The efficacy of intrauterine infusion of platelet rich plasma in women undergoing assisted reproduction: a systematic review and meta-analysis

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Abstract

Background

Platelet-rich plasma (PRP) is an autologous platelet concentration recently used in the reproductive field. Studies had conflicting results regarding its effect on pregnancy outcomes. We aimed to solve the debate on the safety and efficacy of PRP in women undergoing assisted reproduction and assess the influence of covariates on the outcomes of PRP infusion.

Methods

We searched PubMed, Scopus, Cochrane, and Web of Science in May 2023. We included randomized and non-randomized clinical trials as well as cohort studies assessing intrauterine PRP in sub fertile women undergoing assisted reproduction (IVF/ICSI). For the quality assessment, We used the Cochrane Risk of Bias Tool 1, the ROBINS-I tool, and the Newcastle–Ottawa Scale. We pooled the data using RevMan version 5.4.

Results

The data from 23 studies were pooled. PRP had favorable outcomes compared with the control group on clinical pregnancy rate (RR: 1.84, 95% CI 1.62 to 2.09; P < 0.00001), live birth rate (RR: 1.75, 95% CI: 1.24 to 2.47; P = 0.001), and miscarriages (RR: 0.51, 95% CI: 0.36 to 0.72; P = 0.0002). Women with repeated implantation failure had a significantly improved clinical pregnancy rate (RR: 1.83, 95% CI: 1.49 to 2.24; P < 0.00001), live birth rate (RR:1.83, 95% CI: 1.33 to 2.51; P = 0.002), and miscarriage rate (RR: 0.46, 95% CI: 0.31 to 068; P = 0.0001).

Conclusion

PRP showed promising results in assisted reproductive techniques. Further large and multicenter RCTs are required to compare the doses of PRP while identifying the specific population with the most benefits from PRP.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-023-06140-0.

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Most cited references 37

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Platelet biology and functions: new concepts and clinical perspectives

Paola van der Meijden, Johan Heemskerk (2018)

Platelets - blood cells continuously produced from megakaryocytes mainly in the bone marrow - are implicated not only in haemostasis and arterial thrombosis, but also in other physiological and pathophysiological processes. This Review describes current evidence for the heterogeneity in platelet structure, age, and activation properties, with consequences for a diversity of platelet functions. Signalling processes of platelet populations involved in thrombus formation with ongoing coagulation are well understood. Genetic approaches have provided information on multiple genes related to normal haemostasis, such as those encoding receptors and signalling or secretory proteins, that determine platelet count and/or responsiveness. As highly responsive and secretory cells, platelets can alter the environment through the release of growth factors, chemokines, coagulant factors, RNA species, and extracellular vesicles. Conversely, platelets will also adapt to their environment. In disease states, platelets can be positively primed to reach a pre-activated condition. At the inflamed vessel wall, platelets interact with leukocytes and the coagulation system, interactions mediating thromboinflammation. With current antiplatelet therapies invariably causing bleeding as an undesired adverse effect, novel therapies can be more beneficial if directed against specific platelet responses, populations, interactions, or priming conditions. On the basis of these novel concepts and processes, we discuss several initiatives to target platelets therapeutically.

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Evidence that the endometrial microbiota has an effect on implantation success or failure.

Inmaculada Garcia Moreno, Francisco M. Codoñer, Felipe Vilella … (2016)

Bacterial cells in the human body account for 1-3% of total body weight and are at least equal in number to human cells. Recent research has focused on understanding how the different bacterial communities in the body (eg, gut, respiratory, skin, and vaginal microbiomes) predispose to health and disease. The microbiota of the reproductive tract has been inferred from the vaginal bacterial communities, and the uterus has been classically considered a sterile cavity. However, while the vaginal microbiota has been investigated in depth, there is a paucity of consistent data regarding the existence of an endometrial microbiota and its possible impact in reproductive function.

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Inflammation and pregnancy: the role of the immune system at the implantation site.

Gil Mor, Ingrid Cardenas, Vikki Abrahams … (2011)

The concept that pregnancy is associated with immune suppression has created a myth of pregnancy as a state of immunological weakness and, therefore, of increased susceptibility to infectious diseases. A challenging question is whether the maternal immune system is a friend or a foe of pregnancy. In this review, we discuss data associated to the role of the immune system during pregnancy. We propose a new paradigm in terms of the fetal-maternal immune interaction as well as the immunological response of the mother to microorganism. Our challenge is to better understand the immunology of pregnancy in order to deliver the appropriate treatment to patients with pregnancy complications as well as to determine public policies for the protection of pregnant women during pandemics. © 2011 New York Academy of Sciences.

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Author and article information

Contributors

Noran Magdy Shalma:

ORCID: http://orcid.org/0000-0001-9231-7213

nouran_30942456@med.tanta.edu.eg

Journal

Journal ID (nlm-ta): BMC Pregnancy Childbirth

Journal ID (iso-abbrev): BMC Pregnancy Childbirth

Title: BMC Pregnancy and Childbirth

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2393

Publication date (Electronic): 8 December 2023

Publication date PMC-release: 8 December 2023

Publication date Collection: 2023

Volume: 23

Electronic Location Identifier: 843

Affiliations

[1 ]Faculty of Medicine, Tanta University, ( https://ror.org/016jp5b92) Othman Ibn-Affan Street, Beside Tanta Sporting Club, Tanta, Egypt

[2 ]Faculty of Medicine, Zagazig University, ( https://ror.org/053g6we49) Zagazig, Egypt

[3 ]Faculty of Medicine, The Hashemite University, ( https://ror.org/04a1r5z94) Zarqa, Jordan

[4 ]Faculty of Medicine, Al-Azhar University, ( https://ror.org/05fnp1145) Cairo, Egypt

[5 ]College of Medicine and Health Sciences, University of Rwanda, ( https://ror.org/00286hs46) Kigali, Rwanda

[6 ]Faculty of Medicine, Fayoum University, ( https://ror.org/023gzwx10) Fayoum, Egypt

Author information

Noran Magdy Shalma http://orcid.org/0000-0001-9231-7213

Article

Publisher ID: 6140

DOI: 10.1186/s12884-023-06140-0

PMC ID: 10704776

PubMed ID: 38066425

SO-VID: b3952c4a-1eb4-4b44-a36e-a4c8619db976

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 19 August 2023

Date accepted : 20 November 2023

Funding

Funded by: Tanta University

Open Access :

Open access funding provided by The Science, Technology & Innovation Funding Authority (STDF) in cooperation with The Egyptian Knowledge Bank (EKB).

Custom metadata

ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: assisted reproduction,platelet rich plasma,in vitro fertilization,prp,ivf,repeated implantation failure

Data availability:

ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: assisted reproduction, platelet rich plasma, in vitro fertilization, prp, ivf, repeated implantation failure

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The efficacy of intrauterine infusion of platelet rich plasma in women undergoing assisted reproduction: a systematic review and meta-analysis

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Abstract

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Supplementary Information

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Advocacy for Maternal and Women’s Health

Most cited references 37

Platelet biology and functions: new concepts and clinical perspectives

Evidence that the endometrial microbiota has an effect on implantation success or failure.

Inflammation and pregnancy: the role of the immune system at the implantation site.

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