Dados do Trabalho

Title

Platelet-Rich Plasma Infusion in Infertile Women - The Future of Assisted Human Reproduction?

Objective

To perform a comparative analysis of the variables involved in Platelet-Rich Plasma (PRP) processing and its effects on the outcomes of patients undergoing infusion for the treatment of infertility.

Methods

This is a systematic literature review of a descriptive, exploratory, and cross-sectional nature. The search was conducted on major scientific article platforms such as Scielo, PUBMED, Google Scholar, and Science Direct. The inclusion criteria were publications from 2015 to 2023 with titles directly related to the action of PRP (Platelet-Rich Plasma) in the endometrium, processing methodologies, pathologies, and patient screening for this study. Articles that did not address the topic or were outside the time range of 2015 to 2023 were excluded. As a result, 9 relevant articles were found, comprising 4 randomized studies and 5 case reports.

Results

The analysis revealed variability in PRP methods and handling, but some common points regarding the patients' profile drew attention. Pathologies such as repeated implantation failure (RIF), Asherman's syndrome, salpingitis, and polycystic ovary syndrome were more prevalent, along with two or more previous frozen embryo transfer (FET) attempts, ages between 20-45 years, and endometrial thickness <7 mm. Regarding the PRP processing and handling methodology, the collected blood volume varied, but the predominant anticoagulant was acid citrate dextrose (ACD-A). The centrifugation force/velocity was measured in revolutions per minute (RPM) and gravitational force (G-force), with double centrifugation being most common. The final platelet concentrate ranged between 0.5 - 1.0 mL. It is important to note that all studies involved patients under hormonal replacement therapy (HRT) protocols during the FET cycle. Additionally, the predominant PRP infusion site was intrauterine, and the interval between infusion and FET varied from 24 to 48 hours, as reported by the authors who provided this information. To assess the post-infusion effects, endometrial thickness was measured using ultrasonography (USG), and the majority showed thicknesses >7 mm compared to the previous measurement. Out of the 9 studies, 7 obtained pregnancy rates above 40% concerning the sample size of patients.

Conclusion

As an experimental technique, there are variables that can be adjusted to optimize PRP processing and achieve more significant results. For instance, the standardization of a base methodology for PRP processing, from collection to infusion, could be beneficial. Moreover, attention is drawn to the lack of an exact interval of hours between infusion and FET, which is an important factor considering the implantation window, favoring embryo implantation and support. Further standardized studies are needed to verify such considerations. Nevertheless, It is evident that PRP infusion treatment in the endometrium has shown increased pregnancy rates compared to previous frozen embryo transfer (FET) attempts and has positive effects on endometrial thickness, making it a promising adjuvant alongside hormonal treatments and in the FET cycle.

Keywords

Platelet-Rich Plasma, Embryo Transfer, Hormonal Replacement Therapy.