Experience with intrauterine plateletrich plasma infusions for endometrial preparation in thawed embryo transfer programs in patients with an unfavorable prognosis of treatment outcomes


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Patients with chronic endometritis, thin endometrium, and re/eated im/lantation failures are traditionally referred to the grou/ with an unfavorable prognosis of treatment outcomes, by using assisted reproductive technologies (ART). There is no single tactics aimed at increasing the/ositive results of ART/rograms in this/atient category. Objective. To evaluate the experience in using intrauterine platelet-rich plasma (PRP) infusions in endometrial preparation in thawed embryo transfer programs in patients with an unfavorable prognosis of treatment outcomes. Materials and methods. Twenty-eight case histories of patients were analyzed. The inclusion criteria were age < 42 years; a body mass index lower than 30 kg/m2; one or more histories of attempts at embryo transfer; and the quality of transferred embryos (AA, AB, and BB). The exclusion criteria were the use of donor oocytes and embryos; uterine pathology; genital anomalies; and Asherman’s syndrome. There were three patient groups: 1) repeated embryo implantation failures; 2) chronic endometritis; 3) thin endometrium. Preparation of the endometrium for thawed embryo transfer consisted in hormone replacement therapy. Seven days before embryo transfer, 1.0-1.5 ml of PRP was infused into the uterus. The endometrial thickness was measured over time and on the day of embryo transfer. Results. In Group 1 (n=12), clinical pregnancy (CP) was recorded in 7 patients. Spontaneous abortion (SA) was observed in 1 patient. In Group 2, CP was confirmed in 6 patients, SA was noted in 2 women. Group 3 (n=15) showed a significant endometrial thickness increase (p=0.003). CP was seen in 9patients; SA was recorded in 3 women. Conclusion. It is advisable to use intrauterine PRP infusions in order to enhance the effectiveness of ART programs in patients with an unfavorable prognosis of treatment outcomes.

Full Text

Restricted Access

About the authors

Valentina A. Savina

International Center of Reproductive Medicine

Email: savina@mcrm.ru
Ph.D. in Medical sciences, obstetrician-gynecologist of Assisted Reproductive Technologies Department

Yanina A. Samoilovich

International Center of Reproductive Medicine

Email: yanasam@yandex.ru
Ph.D., obstetrician-gynecologist of Assisted Reproductive Technologies Department

Elvira V. Isakova

International Center of Reproductive Medicine

Email: elvira@mcrm.ru
Ph.D. in Medical sciences, Head of Assisted Reproductive Technologies Department

