PRP Whitepapers & PRP Research

Robert F. LaPrade, M.D., Ph.D., Nathan R. Graden, B.S., and David H. Kahat, B.S.

Arthroscopy

The Journal of Arthroscopic and Related Surgery, Vol 35, No 11 (November), 2019: pp 3114-3116

The use of biologics may be the next big revolution in sports medicine since the use of the arthroscope. However, we are currently in the infancy of both the understanding of biologics in sports medicine and in the methods we are employing to evaluate their efficacy. As surgeons undertake further studies to elucidate the efficacy of platelet-rich plasma in the treatment of a variety of sports medicine pathologies, adherence to minimum guidelines such as the minimum information for studies evaluating biologics in orthopedics will help to clarify the true benefits of platelet-rich plasma and allow colleagues to reproduce these therapies in their respective practices.

Gautam Das, Debjyoti Dutta, Chinmoy Roy, Suspa Das

Journal on Recent Advances in Pain, Volume 5 Issue 1 (January–April 2019)

Introduction

Osteoarthritis (OA) of the knee is a chronic degenerative condition where pain is the predominant symptom. The most important reason for replacement surgery in advanced OA of the knee is pain. But pain may persist even after total knee arthroplasty in about 20% situation. Clinicians are searching an easier alternative to knee arthroplasty.

Materials and methods

Platelet-rich plasma (PRP) is a new modality of treatment which helps in regeneration and relieves pain. It has been used successfully in injured and degenerated tissues. It has been used successfully in knee OA too. Most studies indicate it as an excellent modality and superior to hyaluronic acid (HA) injection in the knee. Some studies indicate that the combination of PRP and HA is even better than PRP alone.

Discussion

Inspired by recent studies on PRP, question is raised on whether PRP injection can help avoid replacement surgery? But unless more studies with PRP are conducted on advanced OA, we cannot comment on this based on the available literature.

Keywords

Osteoarthritis of the knee, Platelet-rich plasma, Total replacement of the knee.

Eoghan T. Hurley, Daren Lim Fat, MCh, FEBOT, Cathal J. Moran, MD, FRCSI (Tr&Orth), Hannan Mullett, MCh, FRCSI (Tr&Orth)

The American Journal of Sports Medicine, First Published February 21, 2018

Background

Basic science studies suggest that platelet-rich therapies have a positive effect on tendon repair. However, the clinical evidence is conflicted on whether this translates to increased tendon healing and improved functional outcomes.

Purpose

To perform a systematic review of randomized controlled trials (RCTs) in the literature to ascertain whether platelet-rich plasma (PRP) or platelet-rich fibrin (PRF) improved patient outcomes in arthroscopic rotator cuff repair.

Study Design

Meta-analysis.

Methods

Two independent reviewers performed the literature search based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, with a third author resolving any discrepancies. RCTs comparing PRP or PRF to a control in rotator cuff repair were included. Quality of evidence was assessed using the Jadad score. Clinical outcomes were compared using the risk ratio for dichotomous variables and the mean difference for continuous variables. A P value <.05 was deemed statistically significant.

Results

Eighteen RCTs with 1147 patients were included in this review. PRP resulted in significantly decreased rates of incomplete tendon healing for all tears combined (17.2% vs 30.5%, respectively; P < .05), incomplete tendon healing in small-medium tears (22.4% vs 38.3%, respectively; P < .05), and incomplete tendon healing in medium-large tears (12.3% vs 30.5%, respectively; P < .05) compared to the control. There was a significant result in favor of PRP for the Constant score (85.6 vs 83.1, respectively; P < .05) and the visual analog scale score for pain at 30 days postoperatively (2.9 vs 4.3, respectively; P < .05) and at final follow-up (1.2 vs 1.4, respectively; P < .05) compared to the control. PRF did not result in a significantly decreased rate of incomplete tendon healing for all tears combined (23.0% vs 24.6%, respectively; P = .74) or an improved Constant score (80.8 vs 79.8, respectively; P = .27) compared to the control. PRF resulted in a significantly longer operation time (99.1 vs 83.3 minutes, respectively; P< .05) compared to the control.

Conclusion

The current evidence indicates that the use of PRP in rotator cuff repair results in improved healing rates, pain levels, and functional outcomes. In contrast, PRF has been shown to have no benefit in improving tendon healing rates or functional outcomes.

Patients with intrauterine adhesions (Asherman's Syndrome) and persistent thin endometrial lining in in vitro fertilization (IVF) treatment programs, particularly those resistant to standard therapies, present a significant clinical challenge. The aim of this trial is to assess if intrauterine administration of platelet rich plasma (PRP) improves endometrial lining thickness in patients with thin lining or Asherman's Syndrome.

