Impact of platelet-rich plasma intrauterine perfusion on endometrial receptivity and pregnancy outcomes in patients with recurrent implantation failure and thin endometrium

OBJECTIVES: To evaluate the impact of autologous platelet-rich plasma (PRP) intrauterine perfusion on endometrial receptivity and pregnancy outcomes in patients with implantation failure. METHODS: This retrospective cohort study included patients who visited our hospital between January 2019 and January 2024, all suffering from recurrent implantation failures and diagnosed with thin endometrium. Participants were divided into two groups: conventional-treatment (n=116) and PRP-treatment (n=104). Serum levels of estradiol 2 (E2), follicle stimulating hormone (FSH), and luteinizing hormone (LH) were measured before and 14 days after treatment. Transvaginal Doppler ultrasound assessed uterine artery, arcuate artery, and spiral artery pulsatility index (PI) and resistance index (RI) at both timepoints. Endometrial thickness was measured before and 14 days post-treatment. Pregnancy outcomes, including implantation rate, clinical pregnancy rate, ongoing pregnancy rate, and live birth rate, were recorded. RESULTS: The PRP-treatment group showed a significant increase in endometrial thickness (P=0.037). Uterine artery PI (P=0.004) and RI (P=0.015), arcuate artery PI (P=0.037) and RI (P=0.003), and spiral artery PI (P=0.002) significantly decreased in the PRP-treatment group compared to the conventional-treatment group. Hormonal measurements indicated higher E2 (P=0.001) and lower FSH (P=0.002) and LH (P=0.002) levels post-treatment in the PRP-treatment group. Pregnancy outcomes significantly favored the PRP-treatment group, with higher implantation rates (P=0.004), clinical pregnancy rates (P=0.044), ongoing pregnancy rates (P=0.031), and live birth rates (P=0.032). CONCLUSION: PRP intrauterine perfusion significantly improves endometrial parameters, uterine hemodynamics, and pregnancy outcomes in patients with recurrent implantation failure and thin endometrium.