JBRA Assisted Reproduction 2025;29(Suppl.2 SBRA 2025):84
Poster Presentation
29th Annual Congress of the SBRA. São Paulo/SP - Brazil, 2025
doi: 10.5935/1518-0557.20263663
P-72. Effectiveness of Platelet-Rich Plasma (PRP) in Assisted Reproduction Treatment of Women with Thin Endometrium: Impact on Implantation and Pregnancy Rates
Isabela Ferreira Torres1, Camila Machado Rabelo1, Laura Magalhães dos Santos Amaral1, Fernanda Chaves Capanema Álvares
1 Faculdade Ciências Médicas de Minas Gerais - Belo Horizonte - MG – Brasil
2 Gerar In Vitro - Belo Horizonte - MG - Brasil
Objective: Elucidate, through a literature review, the effectiveness of Platelet-rich plasma (PRP) in increasing endometrial thickness and improving implantation and pregnancy rates in women with thin endometrium refractory to conventional treatment.
Methods: For this integrative literature review, the search was performed using PubMed and Cochrane databases. Keywords included "Platelet-rich plasma", "implantation rates", "endometrial thickness", "pregnancy rates" and "pregnancy outcomes". Research criteria included articles in English, published between 2020 and 2025. Exclusion criteria were articles requiring payment, narrative reviews and case series. Twenty-one articles were included in this review.
Results: A thin endometrium is usually defined as having less than 7 mm of thickness. Although there is medical disagreement regarding the ideal thickness, an endometrium below this threshold presents a challenge in reproductive medicine. It affects approximately 2.4% of women undergoing assisted reproductive techniques and is associated with lower embryo implantation rates, higher rates of in vitro fertilization (IVF) failure, and increased risk of pregnancy loss. Patients with this characteristic at the time of ovulation in natural cycles, human chorionic gonadotropin injection during IVF cycles, or progesterone initiation in frozen embryo transfer cycles tend to have lower reproductive success. Current proposed treatments include prolonged estrogen therapy, change or add other route of estrogen administration, vitamin E supplementation, vaginal sildenafil, low-dose aspirin, pentoxifylline, and granulocyte colony-stimulating factor (G-CSF). However, these methods may be associated with various side effects, poor endometrial response, and low patient adherence. PRP is a technique that uses the patient's own plasma combined with high concentrations of platelets and growth factors. It was first studied in the 1970s and has since been widely used in other medical fields, such as orthopedics, plastic surgery, and dermatology. In reproductive medicine, PRP has been investigated as a promising new therapeutic alternative for the treatment of thin endometrium, with the potential to improve endometrial thickness and, consequently, implantation, pregnancy rates and live birth rates. Reported methods of administration include intrauterine instillation, hysteroscopic injection and subendometrial administration. Most studies demonstrated that PRP significantly increases endometrial thickness, promotes neo-angiogenesis, and leads to significant improvements in the rates of clinical pregnancy, embryo implantation and live birth, without affecting the miscarriage rate. However, a systematic review concluded that there is uncertainty regarding the outcomes of PRP use compared to placebo or G-CSF in women with thin endometrium. No studies reported pain, infection, allergic reaction, fetal growth restriction, or fetal abnormalities. Only one study reported a potential risk of preterm birth. There is insufficient information on other possible adverse effects of PRP. Some studies have indicated benefits even in patients with thin endometrium due to various etiologies, such as polycystic ovary syndrome and genital tuberculosis. Researchers concluded that this new approach influences the proliferation and migration of endometrial cells, as well as the expression of cytokines and growth factors involved in endometrial regeneration and repair, such as VEGF, TGF-beta, and CCL5. PRP appears to be safe and is associated with few significant adverse effects. However, the lack of standardized protocols for PRP preparation and infusion, along with the limited number of high-quality randomized clinical trials, has contributed to the limited exploration of this treatment, despite its significant potential to improve assisted reproduction outcomes in women with thin endometrium.
Conclusion: PRP is a new and promising treatment alternative for women with thin endometrium refractory to conventional therapy, with the potential to increase endometrial thickness and improve success rates in assisted reproduction. However, further high-quality randomized clinical trials with standardized plasma preparation and larger sample sizes are needed to validate its efficacy and safety. The low amount of high-quality studies has impaired the wider use of PRP.