This study is currently recruiting participants.

https://clinicaltrials.gov/ct2/show/NCT02825849

Enrolling 50 patients in a study.

http://cagivf.com/
Center for Advanced Genetics
3144 El Camino Real
Suite 106
Carlsbad, CA 92008 USA
Ph: +1 (760) 994-0156
in collaboration with this company https://inoviumrejuvenation.com/about-us

This Physician is working with PRP and infertility.

Randy Morris M.D. IVF1 Fertility Clinic
3 N Washington St, Naperville, IL 60540
(630) 357-6540

Abstract

Introduction: This study was to evaluate the effectiveness of PRP in the therapy of infertile women with thin endometrium (≤ 7 mm). Material and methods: Five women undergoing in vitro fertilization (IVF) with poor endometrial response still had thin endometrium (< 7 mm) after standard hormone replacement therapy (HRT) and had to cancel embryo transfer cycle. In addition to HRT, intrauterine infusion of PRP was performed. PRP was prepared from autologous blood by centrifugation, and 0.5-1 ml of PRP was infused into the uterine cavity on the 10th day of HRT cycle. If endometrial thickness failed to increase 72 h later, PRP infusion was done 1-2 times in each cycle. Embryos were transferred when the endometrium thickness reached > 7 mm. Results: Successful endometrial expansion and pregnancy were observed in all the patients after PRP infusion. Intrauterine PRP infusion represent a new method for the thin endometrium with poor response. Conclusion: This article reported that platelet-rich plasma (PRP) was able to promote the endometrial growth and improve pregnancy outcome of patients with thin endometrium.

Abstract

Endometrium is one of the main factors in pregnancy. During assisted reproductive technology (ART) treatments, some cycles are cancelled due to inadequate endometrial growth. This study was conducted to evaluate the effectiveness of platelet-rich plasma (PRP) in the treatment of thin endometrium. Ten patients with history of inadequate endometrial growth in frozen-thawed embryo transfer (FET) cycles were recruited into the study. Intrauterine infusion of PRP was performed. Endometrial thickness was assessed. Chemical and clinical pregnancies were reported. In all patients, endometrial thickness increased after PRP and embryo transfer was done in all of them. Five patients were pregnant. According to this study, it seems that PRP was effective for endometrial growth in patient with thin endometrium.

Abstract

Background:

Repeated implantation failure (RIF) is a major challenge in reproductive medicine and despite several methods that have been described for management, there is little consensus on the most effective one.

Objective:

This study was conducted to evaluate the effectiveness of platelet-rich plasma in improvement of pregnancy rate in RIF patients.

Materials and Methods:

Twenty women with a history of RIF who were candidates for frozen-thawed embryo transfer were recruited in this study. Intrauterine infusion of 0.5 ml of platelet-rich plasma that contained platelet 4-5 times more than peripheral blood sample was performed 48 hrs before blastocyst transfer.

Results:

Eighteen participants were pregnant with one early miscarriage and one molar pregnancy. Sixteen clinical pregnancies were recorded and their pregnancies are ongoing.

Conclusion:

According to this study, it seems that platelet-rich plasma is effective in improvement of pregnancy outcome in RIF patients.

Abstract

Platelets modulate clinically relevant yet incompletely understood tissue regeneration processes, and platelet rich plasma (PRP) has been previously used with some success in various non-reproductive medical contexts. Here, we extended PRP application to ovarian tissue with a view to document impact on ovarian reserve among women attending for infertility treatment. PRP was freshly isolated from patients (n= 4) with diminished ovarian reserve as determined by at least one prior IVF cycle canceled for poor follicular recruitment response or estimated by serum AMH and/or FSH, no menses for ≥1 year. Immediately following substrate isolation and activation with calcium gluconate, approximately 5 mL of autologous PRP was injected into each ovary under direct transvaginal sonogram guidance. For each study subject, AMH, FSH, and serum estradiol data were recorded at two-week intervals post-PRP and compared to baseline (pre-PRP) values. In this pilot group, mean (±SD) patient age was 42 ± 4 years with infertility duration reported as 60 ± 25 months. Following this protocol of intraovarian PRP administration, increases in serum AMH (p = .17), decreases in FSH (p < .01), or both, were observed in all cases, sufficient to permit retrieval of 5.3 ± 1.3 MII oocytes. IVF occurred 78 ± 22 (range =  59–110) days after activated PRP injection, and results appeared independent of patient age, infertility duration, baseline platelet concentration or pretreatment antral follicle count. Each patient had at least one blastocyst suitable for cryopreservation. While autologous PRP has been successfully applied therapeutically to various tissues to accelerate healing and wound repair, this is the first description of direct injection of activated PRP into the human ovary of poor prognosis IVF patients. Evidence of improved ovarian function was noted in all who received intraovarian PRP, possibly as early as two months after treatment. Additional research is needed to clarify (and enhance) which PRP components are responsible for altered ovarian function, and to identify predictive characteristics for patients most likely to benefit from this intervention.

