatment of thin endometrium. Fertility and Sterility 2021;116(3):e315.
Lopez 2019 {published data only}
    1. Lopez EG, Bernardo LG, Fernadez FG. Improvement of endometrial receptivity through the use of autologous platelet-derived microparticles. Fertility and Sterility 2019;112(3):e331-2.
Majiyd 2020 {published data only}
    1. Majiyd NA, Thunga C, Ashraf M, Singh S, Basheer R, Ashraf R, Jayaprakasan K. A comparative evaluation of novel sub-endometrial and intrauterine platelet rich plasma treatment for women with recurrent implantation failure (RIF). Fertility and Sterility 2020;114(3):e285. - PubMed
Molina 2018 {published data only}
    1. Molina AM, Sanchez J, Sanchez W, Vielma V. Platelet-rich plasma as an adjuvant in the endometrial preparation of patients with refractory endometrium. Jornal Brasileiro de Reproducao Assistida 2018;22(1):42-8. - PMC - PubMed
Nagireddy 2019 {published data only}
    1. Nagireddy S, Reddy NS, Pandurangi MD, Vembu R, Manjula DG, Srinivasan SN, et al. Autologous PRP for the management of thin endometrium in frozen embryo transfer cycles: would it improve the outcome? Fertility and Sterility 2019;112(3):e418-9.
NCT03734042 {unpublished data only}
    1. NCT03734042. PRP intrauterine infusion in thawed embryo cycles [Intrauterine infusion of platelet-rich plasma infusion before thawed embryo transfer in repeated implantation failure: a randomized controlled study]. clinicaltrials.gov/study/NCT03734042 (first received 6 November 2018).
NCT03937661 {unpublished data only}
    1. NCT03937661. Ovarian platelet rich plasma treatment for poor responders [Investigating improvement of ovarian function following autologous PRP intra-ovarian infusion in poor responders]. clinicaltrials.gov/show/NCT03937661 (first received 23 April 2019).
NCT03945812 {unpublished data only}
    1. NCT03945812. Granulocyte colony stimulating factor versus platelet rich plasma and outcomes of frozen embryo transfer [The impact of using granulocyte colony stimulating factor (G-CSF) versus platelet rich plasma (PRP) on the outcomes of frozen embryo transfer; randomized controlled study]. clinicaltrials.gov/show/NCT03945812 (first received 8 May 2019).
NCT04240860 {unpublished data only}
    1. NCT04240860. Autologous intrauterine platelet-rich plasma instillation and endometrial scratching for thinned endometrium [Randomized clinical trial between autologous intrauterine platelet-rich plasma instillation and three snip hysteroscopic endometrial scratching for thinned endometrium]. clinicaltrials.gov/show/NCT04240860 (first received 13 September 2019).
NCT04354363 {unpublished data only}
    1. NCT04354363. PRP in intracytoplasmic sperm injection [Role of PRP in intracytoplasmic sperm injection in infertile women]. clinicaltrials.gov/show/NCT04354363 (first received 17 April 2020).
NCT04411212 {unpublished data only}
    1. NCT04411212. G-CSF and PRP in patients with recurrent implantation failure [Granulocyte colony-stimulating factor and platelet-rich plasma group in patients with recurrent implantation failure]. clinicaltrials.gov/show/NCT04411212 (first received 27 May 2020).
NCT04922398 {unpublished data only}
    1. NCT04922398. Ovarian injection of PRP (platelet-rich plasma) vs normal saline in premature ovarian insufficiency [Ovarian injection of PRP (platelet-rich plasma) vs normal saline in premature ovarian insufficiency: a randomized controlled trial]. clinicaltrials.gov/show/NCT04922398 (first received 19 May 2021).
Noushin 2021 {published data only}
    1. Noushin MA, Ashraf M, Thunga C, Singh S, Basheer R, Ashraf R, et al. A comparative evaluation of subendometrial and intrauterine platelet-rich plasma treatment for women with recurrent implantation failure. F&S Science 2021;2(3):295-302. - PubMed
Parvanov 2020 {published data only}
    1. Parvanov D, Ganeva R, Vidolova N, Nikolova K, Vasileva M, Stoykov I, et al. Ovarian autologous platelet-rich plasma (PRP) treatment improves oocyte and embryo quality in women with poor ovarian response. Fertility and Sterility 2020;114(3):e452-3.
Patel 2022 {published data only}
    1. Patel G, Singh N, Malhotra N, Mahey R, Saini M. Intra-ovarian platelet-rich plasma instillation improves IVF outcomes in women with diminished ovarian-reserve. BJOG: An International Journal of Obstetrics and Gynaecology 2022;129:186-7.
Singh 2020 {published data only}
    1. Singh S, Ashraf N, Basheer R, Ashraf M. Use of intraovarian platelet rich plasma does not increase the ovarian reserve markers, ovarian response or IVF outcome in Bologna poor responders. Human Reproduction 2020;35:i37-8.
