Effect of autologous platelet-rich plasma treatment on patients with thin endometrium / Efecto del tratamiento con plasma autólogo rico en plaquetas en pacientes con endometrio delgado

ABSTRACT Introduction: The success of frozen embryo transfer cycles depends on a delicate interaction between embryo quality and endometrium. Low pregnancy rates are associated with a thin endometrium. Objective: To evaluate the effect of autologous platelet-rich plasma treatment on patients with thin endometrium. Methods: In 34 patients with thin endometrium (< 7 mm), canceled in the previous frozen embryo transfer cycles, autologous platelet-rich plasma was prepared, from autologous peripheral vein blood; intrauterine infusion was given during hormone replacement therapy in frozen embryo transfer cycles. Frozen embryo transfer was performed when the endometrium thickness reached ≥ 7mm. Results: Six patients canceled the embryo transfer cycle due to endometrium thickness did not reach 7 mm; 28 patients got endometrial thickness ≥ 7 mm and performed frozen embryo transfer. The endometrial thickness was 7.5 ± 0.8 mm, which was significantly thicker than in the previous cycles (5.6 ± 0.79 mm) with p< 0.002, the implantation rate was 23.07 %, and the clinical pregnancy rate was 12/28 (42.8 %). Conclusion: Autologous platelet-rich plasma improves the endometrial thickness and the pregnancy rate outcomes in women with thin endometrium.

RESUMEN Introducción: El éxito de los ciclos de transferencia de embriones congelados depende de una delicada interacción entre la calidad del embrión y el endometrio. Las bajas tasas de embarazo están asociadas con un endometrio delgado. Objetivo: Evaluar el efecto del tratamiento con plasma rico en plaquetas autólogo en pacientes con endometrial delgado. Métodos: En 34 pacientes con endometrio delgado (< 7 mm) canceladas en los ciclos previos de transferencia de embriones congelados, se preparó plasma autólogo rico en plaquetas, a partir de sangre autóloga de venas periféricas; la infusión intrauterina se administró durante la terapia de reemplazo hormonal en los ciclos de transferencia de embriones congelados. La transferencia de embriones congelados se realizó cuando el grosor del endometrio alcanzó ≥ 7 mm. Resultados: En 6s pacientes se canceló el ciclo de transferencia embrionaria debido a que el grosor del endometrio no alcanzó los 7 mm; 28 pacientes obtuvieron un grosor endometrial ≥ 7 mm y realizaron transferencia de embriones congelados. El grosor del endometrio fue de 7,5 ± 0,8 mm, significativamente mayor que en los ciclos anteriores (5,6 ± 0,79 mm) con p< 0,002; la tasa de implantación fue de 23,07 % y la tasa de embarazo clínico fue de 12/28 (42,8 %). Conclusión: El plasma autólogo rico en plaquetas mejora el grosor endometrial y los resultados de la tasa de embarazo en mujeres con endometrio delgado.

Endometritis - Diagnosis,Treatment and its impact on fertility - A Scoping Review.

Endometritis is defined as an infection or inflammation of the endometrium. Endometritis is of two types: acute and chronic. Acute endometritis is the symptomatic acute inflammation of the endometrium, which upon examination with a microscope shows micro-abscess and neutrophil invasion in the superficial endometrium. One of its most common manifestations is postpartum endometritis. Chronic endometritis is a silent disease usually diagnosed on the workup of secondary amenorrhoea and infertility. An important cause of chronic endometritis is tuberculosis, especially in developing nations. Chronic and acute endometritis have been associated with poor reproductive outcomes. Worse outcomes have been reported for individuals with chronic endometritis. This is a scoping review of endometritis and its impact on fertility.

Autologous platelet-rich plasma optimizes endometrial thickness and pregnancy outcomes in women with refractory thin endometrium of varied aetiology during fresh and frozen-thawed embryo transfer cycles.

