Autologous platelet-rich plasma treatment for moderate-severe Asherman syndrome: the first experience

Abstract

Purpose Treatment of Asherman syndrome (AS) presents a significant clinical challenge. Based on our in vitro data showing that PRP could activate endometrial cell proliferation and migration, we hypothesized that intrauterine infusion of autologous platelet-rich plasma (PRP) may improve endometrial regeneration and fertility outcomes in patients with moderate-severe AS. Materials and methods Subjects with moderate-severe AS were randomized to PRP or saline control administered following hysteroscopic adhesiolysis. Due to relative inability to randomize patients to the control group, after initial randomization of 10 subjects (6 in PRP and 4 in control groups), the remainder were prospectively enrolled in PRP group (n = 9), with 11 historic controls added to control group, for a total of 30 subjects (PRP n = 15; saline control n = 15). Right after hysteroscopy, 0.5-1 mL of PRP or saline was infused into the uterus via a Wallace catheter, followed by estrogen therapy. The primary outcomes were changes in endometrial thickness (EMT, checked in 3 weeks) and in menstrual flow; secondary outcomes were pregnancy and live birth rates. EMT and menstrual bleeding pattern were assessed before and after the intervention. Pregnancy was assessed over a 6-month period. Results There were no statistically significant differences in age, gravidity/parity, cause of AS, preoperative menses assessment, AS hysteroscopy score, and intrauterine balloon placement between the groups. There was no statistically significant difference (p = 0.79) in EMT pre-PRP infusion for control (5.7 mm, 4.0-6.0) and study arm (5.3 mm, 4.9-6.0). There was no statistically significant change (p = 0.78) in EMT after PRP infusion (1.4 mm, − 0.5-2.4) vs saline (1.0 mm, 0.0-2.5). Patients tolerated the procedure well, with no adverse effects. There was no difference in the predicted likelihood of pregnancy (p = 0.45) between the control (0.67, 0.41-0.85) and study arm (0.53, 0.29-0.76). Conclusions PRP was well accepted and tolerated in AS patients. However, we did not observe any significant EMT increase or improved pregnancy rates after adding PRP infusion, compared to standard treatment only. The use of intrauterine PRP infusion may be a feasible option, and its potential use must be tested on a larger sample size of AS patients.

The Clinical Application of Platelet-Rich Plasma in the Female Reproductive System: A Narrative Review

“…Repeat hysteroscopy 8-10 weeks post-therapy failed to demonstrate any improvement in the reoccurrence of intrauterine adhesions and menstrual bleeding pattern compared to the control group [28]. In a similar trial of 15 patients with moderate to severe AS, 0.5-1 mL of PRP was infused immediately post-adhesiolysis, but no statistically significant difference was observed in the endometrial thickness or in the clinical and biochemical pregnancy rate [29]. In contrast, subendometrial injection of 5 mL of PRP in addition to coating the intrauterine lining with 5 mL of PRP gel immediately post-hysteroscopic adhesiolysis in 30 women with Asherman's syndrome was shown to result in a reduced rate of adhesions reforming and resulted in a significant increase in the duration of menses [30].…”

Transcriptomic profiling analysis of human endometrial stromal cells treated with autologous platelet‐rich plasma

“…of live births. 36 Although PRP did not considerably improve postsurgical adhesion, endometrial thickness, and the pregnancy rate after hysteroscopic adhesiolysis in some randomized clinical trials with a small sample size, 37,38 some successful pregnancy cases have been reported. 39 In our study, PRP demonstrated great potential for repairing a damaged intrauterine environment; thus, there is a need to reexamine the treatment protocol and conduct further clinical trials.…”

Etiology, Risk Factors, and Management of Asherman Syndrome

“…Platelet-rich plasma has also been studied for regeneration of the endometrium in animal models. [95][96][97] Finally, platelet-derived exosomes may play a regenerating role in the endometrium. A recent report suggests cell proliferation and wound healing in in vitro human endometrial cell lines when exposed to platelet-derived exsosomes.…”