Stojkovska 2019 {published data only}
    1. Stojkovska S, Dimitrov G, Stamenkovska N, Hadzi-Lega M, Petanovski Z. Live birth rates in poor responders' group after previous treatment with autologous platelet-rich plasma and low dose ovarian stimulation compared with poor responders used only low dose ovarian stimulation before in vitro fertilization. Open Access Macedonian Journal of Medical Sciences 2019;7(19):3184-8. - PMC - PubMed

References to studies awaiting assessment

Eftekhar 2018 {published data only}
    1. Eftekhar M, Neghab N, Naghshineh E, Khani P. Corrigendum to "Can autologous platelet rich plasma expand endometrial thickness and improve pregnancy rate during frozen-thawed embryo transfer cycle? A randomized clinical trial" [Taiwan J Obstet Gynecol 57 (2018) 810-813]. Taiwanese Journal of Obstetrics and Gynecology 2021;60(5):973. [DOI: 10.1016/j.tjog.2021.08.003] - DOI - PubMed
    1. Eftekhar Maryam, Neghab Nosrat, Naghshineh Elham, Khani Parisa. Can autologous platelet rich plasma expand endometrial thickness and improve pregnancy rate during frozen-thawed embryo transfer cycle? A randomized clinical trial. Taiwanese Journal of Obstetrics & Gynecology 2018;57(6):810-3. - PubMed
    1. IRCT2016090328950N. Evaluation of intrauterine infusion of autologous platelet rich plasma (PRP) on in vitro fertilization (IVF) [Clinical trial of pregnancy outcome in women with thin endometrium after intrauterine infusion of autologous platelet rich plasma (PRP) in comparison with women with thin endometrium without intervention undergoing frozen thawed cycles]. trialsearch.who.int/Trial2.aspx?TrialID=IRCT2016090328950N2 (first received 10 January 2017).
    1. IRCT2016090728950N. Intrauterine infusion of autologous platelet rich plasma (PRP) on women with repeated frozen thawed cycles failure [Clinical trial of comparison of pregnancy outcome in women with history of repeated implantation failure after intrauterine infusion of autologous platelet rich plasma (PRP) and women without intervention undergoing frozen thawed cycles]. trialsearch.who.int/Trial2.aspx?TrialID=IRCT2016090728950N3 (first received 22 September 2016).
    1. Neghab N, Eftekhar M, Naghshineh E, Khani P. Pregnancy outcome in women with thin endometrium undergoing frozen-thawed cycles after intrauterine infusion of autologous platelet-rich plasma (PRP). International Journal of Reproductive BioMedicine 2017;15(4):56-7.
Nazari 2019b {published data only}
    1. IRCT20160722029027N. Effect of platelet rich plasma (PRP) improving pregnancy outcome [Effect of platelet rich plasma (PRP) on improving pregnancy outcome in recurrent pregnancy loss patients a randomized clinical trial pilot study]. trialsearch.who.int/Trial2.aspx?TrialID=IRCT20160722029027N9 (first received 4 December 2019).
    1. IRCT2016072229027N. Effects of platelet rich plasma on frozen embryo transfer process [Effects of autologous platelet rich plasma on endometrial growth and implantation in intracytoplasmic sperm injection cycles: clinical trial]. trialsearch.who.int/Trial2.aspx?TrialID=IRCT2016072229027N1 (first received 5 September 2016).
    1. Nazari L, Salehpour S, Hosseini MS, Hashemi Moghanjoughi P. The effects of autologous platelet-rich plasma in repeated implantation failure: a randomized controlled trial. Human fertility (Cambridge, England) 2020;23(3):209-13. - PubMed
Nazari 2019c {published data only}
    1. Nazari L, Salehpour S, Hoseini S, Zadehmodarres S, Azargashb E. Effects of autologous platelet-rich plasma on endometrial expansion in patients undergoing frozen-thawed embryo transfer: A double-blind RCT. International Journal of Reproductive Biomedicine 2019;17(6):443-8. - PMC - PubMed
Nazari 2022a {published data only}
    1. Nazari L, Salehpour S, Hosseini S, Hashemi T, Borumandnia N, Azizi E. Effect of autologous platelet-rich plasma for treatment of recurrent pregnancy loss: a randomized controlled trial. Obstetrics & Gynecology Science 2022;65(3):266-72. - PMC - PubMed
Nazari 2022b {published data only}
    1. IRCT20160722029027N. Effect of platelet rich plasma (PRP) improving pregnancy outcome [Effect of platelet rich plasma (PRP) on improving pregnancy outcome in recurrent pregnancy loss patients a randomized clinical trial pilot study]. trialsearch.who.int/Trial2.aspx?TrialID=IRCT20160722029027N9 (first received 4 December 2019).