Abstract

Purpose

The study aims to test the hypothesis that platelet-rich plasma (PRP) stimulates cellular processes involved in endometrial regeneration relevant to clinical management of poor endometrial growth or intrauterine scarring.

Methods

Human endometrial stromal fibroblasts (eSF), endometrial mesenchymal stem cells (eMSC), bone marrow-derived mesenchymal stem cells (BM-MSC), and Ishikawa endometrial adenocarcinoma cells (IC) were cultured with/without 5% activated (a) PRP, non-activated (na) PRP, aPPP (platelet-poor-plasma), and naPPP. Treatment effects were evaluated with cell proliferation (WST-1), wound healing, and chemotaxis Transwell migration assays. Mesenchymal-to-epithelial transition (MET) was evaluated by cytokeratin and vimentin expression. Differential gene expression of various markers was analyzed by multiplex Q-PCR.

Results

Activated PRP enhanced migration of all cell types, compared to naPRP, aPPP, naPPP, and vehicle controls, in a time-dependent manner (p < 0.05). The WST-1 assay showed increased stromal and mesenchymal cell proliferation by aPRP vs. naPRP, aPPP, and naPPP (p < 0.05), while IC proliferation was enhanced by aPRP and aPPP (p < 0.05). There was no evidence of MET. Expressions of MMP1, MMP3, MMP7, and MMP26 were increased by aPRP (p < 0.05) in eMSC and eSF. Transcripts for inflammation markers/chemokines were upregulated by aPRP vs. aPPP (p < 0.05) in eMSC and eSF. No difference in estrogen or progesterone receptor mRNAs was observed.

Conclusions

This is the first study evaluating the effect of PRP on different human endometrial cells involved in tissue regeneration. These data provide an initial ex vivo proof of principle for autologous PRP to promote endometrial regeneration in clinical situations with compromised endometrial growth and scarring.

This fertility clinic is offering PRP ovarian rejuvenation therapy
(212) 369-8700
1625 3rd Avenue, New York, NY

This Facility is offering PRP Infertility Therapy

PRP Treatment Dallas
13727 Noel Road, Tower Ii, Suite 200
Dallas, TX 75240
(214) 740-4973

Would you like more information about how Platelet Rich Plasma Infertility treatments work? Go ahead and call this number: (888)-981-9516.

Abstract

Introduction: Non-obstructive azoospermia is a cause of male infertility and despite the advancement in gynecology it is still one of the most challenging conditions to treat. One of the possible treatments for this condition may be Platelet-Rich-Plasma (PRP) due to its wellknown regenerative potential.

Objectives: To evaluate the effectiveness of autologous PRP in the therapy of infertile men with nonobstructive Azoospermia.

Methods: Seventy-one patients received ½ ml PRP in each testicle which was prepared by centrifuging patient’s own blood. FNA parameters and FSH levels of the patients were measured before and after the procedure. Testosterone level was measured before the procedure. All the required data for the study was collected retrospectively from the hospital records.

Results: A couple of NOA cases developed normal spermatogenesis. Post-procedure FSH was higher than preprocedural FSH (MD 1.737, p .560). Patients with spermatocytes in the initial FNA report showed a lower percentage of azoospermia than their counterparts (11.4% vs 44.4%).

Study Type : Observational
Actual Enrollment : 20 participants
Observational Model: Case-Only
Time Perspective: Prospective
Official Title: Effect of Plasma Rich in Growth Factors (PRGF) on Semen Quality
Actual Study Start Date : March 2016
Actual Primary Completion Date : July 2016
Actual Study Completion Date : December 2017

For men, it’s an opportunity to become a biological father!

PRP-therapy of the testicles is carried out in the most complicated cases of infertility:

• There are very few spermatozoa in the sperm (oligozoospermia <10 million / ml)
• Hormone therapy is not recommended
• Hormone therapy did not give results

Usually in such cases, the chances for pregnancy are very small. But we can offer a new innovative treatment - using PRP-therapy of the testicles!

The purpose of the procedure is to activate spermatogenesis (sperm production) in the testicles, which is not active enough, that’s why sperm quality is reduced and pregnancy in the partner does not appear. When high concentrated platelet-derived factors are injected into the testicular tissues, cell healing and regeneration processes are activated, which supports to the restoration of spermatogenesis.

