Efficacy of intrauterine autologous blood cell derivatives in enhancing endometrial thickness and IVF outcomes for women with recurrent implantation failure: a retrospective cohort study

Abstract

Purpose: The purpose of this study was to determine the effects of intrauterine infusion of autologous blood cell derivative (ABCD) on endometrial thickness and pregnancy outcomes in a group of patients who underwent IVF with recurrent implantation failure (RIF) and who had either a normal endometrium or thin endometrium.

Methods: This retrospective study included 63 patients who experienced RIF at the Department of Reproductive Medicine and Surgery, KMC, Manipal, between January 2021 and March 2024 and who received three doses of intrauterine ABCD infusion to prepare the endometrium for frozen embryo transfer (FET).

Results: We enrolled 63 RIF patients, 30 with a normal endometrium (NEM) and 33 with a thin endometrium (TEM). The endometrial thickness (EMT) significantly increased across all the groups. After 3 cycles of intrauterine ABCD infusion, the mean increases in EMT in the NEM and TEM groups were 0.77 mm and 1.36 mm, respectively, which were statistically significant. Among the 62 completed FET cycles, 40.3% were positive for beta-hCG. The clinical pregnancy rate was 33.8% (40% in the NEM group, 28.1% in the TEM group), and the live birth rate was 24.2% (30% in the NEM group, 18.8% in the TEM group). A total of 9.7% of pregnancies had spontaneous miscarriages. Moreover, the EMT did not differ between the pregnant and nonpregnant groups.

Conclusion: Intrauterine ABCD infusion improves the pregnancy outcomes of patients with RIF, regardless of the EMT. The results of this study revealed that endometrial receptivity improved significantly along with the EMT.

Keywords: Autologous blood cell derivatives; Endometrial insufficiency; Normal endometrium; Platelet-rich plasma; Recurrent implantation failure; Thin endometrium.

Fig. 1

The chronological sequence of the embryo transfer cycle protocol, including intrauterine ABCD infusion. The first dose of ABCD was given on days 5, 6, or 7 of the menstrual cycle or after the bleeding had completely stopped, and the second dose was given 5 days later. *A third dose of ABCD infusion was given 2 days before embryo transfer. The endometrial preparation involved the use of oral estradiol valerate at a dosage of 4 mg/day beginning on days 2–3 of the menstrual cycle. When the endometrium appeared trilaminar and had a thickness of more than 7 mm, transvaginal progesterone supplementation (8% twice daily) was administered. **Embryonic transfer to the uterine cavity occurred either 3 days (day 3 embryo) or 5 days (day 5 embryo) after the initial progesterone treatment. The serum β-hCG concentration was measured 14 days after embryo transfer. Abbreviations: ABCD, autologous blood cell derivative; CD, cycle day; HCG, human chorionic gonadotropin

Fig. 2

Study flow chart showing the participation of patients throughout the study. The numbers of participants are shown. Abbreviations: ABCD, autologous blood cell derivative; FET, frozen embryo transfer; HCG, human chorionic gonadotropin; NEM, normal endometrium; TEM; Thin endometrium