References

  1. Lintsen A.M., Eijkemans M.J., Hunault C.C., Bouwmans C.A., Hakkaart L., Habbema J.D. et al. Predicting ongoing pregnancy chances after IVF and ICSI: a national prospective study. Hum. Reprod. 2007; 22(9): 2455-62. https://dx.doi. org/10.1093/humrep/dem183.
  2. Shapiro B.S., Daneshmand S.T., Desai J., Garner F.C., Aguirre M., Hudson C. The risk of embryo-endometrium asynchrony increases with maternal age after ovarian stimulation and IVF. Reprod. Biomed. Online. 2016; 33(1): 50-5. https://dx.doi.org/10.1016/j.rbmo.2016.04.008.
  3. Laasch C., Puscheck E. Cumulative embryo score, not endometrial thickness, is best for pregnancy prediction in IVF. J. Assist. Reprod. Genet. 2004; 21(2): 47-50. https:/dx./doi.org/10.1023/b:jarg.0000025937.43936.73.
  4. Elnashar A.M., Aboul-Enein G.I. Endometrial receptivity. Middle East Fertil. Soc. J. 2004; 9(1): 10-24.
  5. Edwards R.G. Human implantation: the last barrier in assisted reproduction technologies? Reprod. Biomed. Online. 2006; 13(6): 887-904. https://dx.doi. org/10.1016/s1472-6483(10)61039-5.
  6. Wilcox A. J., Baird D.D., Weinberg C.R. Time of implantation of the conceptus and loss of pregnancy. N. Engl. J. Med. 1999; 340(23): 1796-9. https://dx.doi. org/10.1056/NEJM199906103402304.
  7. Казачков Е.Л., Казачкова Э.А., Воропаева Е.Е., Хелашвили И.Г., Мирошниченко Л.Е. Морфофункциональные характеристики нарушения восприимчивости эндометрия при хроническом эндометрите. Архив патологии. 2014; 76(3): 53-8. [Kazachkov E.L., Kazachkova E.A., Voropaeva E.E., Khelashvili I.G., Miroshnichenko L.E. Morphofunctional characteristics of endometrial susceptibility disorders in chronic endometritis. Arch Patol. 2014; 76 (3): 53-8. (in Russian)].
  8. Heger A., Sator M., Pietrowski D. Endometrial receptivity and its predictive value for IVF/ICSI-outcome. Geburtshilfe Frauenheilkd. 2012; 72(8): 710-15. https://dx.doi.org/10.1055/s-0032-1315059.
  9. Wu D., Kimura F., Zheng L., Ishida M., Niwa Y., Hirata K. et al. Chronic endometritis modifies decidualization in human endometrial stromal cells. Reprod. Biol. Endocrinol. 2017; 15(1): 16. https://dx.doi.org/10.1186/s12958-017-0233-x.
  10. Kasius A., Smit J.G., Torrance H.L., Eijkemans M.J., Mol B.W., Opmeer B.C., Broekmans FJ. Endometrial thickness and pregnancy rates after IVF: a systematic review and meta-analysis. Hum. Reprod. Update. 2014; 20(4): 530-41. https:// dx.doi.org/10.1093/humupd/dmu011.
  11. Romero R., Espinoza J., Mazor M. Can endometrial infection/inflammation explain implantation failure, spontaneous abortion, and preterm birth after in vitro fertilization? Fertil. Steril. 2004; 82(4): 799-804. https://dx.doi. org/10.1016/j.fertnstert.2004.05.076.
  12. Johnston-MacAnanny E.B., Hartnett J., Engmann L.L., Nulsen J.C., Sanders M.M., Benadiva C.A. Chronic endometritis is a frequent finding in women with recurrent implantation failure after in vitro fertilization. Fertil. Steril. 2010; 93(2): 437-41. https://dx.doi.org/10.1016/j.fertnstert.
  13. Cicinelli E., Matteo M., Tinelli R., Lepera A., Alfonso R., Indraccolo U. et al. Prevalence of chronic endometritis in repeated unexplained implantation failure and the IVF success rate after antibiotic therapy. Hum. Reprod. 2015; 30(2): 323-30. https://dx.doi.org/10.1093/humrep/deu292.
  14. Yang R., Du X., Wang Y., Song X., Yang Y., Qiao J. Hysteroscopy and histological diagnosis and treatment value of chronic endometritis in recurrent implantation failure patients. Arch. Gynecol. Obstet. 2014; 289(6): 1363-9. https:// dx.doi.org/10.1007/s00404-013-3131-2.
  15. Weckstein L.N., Jacobson A., Galen D., Hampton K., Hammel J. Low-dose aspirin for oocyte donation recipients with a thin endometrium: prospective, randomized study. Fertil. Steril. 1997; 68(5): 927-30. https://dx.doi.org/10.1016/s0015-0282(97)00330-0.
  16. Firouzabadi R.D., Davar R., Hojjat F., Mahdavi M. Effect of sildenafil citrate on endometrial preparation and outcome of frozen-thawed embryo transfer cycles: a randomized clinical trial. Iran. J. Reprod. Med. 2013; 11(2): 151-8.
  17. Barad D.H., Yu Y., Kushnir V.A., Shohat-Tal A., Lazzaroni E., Lee H.J., Gleicher N. A randomized clinical trial of endometrial perfusion with granulocyte colony-stimulating factor in in vitro fertilization cycles: impact on endometrial thickness and clinical pregnancy rates. Fertil. Steril. 2014; 101(3): 710-5. https:// dx.doi.org/10.1016/j.fertnstert.2013.12.016.
  18. Groenewoud E.R., Cantineau A.E., Kollen B.J., Macklon N.S., Cohlen B.J. What is the optimal means of preparing the endometrium in frozen-thawed embryo transfer cycles? A systematic review and meta-analysis. Hum. Reprod. Update. 2013; 19(5): 458-70. https://dx.doi.org/10.1093/humupd/dmt030.
  19. Lebovitz O., Orvieto R. Treating patients with “thin” endometrium - an ongoing challenge. Gynecol. Endocrinol. 2014; 30(6): 409-14. https://dx.doi.org/10.310 9/09513590.2014.906571.