    1. IRCT2016072229027N. Effects of platelet rich plasma on frozen embryo transfer process [Effects of autologous platelet rich plasma on endometrial growth and implantation in intracytoplasmic sperm injection cycles: clinical trial]. trialsearch.who.int/Trial2.aspx?TrialID=IRCT2016072229027N1 (first received 5 September 2016).
    1. Nazari L, Salehpour S, Hosseini S, Sheibani S, Hosseinirad H. The effects of autologous platelet-rich plasma on pregnancy outcomes in repeated implantation failure patients undergoing frozen embryo transfer: a randomized controlled trial. Reproductive Sciences (Thousand Oaks, Calif.) 2022;29(3):993-1000. - PubMed
Neghab 2017 {published data only}
    1. Neghab N, Eftekhar M, Naghshineh E, Khani P. Pregnancy outcomes in women with history of repeated implantation failure after intrauterine infusion of autologous platelet-rich plasma (PRP) in frozen-thawed cycles. International Journal of Reproductive BioMedicine 2017;15(4):22.
Pourkaveh 2022 {published data only}
    1. Pourkaveh B, Pakravesh J, Shabani M, Gachkar L, Nazarian H, Novin MG, et al. Intrauterine platelet rich plasma (PRP) infusion could change the leukemia inhibitory factor (LIF) pattern in the endometrial secretion of women with recurrent implantation failure: a randomized clinical trial. International Journal of Medical Toxicology and Forensic Medicine 2022;12(4):38493.

References to ongoing studies

ACTRN12622000459729 {unpublished data only}
    1. ACTRN12622000459729. I-PRP-FET Trial: intrauterine platelet-rich-plasma infusion prior to frozen embryo transfer in women undergoing in vitro fertilisation (IVF) [Effect of intrauterine platelet-rich-plasma infusion prior to frozen embryo transfer on the chemical and clinical pregnancy rate in women undergoing in vitro fertilisation (IVF): a randomised controlled trial]. trialsearch.who.int/Trial2.aspx?TrialID=ACTRN12622000459729 (first received 23 March 2022).
CTRI/2021/04/032927 {unpublished data only}
    1. CTRI/2021/04/032927. Scope of a specified blood component instillation into the womb for improving pregnancy rate [Scope of PRP for endometrial receptivity-randomized controlled trial - SCOPE trial]. trialsearch.who.int/Trial2.aspx?TrialID=CTRI/2021/04/032927 (first received 19 April 2021).
IRCT20120215009014N230 {unpublished data only}
    1. IRCT20120215009014N230. Effect of infertility treatment with and without addition of autologous platelet-rich plasma in embryo transfer in patients candidate for intra cytoplasmic sperm injection [Effect of infertility treatment with and without addition of autologous platelet-rich plasma in embryo transfer in patients candidate for intra cytoplasmic sperm injection: a randomized clinical trial]. trialsearch.who.int/Trial2.aspx?TrialID=IRCT20120215009014N230 (first received 24 August 2018).
IRCT20160722029027N12 {unpublished data only}
    1. IRCT20160722029027N12. Comparison of the effect of intraovarian injection of PRGF and PRP on improving the response and pregnancy outcomes [Comparison of the effect of intraovarian injection of Plasma Rich Growth Factor (PRGF) and Plasma Rich Platelate (PRP) on improving the response and pregnancy outcomes in women undergoing IVF with poor ovarian response]. trialsearch.who.int/Trial2.aspx?TrialID=IRCT20160722029027N12 (first received 14 May 2022).
IRCT201608319014N113 {unpublished data only}
    1. IRCT201608319014N113. Effects of platelet-rich plasma versus Hams F10 on the pregnancy outcome in infertile women with recurrent implantation failure [Effects of platelet-rich plasma versus Hams F10 on the pregnancy outcome in infertile women with recurrent implantation failure: a single blind randomized clinical trial]. trialsearch.who.int/Trial2.aspx?TrialID=IRCT201608319014N113 (first received 9 September 2016).
    1. IRCT2017033133179N1. Comparison of intrauterine injection effects of PRP (platelet-rich plasma) and Hams F10 on the pregnancy outcome in recurrent implantation failure of infertile women after transferring unfrozen embryo. trialsearch.who.int/Trial2.aspx?TrialID=IRCT2017033133179N1 (first received 4 August 2017).
IRCT2016102510210N6 {unpublished data only}
    1. IRCT2016102510210N. Effect of platelet-rich plasma(PRP)on fertility in women with thin endometrium [Effect of intrauterine infusion of autologous platelet-rich plasma(PRP)on endometrial thickness and pregnancy rate as secondary endpoint in FET cycles]. trialsearch.who.int/Trial2.aspx?TrialID=IRCT2016102510210N6 (first received 30 October 2016).