OBJECTIVE: To evaluate whether platelet-rich plasma (PRP) optimizes endometrial thickness (EMT) and improves live birth rates (LBR) in women with refractory thin endometrium due to varied aetiology during fresh in vitro fertilization (IVF) and frozen-thawed embryo transfer (FET). METHODS: A prospective interventional study was conducted at the ART Centre of a tertiary care academic hospital. Twenty-two infertile women with refractory thin endometrium (<7mm) despite standard hormone replacement therapy were assessed. Twenty patients underwent 26 PRP cycles from December 2018 - June 2020 during fresh IVF-ET and FET. Primary endpoint was expansion of EMT and secondary outcomes were implantation rate (IR), clinical pregnancy rate (CPR) and LBR in fresh and FET cycles and aetiology wise. RESULTS: Mean EMT increased significantly following PRP administration (p<0.001) with average increase of 1.07mm and 0.83mm after first PRP (p<0.001) during fresh IVF and FET, respectively. CPR, IR and LBR showed no significant difference when compared during fresh vs. FET cycles (p>0.05). PRP led to significant increase in EMT in tuberculosis (TB), diminished ovarian reserve (DOR) and polycystic ovary syndrome (PCOS) (p<0.001). There was no significant difference in CPR, IR and LBR among three aetiological factors (p>0.05). Overall, clinical pregnancy and LBR reached up to 20% and 25%, respectively. No adverse reactions were reported. CONCLUSIONS: PRP enhances EMT significantly during fresh and FET cycles in thin endometrium associated with TB, PCOS and DOR, thus improving the CPR and LBR in these low prognosis patients.

Regenerative therapy by endometrial mesenchymal stem cells in thin endometrium with repeated implantation failure. A novel strategy.

OBJECTIVE: Our primary objective was to evaluate the endometrial changes before and after the transfer of endometrial mesenchymal stem cells (enMSCs) in a population of thinned endometrium women, with absence or hypo-responsiveness to estrogen and repeated implantation failure (RIF). The secondary objective was to evaluate the clinical outcomes of the intervention in terms of clinical pregnancy (CP), early abortions, ongoing pregnancy and live birth delivery rate (LBDR) per in vitro fertilization (IVF) cycle. METHODS: A longitudinal and experimental study. The intervention was defined as "subendometrial inoculation of enMSCs," and the post-intervention changes were evaluated by the following variables: endometrial thickness (Eth), endometrial flow cytometry (enFC), endometrial histopathology (enHP) and endometrial immunohistochemistry (enIHQ). The variables were analyzed after the intervention (Post-treatment) regarding previous values (Pretreatment). RESULTS: Eth values before and after treatment with enMSCs were 5.24±1.24 mm vs. 9.93±0.77 (p=0.000), respectively. Endometrial Flow Cytometry showed significant differences in favor of Normalized variables in the post-treatment assessment, associated with the pretreatment, LT/Li, LB/Li, NK/Li, CD8/CD3+ and CD4/CD8 (p≤0.015), respectively. Only two variables Li/PC and CD4/CD3 had NS (p=0.167 and 0.118). A similar analysis was performed on enHP with an HP increase post-treatment (p=0.007). The CP rate was 79.31% (23/29), a live birth delivery rate per embryo transfer was 45.45% (10/22) and ongoing pregnancy 7/29 (24.14%). CONCLUSION: Subendometrial enMSCs inoculation produces a significant increase in endometrial thickness; normalize the enHP, enIHQ and enFC. As a result, IVF after treatment with enMSCs yields a higher rate of CP and LBDR.

Treatment of thin endometrium with autologous platelet-rich plasma: a pilot study.

Endometrium is one of the main factors in pregnancy. During assisted reproductive technology (ART) treatments, some cycles are cancelled due to inadequate endometrial growth. This study was conducted to evaluate the effectiveness of platelet-rich plasma (PRP) in the treatment of thin endometrium. Ten patients with history of inadequate endometrial growth in frozen-thawed embryo transfer (FET) cycles were recruited into the study. Intrauterine infusion of PRP was performed. Endometrial thickness was assessed. Chemical and clinical pregnancies were reported. In all patients, endometrial thickness increased after PRP and embryo transfer was done in all of them. Five patients were pregnant. According to this study, it seems that PRP was effective for endometrial growth in patient with thin endometrium.