  20. Zadehmodarres S., Salehpour S., Saharkhiz N., Nazari L. Treatment of thin endometrium with autologous platelet-rich plasma: a pilot study. JBRA Assist. Reprod. 2017; 21(1): 54-6. https://dx.doi.org/10.5935/1518-0557.20170013.
  21. Eftekhar M., Neghab N., Naghshineh E., Khani P. Can autologous platelet rich plasma expand endometrial thickness and improve pregnancy rate during frozen-thawed embryo transfer cycle? A randomized clinical trial. Taiwan. J. Obstet. Gynecol. 2018; 57(6): 810-3. https://dx.doi.org/10.1016/j.tjog.2018.10.00.
  22. Nazari L., Salehpour S., Hoseini S., Zadehmodarres S., A'ori L. Effects of autologous platelet-rich plasma on implantation and pregnancy in repeated implantation failure: A pilot study. Int. J. Reprod. Biomed. 2016; 14(10): 625-8. https://dx.doi.org/10.1016/j.tjog.2018.10.007.
  23. Aghajanzadeh F., Esmaeilzadeh S., Basirat Z., Mahouti T., Heidari F.N., Golsorkhtabaramiri M. Using autologous intrauterine platelet-rich plasma to improve the reproductive outcomes of women with recurrent implantation failure. JBRA Assist. Reprod. 2020; 24(1): 30-3. https:// dx.doi.org/10.5935/1518-0557.20190055.
  24. Maleki-Hajiagha A., Razavi M., Rouholamin S., Rezaeinejad M., Maroufizadeh S., Sepidarkish M. Intrauterine infusion of autologous platelet-rich plasma in women undergoing assisted reproduction: A systematic review and metaanalysis. J. Reprod. Immunol. 2020; 137: 103078. https://dx.doi.org/10.1016/j. jri.2019.103078.
  25. Drago L., Bortolin M., Vassena C., Taschieri S., Del Fabbro M. Antimicrobial activity of pure platelet-rich plasma against microorganisms isolated from oral cavity. BMC Microbiol. 2013; 13: 47. https://dx.doi.org/10.1186/1471-2180-13-47.
  26. Mazzocca A.D., McCarthy B.R., Intravia J., Beitzel K., Apostolakos J., Cote M.P. et al. An in vitro evaluation of the anti-inflammatory effects of platelet-rich plasma, ketorolac, and methylprednisolone. Arthroscopy. 2013; 29(4): 675-83. https://dx.doi.org/10.1016/j.arthro.2012.12.005.
  27. Chang Y., Li J., Chen Y., Wei L., Yang X., Shi Y., Liang X. Autologous platelet-rich plasma promotes endometrial growth and improves pregnancy outcome during in vitro fertilization. Int. J. Clin. Exp. Med. 2015; 8(1): 1286-90.
  28. Sfkianoudis K., Simpoulog M., Nitsos N., Lazaros L., Rapani A., Pantou A. et al. Successful implantation and live birth following autologous platelet-rich plasma treatment for a patient with recurrent implantation failure and chronic endometritis. In Vivo. 2019; 33(2): 515-21. https://dx.doi.org/10.21873/ invivo.11504.
  29. Li M.O., Mavell R.A. TGF-p: a master of all T. cell trades. Cell. 2008; 134(3): 392-404. https://dx.doi.org/10.1016/j.cell.2008.07.025.
  30. Sanjabi S., Oh S.A., Li M.O. Regulation of the immune response by TGF-в from conception to autoimmunity and infection. Cold Spring Harbor Perspect. Biol. 2017; 9(6): a022236. https://dx.doi.org/10.1101/cshperspect.a022236.
  31. Wegmann T.G., Lin H., Guilbert L., Mosmann T.R. Bidirectional cytokine interactions in the maternal-fetal relationship: is successful pregnancy a TH2 phenomenon? Immunol. Today. 1993; 14: 353-6. https://dx.doi. org/10.1016/0167-5699(93)90235-D.
  32. Munoz-Suano A., Hamilton A.B., Betz A.G. Gimme shelter: the immune system during pregnancy. Immunol. Rev. 2011; 241(1): 20-38. https://dx.doi. org/10.1111/j.1600-065X.2011.01002.x.
  33. Laird S.M., Tuckerman E.M., Li T.-C. Cytokine expression in the endometrium of women with implantation failure and recurrent miscarriage. Reprod. Biomed. Online. 2006; 13(1): 13-23. https://dx.doi.org/10.1016/s1472-6483(10)62011-1.
  34. Nazari L., Salehpour S., Hosseini M.S., Moghanjoughi P.H. The effects of autologous platelet-rich plasma in repeated implantation failure: a randomized controlled trial. Hum. Fertil. (Camb.). 2020; 23(3): 209-13. https://dx.doi.org/1 0.1080/14647273.2019.1569268.
  35. Обидняк Д.М., Гзгзян Д.А., Ниаури Д.О., Чхаидзе И.З. Перспективы применения аутологичной обогащенной тромбоцитами плазмы крови у пациенток с повторными неэффективными попытками имплантации. Проблемы репродукции. 2017; 23(5): 84-8. https://doi. org/10.17116/repro201723584-88.
  36. Magnus M.C., Wilcox A.J., Morken N.H., Weinberg C.R., Haberg S.E. Role of maternal age and pregnancy history in risk of miscarriage: prospective register based study. BMJ. 2019; 364: l869. https://dx.doi.org/10.1136/bmj.l869.
  37. Cohain J.S., Buxbaum R.E., Mankuta D. Spontaneous first trimester miscarriage rates per woman among parous women with 1 or more pregnancies of 24 weeks or more. BMC Pregnancy Childbirth. 2017; 17(1): 437. https://dx.doi. org/10.1186/s12884-017-1620-1.
  38. Buckett W.M., Chian R.C., Dean N.L., Sylvestre C., Holzer H.E.G., Tan S.L. Pregnancy loss in pregnancies conceived after in vitro oocyte maturation, conventional in vitro fertilization, and intracytoplasmic sperm injection. Fertil. Steril. 2008; 90(3): 546-50. https://dx.doi.org/101016/j.fertnstert.2007.06.107.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2020 Bionika Media

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies