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While the PRP here is being injected into the elbow region, it is injected directly into the uterus when used as an adjunct therapy for IVF. — Photos: Filepic

Platelet-rich plasma therapy could help in IVF

Platelet-rich plasma (PRP) is a concentrated blood product containing a high percentage of platelets used to treat wounds and other parts of the body, but have you heard of it being used to treat infertility?

Although PRP has previously been used for facial rejuvenation, hair restoration and muscle strain injuries, it is being evaluated as a treatment for low ovarian function and poor uterine lining – two of the most challenging fertility problems.

While it is still an experimental treatment, PRP appears to help improve egg quality, uterine lining thickness and endometrial receptivity when used as an adjunct to conventional fertility treatments like in vitro fertilisation (IVF). It has been tested primarily in cases of recurrent IVF failures.

Too thin an endometrium

During IVF, many couples experience postponed embryo transfers at the last minute due to insufficient endometrium thickness. The endometrium needs to have a minimum thickness of 7mm, based on ultrasound readings.

This tissue plays an important role during the implantation of the embryo. There is biochemical communication between the endometrium and the blastocyst at the time of implantation. If the thickness of the endometrium is insufficient, implantation will fail.

Oestrogen and progesterone are the two hormones responsible for the preparation of the endometrium in anticipation of pregnancy. If the endometrium is unable to respond to oestrogen, its thickness will be affected.

This unresponsiveness to oestrogen can result from uterine infections and inflammations, as well as pelvic infectious diseases.

Aside from that, other factors than can cause a thin endometrium include:

  • Endometrial basal layer damage caused by repetitive curettage (a procedure done to remove tissue from within the uterus).
  • Asherman’s syndrome, where there is scarring of the uterus.
  • Repeated use of anti-oestrogenic medications (e,g, clomiphene citrate).
  • Permanent damage to the uterine lining caused by cancer treatments, such as radical surgery, chemotherapy and radiotherapy.

According to research

If a woman’s endometrium is too thin, her embryos (as seen under the microscope here) will not be able to implant successfully. — Bloomberg

In both natural pregnancy and during IVF cycles, endometritis (inflammation and infection of the uterus) and endometriosis (where endometrial cells grow outside the uterus) can initiate inflammatory processes that affect embryo implantation.

Injections of PRP help to eliminate these inflammatory processes in the uterus and enhance the activity of progesterone receptors, which promote the growth of the endometrium, and in turn, assist with embryo implantation. Indeed, studies looking into this treatment have been positive so far.

In one study using PRP therapy for thin endometrial lining, all five patients who participated were found to have thickened endometriums following intrauterine PRP injections, and conceived as a result. Another study suggests that PRP is quite effective in improving pregnancy outcome in patients with repeated implantation failure (RIF), following several cycles of IVF.

A total of 16 out of 20 women who received intrauterine PRP transfusions 48 hours before their embryo transfer during IVF became pregnant. The advantages of PRP is that it is affordable, simple and easy to perform, while its possible side effects are infection, bleeding and nerve damage.

Is it right for me?

Repeated curettage can cause damage to the endometrium that results in it becoming too thin to support the implantation of an embryo.

In order to determine whether or not you are a good candidate for PRP therapy, your doctor should request for the appropriate blood tests and an ultrasound, as well as thoroughly review your medical history. After PRP therapy is administered, the fluctuations in your sex hormone levels need to be monitored and ultrasound scans repeated to determine whether or not the treatment has worked.

If it has, then the appropriate time to begin your IVF cycle can be determined. In most cases, PRP is made from a patient’s own blood, but it can also be made from another patient’s blood; however, the latter is very rarely recommended.

Here are the steps required for the PRP therapy:

  • Taking the patient’s history and performing a quick scan.A PRP treatment appointment will be scheduled after all the test and scanning reports are completed.
  • During the PRP procedure, the doctor will draw a blood sample, similar to how blood is collected for blood tests.
  • A centrifuge is used to separate the various components of blood in this sample.The process takes about 15 minutes.
  • Once the PRP (now devoid of cellular components) is ready, it is collected and injected into the patient’s uterus.The appropriate painkillers will be administered throughout the process to avoid any discomfort.
  • After the injection, the patient will be required to rest for about 10 to 15 minutes.

Upon completion of the procedure, you will be able to resume your daily activities – there are no restrictions. There may be some discomfort following the procedure; this is completely normal.

As PRP is made from autologous blood samples (i.e. obtained from your own self), it poses minimal risks of infectious disease transmission and immunological reactions. Before your embryo transfer, you will return to your fertility centre for an ultrasound scan.

You may need another PRP therapy session if your endometrial lining is still not as thick as required. PRP is usually done four days before embryo transfer, and repeated two days before the transfer if needed. The use of PRP in the treatment of infertility is still a relatively new practice and is considered experimental with no proven benefit yet.

But it is one of the most promising advances in fertility treatment in recent years and may be able to address some of the most common barriers to successful pregnancy. If you have been experiencing RIF, you may want to discuss with your fertility specialist if PRP treatment should be considered to help improve your IVF outcome.

By Datuk Dr Nor Ashikin Mokhtar
Published in Star Newspaper, 06 Feb 2023

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