platelet rich plasma is being used in infertility management extensively without sound evidence of its value. In this talk, we will discuss the real impact of using PRP in IVF

1. Platelet Rich Plasma in Infertility

2.  Supplement in infertility management
 without sufficient evidence showing their
effectiveness.
 may be associated with yet unknown risks

3.  IMSI;
 Intrauterine hCG
 Reproductive immunology tests and
treatment
 Embryo glue
 Endometrial scratching;
 PGS;
 Time-lapse imaging

4.  PRP contains 3 to 5 times higher concentration
of platelets than whole blood.
 PRP is extremely rich in plasma
proteins,growth factors and cytokines

6.  Implantation
 Thin endometrium
 POI
 Male infertility

7. Implantation
Colombo GVL1, Fanton V2, Sosa D3, Criado Scholz E3, Lotti J4, Aragona SE5, Lotti
T6. Use of platelet rich plasma in human infertility. J Biol Regul Homeost
Agents. 2017 APR-JUN;31(2 Suppl. 2):179-182.
Diabetic Foot
•PRP increases expression of
adhesion molecules on
Endometrial surface, thus
increases chances of
Implantation.

8. Pregnancy

9.  625 women
 clinical pregnancy (RR: 1.79, 95 % CI: 1.37,
2.32; P < 0.001)
 endometrial thickness increased (SMD: 1.79
mm, 95 % CI: 1.13, 2.44; P < 0.001)
Feb.,2020

10.  98 women
 clinical pregnancy (48.3% versus 23.26; p =
.001)
 ongoing pregnancy (46.7% versus 11.7%; p =
.001)
 implantation rate (58.3% versus 25%; p =
.001)

11.  97 women
 chemical pregnancy rate was higher in the
PRP group than control group (53.06% versus
27.08%, respectively; p value: 0.009).
 Clinical pregnancy rate was higher in PRP
group than control group (44.89% versus
16.66%, respectively; p value: 0.003)

12.  Implantation
 Thin endometrium
 POI
 Male infertility

13.  defined as <7 mm on day of hCG
 PRP supplies supra physiologic amounts of
essential growth factors to provide a
regenerative stimulus for promoting tissue
repair

14.  For example , a trial of only 10 women was
published in 2017 Endometrial thickness
increased >7 mm after 2 injections of PRP 48
hours apart.
 ET was carried for all of them 5 patients were
pregnant (50%). 4 of them continued their
pregnancy normally.
Mostly uncontrolled small trials

15.  Can autologous platelet rich plasma expand endometrial thickness and
improve pregnancy rate during frozen-thawed embryo transfer cycle? A
randomized clinical trial
 M Eftekhar, N Neghab, E Naghshineh, P Khani Taiwanese journal of obstetrics
& gynecology, 2018,
 Effects of autologous platelet-rich plasma on endometrial expansion in
patients undergoing frozen-thawed embryo transfer: a double-blind RCT
 L Nazari, S Salehpour, S Hoseini, S Zadehmodarres, E Azargashb.
International journal of reproductive biomedicine, 2019, 17(6), 445‐450
 Autologous PRP for the management of thin endometrium in frozen embryo
transfer cycles: would it improve the outcome?
 S Nagireddy, NS Reddy, M Pandurangi, R Vembu, MD G, SN Srinivasan, L
Katneni Fertility and sterility, 2019, 112(3), e418‐e419
 Pregnancy outcome in women with thin endometrium undergoing frozen-
thawed cycles after intrauterine infusion of autologous platelet-rich plasma
(PRP) N Neghab, M Eftekhar, E Naghshineh, P Khani International journal of
reproductive biomedicine, 2017, 15(4),

16.  All showed highly significant improvement in
endometrial thickness (P < 0.01)
 All were in FET
 All were done 48 hrs before E.T
 All reported higher pregnancy rate
 So we should be very cautious

17.  Implantation
 Thin endometrium
 POI
 Male infertility

18. Pantos et al, in the ESHRE (2016) at Helsinki finland,
injected 8 perimenopausal women with PRP in 1 to
3 months all cases undergone natural IVF cycles
with resulting follicles of 15.2±2.5 mm in
diameter, all were inseminated by ICSI & all
embryos were cryopreserved.

19.  A single dose of autologous PRP (extracted
from 40 mL of peripheral blood) in
combination with gonadotropin (150IU
rFSH/75 IU rLH) was directly injected into the
stroma of bilateral ovaries
 ICSI was done later
Case report

22.  Inclusion criteria : Age below 40
 FSH : 20-30
 BMI <30
 still menstruating
 2019: Intraovarian injection was done TVS
 2020: Intraovarian injection was done
Laparoscopically

23.  6 month
 Blood assay E2
 Start stimulation with Gn within one month
 7 days Gn / cycle for 6 month

24.  TVS injection was done in 9 cases with
premature ovarian insufficiency
 Menses still occur
 Unfortunately no follicles were developed to
be retrieved ( 4 discontinued ttt)
 E2 assay was always less than 100

25.  Laparoscopic intraovarian injection was done
for 7 cases
 Follow up is still continued
 Results : disappointing : only one case
developed follicle ( OPU was done but was
empty follicle)
 No pregnancy

26.  Strict inclusion criteria
 High FSH level at time of injection
 Site of injection : stroma !!!
 Volume : low ?

28.  Intrauterine infusion of PRP has been
conducted for women with thin endometrium
(<5 mm) on cycle day 12-14
 Over 2019-2020 almost 27 women were
injected with PRP
 this was followed by adjuvants as estradiol
supplementation or Gn injections

29.  Significant improvement was achieved in 16
cases and FET was done
 Pregnancy was achieved in only 2 cases
 11 were refractory and remain thin
So

30.  Injection of PRP in the subendometrial niche
 Using OPU needle ( under U/S )
 Blood sample 20 cc blood
 Injection in both layers ( anterior & posterior)

31.  Among the 11 cases , 5 showed improvement
in endometrial thickness
 3 of them got FET, 2 drop out
 No pregnancy
 Remaining 6 cases still having their embryos
frozen

32.  Implantation
 Thin endometrium
 POI
 Male infertility

33.  No potential role for PRP in severe
oligospermia or azoospermia

34.  POI with FSH 15-22
 Combining PRP with Gn
 Injecting GSF amouples for five days before
PRP

35.  PRP is a potential tool for those with RIF
 PRP is not an option in male infertility or Male
infertility

36. THANK YOU
Dr. Hesham Al-Inany MD, PhD
e-mail : kaainih@yahoo.com