INTRAUTERINE PRP

INTRAUTERINE PRP

You have heard of Platelet- Rich Plasma (PRP), a concentrated blood product that contains a high percentage of platelets, used on the face, scalp, other parts of the body but have you heard of it being used as part of infertility treatment? 

In recent years, PRP has been used alongside conventional fertility treatments like In Vitro Fertilization (IVF) to improve egg quality, uterine lining thickness, and endometrial receptivity, primarily in the treatment of recurrent implantation failure experienced over multiple IVF cycles. Not only has it proven clinical success, multiple studies are now available to show the treatments efficacy!

Also read: Platelet-Rich Plasma (PRP) For Wound Treatment


How Effective Is PRP Therapy? 

Results of a study on the effectiveness of PRP therapy on Thin endometrial lining [by Chang et al. (2)], has been encouraging as all the 5 patients who participated in this therapy responded with successful thickening of endometrium following intrauterine infusion of PRP and all of them conceived.

Another study by Nazari et al. (3) gives supportive evidence that PRP is quite effective in improving pregnancy outcome in patients with Repeated Implantation Failure (RIF). 16 out of the twenty women who received intra-uterine PRP transfusion 48 hours before transfer became pregnant.

PRP is an innovative therapeutic modality, as it is affordable, simple, easily performed, and effective. It is also a noninvasive modality with promising results and no side effects. In the field of fertility, the few studies that have been conducted are pilot studies, case series, and case reports. The risks of PRP therapy as infection, bleeding, and nerve damage, appear to be minimal to none.


PRP Therapy for Uterine Lining Rejuvenation

During IVF, many couples experienced postponed embryo transfer at the last moment due to insufficient thickness of the endometrium. From various studies, it is 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 the endometrium is insufficient then implantation fails.

As an alternative therapeutic method in the cases of chronic endometritis and endometriosis. These diseases can initiate inflammation processes that can make embryo implantation difficult in both natural pregnancy and IVF cycles. Application of the PRP injections helps to eliminate inflammation processes in the uterus, as well as enhances the activity of the progesterone receptors that stimulates proper growth of the endometrium and, in turn, helps to the implantation of the embryos. 

After this therapy, it is possible to continue IVF treatment with better results.

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.
  • Repetitive curettage causing damage to the basal layer of endometrium
  • Asherman’s syndrome – existence of scar tissue in the uterus
  • 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.

Am I Eligible?

You may be eligible if you:

  • Are between the ages of 18 and 45
  • Have a history of two or more unsuccessful embryo transfers
  • Have a normal uterine cavity, established within 12 months by hysteroscopy or saline infusion sonogram
  • Are planning to undergo in vitro fertilization with an embryo transfer.
  • Endometrial lining of less than 7mm (for fertility treatment)
  • Not Pregnant currently
  • Never diagnosed of cancer
  • Hb >11 g/dL, platelets >150,000/mm3
  • Not on any anticoagulation
  • Did not have any NSAIDs in the 10 days before procedure

How is PRP prepared and performed?

PRP is most often used from the person’s blood undergoing the PRP therapy but can be made from another individual’s blood (NOT RECOMMENDED). 

Step 1: Patient comes in for a short history taking and a quick scan. It is suggested to bring in all the recent tests and scannings reports. Appointment dates will then be set for the PRP treatment. 

Step 2: On the day of the therapy, the PRP process starts with us doctors, drawing a sample of blood similar to how we would normally collect tubes of blood.

Step 3: The blood is centrifuged (put in a machine that spins very quickly causing the different components of blood to separate) for about 15 minutes.

Step 4: We then collect the plasma (now rich in platelets and devoid of cellular components) in preparation for its injection. Pain killers will be administered to prevent any form of discomfort throughout the process

Step 5: Then, a small amount of PRP will be infused into the uterine cavity with the IUI catheter, and you will be allowed to rest 10-15 minutes post insertion. DONE! As simple as that. 


Post Procedure

After the therapy is done, you will be allowed to return to your daily activities. No restrictions.

Some may experience slight discomfort post procedure and this is completely normal. PRP is a safe procedure, with minimal risks of transmission of infectious disease and immunological reactions since it is made from autologous blood samples. You will return back to your fertility centre for a scan prior to your embryo transfer. If the lining is still not as per expectation, you may come in for another PRP therapy session. For a better outcome, PRP is performed 4 days in advance of the embryo transfer date in all the patients due to thin endometrium and will be repeated 2 days prior to the transfer. 

Also read: INTRAUTERINE INSEMINATION – IUI In Malaysia

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