A narrative review of platelet-rich plasma (PRP) in reproductive medicine

PRP is autologous blood plasma that has been enriched with platelets at about 4-5 times more than the circulating blood. PRP can stimulate proliferation and regeneration with a large amount of growth factors and cytokines, including PDGF, TGF, VGEF, EGF, fibroblast growth factor (FGF), insulin-like growth factor I, II (IGF I, II), interleukin 8 (IL-8) and connective tissue growth factor (CTGF).
Currently, PRP infusion is being increasingly used in several fields in medicine such as nerve injury, osteoarthritis, chronic tendinitis, bone repair and regeneration, cardiac muscles, alopecia, plastic surgery and oral surgery, but there is limited experience in gynecology and obstetrics
In women with thin endometrium, the literature shows an increase in endometrial thickness and increase in chemical and clinical pregnancy rates following autologous PRP therapy.
In women with poor ovarian reserve, autologous intraovarian PRP therapy increased anti-Mullerian hormone (AMH) levels and decreased follicle-stimulating hormone (FSH), with a trend toward increasing clinical and live birth rates.
This trend was also noted in women with recurrent implantation failure.
Limited literature shows promise in increasing endometrial thickness, increasing AMH, and decreasing FSH levels, as well as increasing chemical and clinical pregnancy rates.
The lack of standardization of PRP preparation along with the lack of large randomized controlled trials needs to be addressed in future studies.

the methods of preparation for PRP also lacked consistency.
Kamath et al. discuss using 0.5 to 1.0 ml of PRP for intrauterine infusion; however, they do not discuss the method of preparation or if a platelet agonist was used to activate the platelets and if so, which agonist was used [19].
There are different types of platelet agonists used for activation, including calcium chloride, thrombin, and collagen [20].
Chang et al. collected 15ml of whole blood from the participants and then used the two-step centrifugation process, the initial at 300 × g for 10 min at 18°C which results in 3 layers consisting of red blood cells at the bottom, buffy coat in the middle, and cellular plasma in the supernatant [21].
The top two layers were placed in a separated tube and centrifuged at 700 × g for 15 min at 18°C, and 0.5 to 1.0 ml of PRP was pipetted out for infusion purposes [21].
Coksuer et al. collected the sample at room temperature and centrifuged at 1500 × g for 5 min, the supernatant was then removed from the tube which was then recapped and underwent inversion/resuspension, and the remaining sample (1 ml of PRP) was utilized for infusion [5].
Nazari et al. centrifuged the sample immediately after collection initially at 1200 rpm for 10 min and then centrifuged again at 3300 rpm for 5 min to collect 0.5ml of PRP for infusion [9].
PRP was prepared from autologous blood using a two-step centrifuge process. On the 9th or 10th day of the mensural cycle, 17.5 ml of peripheral venous blood was drawn in the syringe that contained 2.5 ml of Acid Citrate A Anticoagulant solution (ACD-A) (Arya Mabna Tashkhis, Iran) and centrifuged immediately at 1200 rpm for 12 min to separate the red blood cells.
The plasma was centrifuged again at 3300 rpm for 7 min to obtain the PRP. Then, 0.5 ml of PRP was infused into the uterine cavity with the IUI catheter (Takwin, Iran).
Three months after undergoing intraovarian autologous PRP injection, there was an overall decrease in FSH by 67.33% and an increase in AMH by 75.18%

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2023年4月15日

A narrative review of platelet-rich plasma (PRP) in reproductive medicine

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