Hysteroscopic injections of autologous endometrial cells and platelet-rich plasma in patients with thin endometrium: a pilot randomized study

Abstract

The aim of this study was to evaluate the efficacy of hysteroscopically controlled injections of autologous platelet-rich plasma (PRP) and autologous endometrial cells as a treatment for infertile women with thin endometrium. The study enrolled 115 patients with thin endometrium (< 7 mm at implantation window) and infertility, who were divided into groups: Group 1 (the control) underwent conservative therapy; Group 2 received intraendometrial PRP injections instead of the conservative therapy; Group 3 received identical injections after conservative therapy; Group 4 received injections of the autologous endometrial cells suspended in PRP. A single injection dose of PRP contained 0.6–0.7 × 1011 of platelets. The levels of PDGF-BB and VEGF in PRP were increased compared with ordinary plasma. The autologous endometrial cells, obtained from pipelle biopsies, constituted heterogeneous cell populations containing stromal and epithelial cells. Intraendometrial PRP injections had significant impact on endometrial thickness and local microcirculation in Group 2 and Group 3. In Group 4, injections of PRP reinforced with endometrial cells also facilitated a significant increase in endometrial thickness. This work describes a novel approach for infertility treatment in patients with refractory thin endometrium. PRP injections and injections of the endometrial cells suspended in PRP into endometrium enhanced cell proliferation and angiogenesis.

Intrauterine Infusion and Hysteroscopic Injection of Autologous Platelet-Rich Plasma for Patients with a Persistent Thin Endometrium: A Prospective Case–Control Study

“…Additionally, we did not analyze the platelet concentration or the content of cytokines and growth factors in the PRP. The smaller amount of PRP used for hysteroscopic injection in our study compared to the previous published study [9] may also affect the effectiveness of PRP therapy.…”

“…The injected CD133+ BMDSCs were detected in the endometrium, confirming the engraftment of stem cells around the endometrial vessels and the proliferation of surrounding cells [43]. A pilot randomized study published in 2023 demonstrated the efficacy of hysteroscopic injection of autologous PRP for patients with refractory thin EM, and the curative effects of PRP may be related to the growth factors in PRP, stimulating the EM stem cells [9,44]. In the current study, 38 patients received the hysteroscopic injection and 21 patients (55.3%) exhibited an EM thickness exceeding 7 mm (with an average of 8.7 mm).…”

“…To compare intrauterine infusion of autologous PRP with hysteroscopic injection, the advantage of hysteroscopic injection is the ability to deliver a larger volume of PRP (2 mL in our study, up to 40 mL in the literature) compared to the 1-2 mL used in most intrauterine infusion studies [9]. This larger volume increases the number of functional cytokines and growth factors reaching the endometrium.…”

“…Autologous platelet-rich plasma (PRP) is prepared from the patient's whole blood, resulting in a 4-5-fold increase in the platelet concentration [8]. It contains growth factors in the platelet α-granules, including platelet-derived growth factor (PDGF), endothelial growth factor (EGF), transforming growth factor (TGF), vascular endothelial growth factor (VEGF), insulin-like growth factor (IGF), connective tissue growth factor (CTGF), hepatocyte growth factor (HGF), and both anti-inflammatory and proinflammatory cytokines such as interleukin (IL)-4, IL-8, IL-13, IL-17, tumor necrosis factor (TNF)-α, interferon (IFN)-α and stromal cell-derived factor 1-α [9][10][11][12][13]. These factors enable PRP to stimulate cell migration, proliferation, differentiation, and angiogenesis, leading to tissue regeneration [10].…”

Autologous Platelet-Rich Plasma (PRP) Efficacy on Endometrial Thickness and Infertility: A Single-Centre Experience from Romania

“…PRP intrauterine infusions could possibly help with endometrial receptivity and studies have started to study this with encouraging results [ 4 , 37 , 38 ]. It is hypothesised that the endometrial stem cells are stimulated by the regenerative properties of PRP and improve endometrial response and embryo implantation [ 39 ].…”