PRP Therapy for Uterine Lining Rejuvenation

During IVF we experienced that we have to postpone embryo transfer at the last moment due to insufficient thickness of the endometrium. From various studies, we have noticed that the minimum thickness has to be at least 7mm in ultrasound readings. The endometrium plays a very important role during implantation. There is biochemical communication between the endometrium and the blastocyst at the time of implantation.

The two hormones responsible for the preparation of the endometrium, are estrogen followed by progesterone. If the endometrium does not respond to estrogen then its thickness is affected. If the thickness of endometrium is insufficient then implantation fails.

This is the main cause of IVF cycle failure or postponement of embryo transfer. There can be several causes for thin endometrium.

Common causes of the thin endometrium:

Uterine Infections and inflammations, pelvic infectious diseases lead to unresponsiveness to estrogens.

• Uterine Infections and inflammations, pelvic infectious diseases lead to unresponsiveness to estrogens.

• Repetitive curettage causing damage to the basal layer of endometrium

• Asherman’s syndrome

• Low estrogen levels due to repetitive use of anti estrogenic treatment (clomiphene Citrate)

• Cancer treatments, such as radical surgery, chemotherapy and radiotherapy (RT) can permanently affect the uterus lining.

Treatment:

Endometrium thickness less than 7 mm is called thin endometrium and is considered responsible for cycle failure or frozen embryo transfer. Currently, there are reports in literature that infusion of PRP(Platelet Rich Plasma)in uterus, helps in improving the thickness of endometrium. This can be the basis of improving the receptivity of the endometrium to the implanting blastocyst.

Data presented at the Annual meeting of American Society for Reproductive medicine (ASRM) in 2016 has shown that PRP not only causes endometrial cell proliferation in culture by acting on mesenchymal cells which help endogenous stem cells to increase endometrial cells. This is the basis of our use of PRP for management of endometrial thickening.

• Done 48 hours before embryo transfer

• Patient has normal platelet count

• PRP is prepared from patients own blood (autologous), by collection of 10 ml blood from the vein

• PRP is prepared by double centrifugation as on the 10th day of ART cycle

• 8-10 ml of venous blood is drawn from the pre-filled syringe, and centrifuged at 1500g for 10 min.

• The Buffy coat along with some plasma is aspirated and centrifuged again at 1000g for 10 min.

• PRP is infused into the uterine cavity via a catheter (0.5–1 ml)

• Endometrial thickness is re-assessed 48–72 h later.

• Infusion of PRP can be performed 1-2 times more if the endometrial thickness is not satisfactory.