Autologous platelet-rich plasma for assisted reproduction
- PMID: 38682756
- PMCID: PMC11057220
- DOI: 10.1002/14651858.CD013875.pub2
Autologous platelet-rich plasma for assisted reproduction
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.
Copyright © 2024 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
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.
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Update of
- doi: 10.1002/14651858.CD013875
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- 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).
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- 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}
Nazari 2022a {published data only}
Nazari 2022b {published data only}
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- 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).
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- 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).
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- 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}
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- 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}
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- 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}
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- 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}
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- 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}
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- 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).
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- 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}
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- 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}
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- 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}
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- 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}
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- 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}
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- 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}
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- 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}
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- 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}
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- 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}
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- 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}
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- 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}
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- 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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