Autologous Platelet-Rich Plasma (PRP) Intrauterine Application During the Assisted Reproduction Technique

Bernardo R. L. Moura¹; Luana N. G. Adami²; Marcelo L. Montenegro²; Fernanda S. Peruzzato³; Camila S. Souza²; Lister L. Salgueiro⁴; Luana T. S. Rodrigues¹; José M. Soares Jr.⁵, Fernando P. Ferreira²; Edson G. Lo Turco¹

1. Department of Surgery - Division of Urology - Human Reproduction Section, São Paulo Federal University, São Paulo, Brazil

2. Department of Gynecology, Neo Vita Clinic, São Paulo, Brazil

3. Department of Embryology, Fecondare Clinic

4. Department of Gynecology, Fértilis Clinic

5. Department of Obstetrics and Gynecology - Research Laboratory in Structural and Molecular Gynecology (LIM-58), University of São Paulo

Abstract Text:

The endometrium is a dynamic tissue capable of growth and differentiation in response to hormonal regulation. Through cell proliferation and growth factors induced by PRP, the tissue attains a functional state that allows for receptivity and embryo implantation.
A prospective study was conducted with 890 participants divided into two groups: 519 control patients (C) and 371 volunteers for PRP application (PRP). The study was conducted over four years. Participants from the PRP group had their blood drawn, which was centrifuged in two steps to produce autologous PRP. All participants underwent controlled ovarian stimulation, and only PRP group received the prepared PRP via uterine infusion. The retrieved oocytes were injected using the ICSI technique, to both groups. The blastocysts were transferred to the uterus. Follicle, oocyte, fertilization, embryonic development, and pregnancy rates were compared between the groups. For statistical analysis, with age as a control variable, the logistic and linear regression was applied for continuous variables, with α = 5%.
According to the exclusion criteria, 487 women remained in the C group, and 361 in the PRP group; however, only 10% of them progressed to embryo transfer. Although the number of blastocysts (4.65 vs. 3.27, p=0.024), Grade A D3 embryos (2.34 vs. 1.97, p=0.019), blastocyst rate (0.13 vs. 0.05, p< 0.001), and the number of transferred embryos (2.54 vs. 2.34, p< 0.001) were higher in the group of women who received PRP, the number of live births was lower (0.28 vs. 2.00, p=0.024).
The promotion of cell proliferation and other growth factors resulted from aids in endometrial receptivity, facilitating embryo implantation and contributing to a positive pregnancy outcome. Autologous PRP suggests potential benefits in improving embryo quality and endometrial receptivity, which could enhance IVF protocols. However, the lower live birth rate indicates the need for caution. The study highlights the importance of standardizing PRP preparation, understanding long-term safety, and conducting further research.