IRCT2017061034422N1 {unpublished data only}
    1. IRCT2017061034422N. Effects of autologous platelet- rich plasma on pregnancy rate in intra cytoplasmic sperm injection (ICSI) cycles in repeated implantation failure patients [The single blind clinical trial of effects of autologous platelet-rich plasma on pregnancy rate in ICSI cycles in repeated implantation failure patients]. trialsearch.who.int/Trial2.aspx?TrialID=IRCT2017061034422N1 (first received 5 November 2017).
IRCT20180528039878N3 {unpublished data only}
    1. IRCT20180528039878N. Comparison of intrauterine PRP versus G-CSF in RIF patients [Comparison of clinical pregnancy outcome between intrauterine injection of platelet rich plasma (PRP) and granulocyte colony stimulating factor (G-CSF) in patients with more than two failed embryo transfer cycles -clinical trial]. trialsearch.who.int/Trial2.aspx?TrialID=IRCT20180528039878N3 (first received 8 May 2021).
IRCT20180619040147N3 {unpublished data only}
    1. IRCT20180619040147N. Evaluation and comparison of the safety and effectiveness of Intra uterine injection of autologous menstrual blood-derived stem cells (MenSCs) and PRP in unfertilized women with thin unfunctional endometrium. trialsearch.who.int/Trial2.aspx?TrialID=IRCT20180619040147N3 (first received 19 May 2020).
IRCT20190503043454N1 {unpublished data only}
    1. IRCT20190503043454N. Efficacy of platelet-rich plasma on embryo implantation [Efficacy of intrauterine infusion of platelet-rich plasma on pregnancy outcome in patients with repeated implantation failure]. trialsearch.who.int/Trial2.aspx?TrialID=IRCT20190503043454N1 (first received 6 July 2019).
IRCT20211108052998N1 {unpublished data only}
    1. IRCT20211108052998N. The effect of platelet rich plasma on pregnancy in patients with repeated implantation failure [Comparison of the effectiveness of one time and two times PRP and non-performing PRP in three groups of women with at least two or more pregnancy failures in high-quality embryo transfer who are candidates for embryo freezing in the embryo transfer cycle]. trialsearch.who.int/Trial2.aspx?TrialID=IRCT20211108052998N1 (first received 9 March 2022).
NCT02660294 {unpublished data only}
    1. NCT02660294. Intrauterine autologous PRP infusion compared to HRT for enhancing endometrial thickness in patients undergoing ICSI [Intrauterine autologous platelet -enriched plasma infusion compared to hormonal replacement therapy for enhancing endometrial thickness in patients undergoing ICSI]. clinicaltrials.gov/show/NCT02660294 (first received 16 January 2016).
NCT03166345 {unpublished data only}
    1. NCT03166345. Use of platelet rich plasma (PRP) for improving thin endometrium [Use of platelet rich plasma (PRP) for improving thin endometrium for IVF women]. clinicaltrials.gov/show/NCT03166345 (first received 18 May 2017).
NCT03379649 {unpublished data only}
    1. NCT03379649. Platelet rich plasma for patients with recurrent implantation failure [Platelet rich plasma for patients with recurrent implantation failure: a prospective randomized pilot study]. clinicaltrials.gov/show/NCT03379649 (first received 15 December 2017).
NCT03996837 {unpublished data only}
    1. NCT03996837. Platelet rich plasma and recurrent implantation failure [Evaluation of the application platelet rich plasma in the treatment of patients with recurrent implantation failure in IVF-ICSI & freeze embryo transfer cycles in Royan Institute; a randomized controlled trial]. clinicaltrials.gov/show/NCT03996837 (first received 26 May 2019).
NCT04434495 {unpublished data only}
    1. NCT04434495. Outcome of platelet rich plasma in ICSI Patients, a randomized controlled trial [Outcome of platelet rich plasma injection in ICSI Patients, a randomized controlled trial]. clinicaltrials.gov/show/NCT04434495 (first received 12 June 2020).
NCT04434547 {unpublished data only}
    1. NCT04434547. An RCT on the effect of platelets rich plasma in ICSI patients with recurrent implantation failure [A randomized controlled trial on the effect of adding platelets rich plasma intrauterine on the day of ovum pickup in ICSI patients with recurrent implantation failure]. clinicaltrials.gov/show/NCT04434547 (first received 12 June 2020).
NCT05279560 {unpublished data only}
    1. NCT05279560. Ovarian PRP (platelet rich plasma) injection for follicular activation [The efficacy and safety of intra-ovarian PRP injection within a prospective, single-blinded, placebo-controlled, randomized, clinical superiority trial in subjects with low ovarian reserve/expected poor ovarian response]. clinicaltrials.gov/show/NCT05279560 (first received 16 January 2022).

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