Dados do Trabalho

Title

Autologous platelet-rich plasma for thin endometrium treatment: a case report

Objective

The aim of this case report is to share a satisfactory outcome on the use of intrauterine infusion of PRP (platelet-rich plasma) in a patient with thin endometrium and refractoriness to other therapies.

Methods

Data from medical records were used to embase this case report, as well as scientific studies and other case reports published worldwide. PubMed and Embase were the data base used for the the literature review.

Results

Patient J.O.R.C, 41 years-old, female, diagnosed with premature ovarian failure, married to E.A.C., male, 40 years-old, healthy and with an unchanged spermogram.
The couple had a frozen blastocyst stored, product of an intracytoplasmic sperm injection (ICSI) carried out with egg donation and E.A.C.’s sperm.
During the cycle, endometrium was permanently thin and some attempts to thicken were made with both estrogen gel and low-dose aspirin, achieving the maximum thickness of 5mm.
Administration of intrauterine PRP was attempted twice in the same cycle, with the gap of three days, in order to magnify the chances of a satisfactory outcome.
Endometrial thickness was 7mm by the time of the transfer, after two intrauterine infusions of PRP. The stored frozen blastocyst was transfered, with the outcome of a healthy pregnancy and a child born and alive.

Conclusion

Assisted reproduction treatments (ART) may sometimes be challenging. Unsatisfactory endometrial growth (less than 7mm) is considered a bad prognostic factor, with lower chances of a successful implantation and pregnancy. Some embryo transfer cycles are cancelled due to a thin endometrium, leading to a extended treatment and increasing the anxiety which is inherent in the process.

Numerous treatment modalities have been proposed, such as estrogen gel, low-dose aspirin, vitamin E, vaginal sildenafil and G-CSF (granulocyte-colony stimulating factor) intrauterin infusion. Nevertheless, in addition to the weak evidence level of those therapies, some patients remain non-responsive.

PRP made with autologous blood plasma was tested in some pilot studies with a satisfactory response. It is already used for nerve repair and for multiple regeneration therapies in the Orthopaedic field, but in Ginaecology, studies with a higher number of patients are still needed in order to enrich evidence. It seems to work on proliferation and migration of endometrial cells, also enhancing the expression of regeneration and repairing factors and increasing local blood supply. Studies suggest a higher success rate in IVF (in-vitro fertilization) with the use of PRP, which could be a suitable alternative in cases of low-response to other methods. In addition, there is no risk of contracting infectious diseases or activating the immune system – the blood plasma enriched with platelets is autologous.

Keywords

PRP, Platelet-Rich plasma, endometrium