Fertility Physican's Guide to Platelet-Rich Plasma

For couples who want to start a family, an infertility diagnosis can be crushing. Despite wanting so badly to have a baby, the simple truth is that no amount of money, positive thinking, skills, supplements, or work can force a pregnancy.

Assisted reproductive technologies (ARTs), such as in vitro fertilization (IVF) and intrauterine insemination (IUI), have led to considerable improvements in pregnancy rates. But as a fertility specialist, you’ve likely come across frustrating cases in which ARTs fail again and again for a patient. What then?

Emerging data suggest a potential role for platelet-rich plasma (PRP) as a solution for some of the most difficult fertility issues. Here are some cases in which PRP may benefit your patients.

Evidence-Based PRP Benefits in Fertility

1. PRP May Increase Endometrial Receptivity

Despite the advances in ARTs, implantation failure remains a persistent unresolved problem. Implantation failure can be due to several reasons, a few of which include:¹

• Embryo reasons
• Poor endometrial receptivity
• Poor embryo-endometrium communication

In particular, clinicians have struggled to find a solution for unsatisfactory endometrial receptivity.

But PRP may change all of that.

Several clinical studies have explored the use of PRP in patients with thin endometrium, repeated implantation failure, chronic endometritis, and Asherman Syndrome. Results from these studies indicate that intrauterine PRP infusion can have positive influences, including a successful pregnancy and live birth.²

Let’s look at thin endometrium for example, one of the most significant factors in implantation. Multiple studies suggest a minimal endometrial thickness of 7 mm at the end of the follicular phase is required for embryo transfer. Thus, an endometrial thickness less than 7 mm is considered thin and is associated with a lower chance of pregnancy.^3,4

Chang and colleagues were the first to use PRP in women with a thin endometrium. They analyzed 5 women who had undergone IVF and other standard treatments without success. The subjects underwent standard hormone replacement therapy (HRT) followed by an intrauterine infusion of PRP on the 10th day of the HRT cycle. If their endometrial thickness failed to increase 72 hours later, they received another PRP infusion. The authors reported successful endometrial expansion and pregnancy in all 5 patients after the PRP infusion , demonstrating that PRP could improve pregnancy outcome.⁵

A larger study by Tandulwadkar and colleagues examined 68 women with a history of thin endometrium despite HRT. Similar to the above study, the subjects with poor responding endometrium received intrauterine PRP infusion and were reassessed 72 hours later. Those with good response (good vascularity and endometrial thickness >7 mm) underwent embryo transfer, while those who didn’t repeated the PRP infusion. The results showed significant positive benefits, with a positive beta Human Chorionic Gonadotropin rate of 60.93% and a clinical pregnancy rate 45.31%.

The studies discussed above are just two examples of several demonstrating the promise of PRP therapy in the treatment of women with poor endometrial receptivity. Some experts believe PRP could help ease the financial and psychological burden of infertility in some women.

2. PRP May Offer Promise to Women With Diminished Ovarian Reserve

One of the major limiting factors for a successful pregnancy is the decline in quality and quantity of oocytes reserves that occurs with ovarian aging. Available treatments to tackle this issue include IV with an oocyte donation, and while this is an effective treatment, it is seen as a last resort for many women.

Ovarian PRP treatment may be the breakthrough approach clinicians have been searching for.

Panda and colleagues conducted a systematic review of four studies that evaluated the effectiveness of PRP in women with diminished ovarian reserve, premature ovarian failure, or menopause. Intrauterine PRP infusion was found to improve ovarian reserve parameters , which included serum anti-Müllerian hormone, antral follicle count, or follicle-stimulating hormone.⁶

Three of the four studies analyzed by Panda and colleagues also provided outcomes of the subsequent intracytoplasmic sperm injection cycles. The investigators found that subjects who received PRP infusion showed positive changes in the following:

• Total number of oocytes retrieved
• Number of two-pronuclei embryos
• Fertilization rate
• Number of cleavage stage embryos
• Number of good quality embryos
• Cycle cancellation rate

So, could PRP put a stop to our long quest in the search of answers for women with diminished ovarian reserves? Research is still early, but there’s no denying that PRP can finally offer hope to women who for so long had no other options.

3. PRP May Help Improve Sperm Quality

Much of the focus in fertility treatments has traditionally been placed on women. But male infertility is known to be solely responsible for about 20% of infertility cases and is a contributing factor in another 30% to 40%.⁷

Sperm quality can play a major role in the success of an ART. But the centrifugation processes used in an ART preparation cycle can damage the sperm, possibly due to the generation of reactive oxygen species (ROS).⁸

Several studies have considered the use of PRP to improve sperm quality. Platelets are a rich reservoir of growth factors, such as fibroblast growth factor (FGF), transforming growth factor β (TGF-β), vascular endothelial growth factor (VEGF), platelet-derived growth factor (PDGF), superoxide dismutase (SOD), and more. Many of these factors have also been shown to exert a positive effect on sperm quality and function. For instance, incubation with FGF2 has been shown to significantly increase sperm motility and kinetics.⁹

Results from a novel in vitro study indicated significantly better motility and morphometrics of spermatozoa after incubation with PRP.¹⁰ Another study assessed the effect of PRP on sperm parameters in the presence and absence of H2O2. Samples treated with PRP after H2O2 exposure demonstrated significantly better vitality and motility compared to untreated samples. Also noted was the decrease in ROS-positive cells, DNA fragmentation, vacuolization, and dead cells in the treated group.¹¹

A recent study published by Angellee and colleagues reported similar results. This study involved 40 male couples undergoing infertility treatments. Each sample was assessed for sperm quality and then incubated with PRP for 1 hour. As with the studies discussed above, the investigators observed increased sperm concentration, motility, progressive motility, and morphology after incubation with PRP. Remarkably, they also reported an increased percentage of sperm with good fertilization ability. ²

Pregnancy Shouldn’t Be About Getting Lucky

Some couples spend several years trying to conceive, thinking, “One day we’ll get lucky.” But for many, that day never comes. Others may suffer from one miscarriage after another.

Few people like talking about it, but the infertility rollercoaster is real – it affects your patients emotionally, mentally, and even financially.

As a fertility specialist, there’s likely no greater feeling than helping a couple bring a baby into the world. And PRP can help your patients finally get off the rollercoaster. If you want to give your patients a sense of hope during one of the darkest times of their lives, consider incorporating PRP into your practice.

Dr. PRP makes it super easy to create high quality PRP at an affordable cost to you with our PRP kits and centrifuges. Got questions? Our customer service is ready to help. Call us today at (844) 377-7787 (DR-PRP-US).