This procedure is innovative and, due to its recent appearance, still experimental. However, according to currently available data, it succeeds in about 50-60% of cases. In any case, advanced medicine specialists believes this is a breakthrough in reproductive technologies that could potentially give a chance for pregnancy with own eggs – or for the restoration and activation of spermatogenesis in men and the opportunity to have their own children in seemingly hopeless situation.

For women, it’s an opportunity to cheat the biological clock!

The main indications for PRP-therapy:

• Ovarian failure syndrome – PRP-therapy helps for ovarian rejuvenation and makes it possible to restart menstrual cycle
• Women of advanced maternal age (menopausal and perimenopausal women) – PRP-therapy can help to grow more eggs, which will increase the chances for a positive result in the IVF cycle or for spontaneous pregnancy.
• Patients with endometrial hypoplasia – successful embryo implantation is impossible for them due to a thin layer of the endometrium. PRP-therapy for such women is a real breakthrough, especially in cases when it is not possible to grow endometrium with the help of medicines.
• Chronic endometritis and endometriosis of the uterus
• Asherman's syndrome
• Recurrent failed IVF cycles
• Complications after unsuccessful surgical treatment
• Complications after abortions

In all these cases, PRP-therapy significantly improves embryo implantation in both IVF cycles and natural pregnancy.

Abstract

Study question

To evaluate the effect of platelet-rich plasma (PRP) testicular injections on spermogram parameters of men with severe oligoasthenoteratozoospermia (OAT).

Summary answer

The PRP testicular injections have beneficial effects on spermatogenesis and enhance sperm concentration and motility in infertile men with OAT.

What is known already

The use of PRP therapy in assisted reproductive technologies is debatable. Despite the recent evidence of its positive effects in promoting endometrial and follicular growth, data from clinical studies are limited. There are only a few papers on the effectiveness of PRP therapy in the treatment of male infertility and sexual dysfunction. In more detail, the influence of PRP on spermatogenesis was carried out only on experimental animals. Although the mechanisms of its action have not yet been clarified, it is assumed that PRP, containing many biologically active molecules, realizes its effect through the tissue regeneration and cell proliferation.

Study design, size, duration

This prospective study included 68 men (34.6±5.2) years old with severe OAT (≤4 million/ml, motility ≤30%, normal sperm morphology ≤1%) receiving hormonal and antioxidant (AO) therapy during 6 months before in vitro fertilization cycles. 33 of them were injected once with autologous PRP (0.5 ml in each testicle). Spermogram and testosterone level were analyzed before the treatment and in 3, 4 and 6 months after it.

Participants/materials, setting, methods

Sperm concentration, motility and morphology in ejaculate of 33 men of PRP group were compared with those in the group of 35 men without PRP within 6 months of starting the treatment. Total and free testosterone level were measured in blood serum. PRP was prepared by centrifuging the patient’s own blood in the anticoagulant-containing tubes. The final concentration of platelets in the obtained sample was 950.000 – 1.250 000 cells in 1 ml.

Main results and the role of chance

4 months after the PRP injection, sperm concentration and motility increased in 18 of 33 men of the PRP group compared with the baseline (before the treatment) – 4.2 (1.0;6.9) vs 1.4 (0.1;3.4) mln/ml (p < 0.05) and 36.7 (30.6;45.8) vs 17.7 (6.7;28.2) % respectively (p < 0.05).The maximum increase in sperm motility (but not in sperm concentration!) was observed in 24 men in 6 months – 49.6 (39.6;56.4) % (p < 0.05). Percent of morphologically normal spermatozoa in ejaculate slightly increased only in 12 men in that time period from 0-1 % to 1-2%. The total testosterone level was 2.4 times higher than the baseline (31.6±7.2 vs 13.2±4.3 nmol/l, p < 0.05), the free testosterone level was 1.8 times higher (14.5±3.5 vs 7.9±3.0 pgl/ml, p < 0.05).

Unlike the PRP group, in the group of men without PRP treatment, the sperm parameters did not changed compared with the baseline in 4 months after the starting hormonal and AO treatment. A significant increase of sperin concentration was observed only in 17 of 35 patients in 6 months. Sperm motility and percent of morphologically normal spermatozoa after the treatment did not differ from the baseline. Changes in the testosterone levels were similar to changes in PRP group.

Limitations, reasons for caution

Only young and middle-aged men were considered in the study. Large randomized controlled studies are required to confirm the PRP therapy efficacy and safety of f various fertility disorders. There are also no standardized protocols for PRP preparation.

Wider implications of the findings

PRP therapy may have great potential for the treatment of male infertility and improving spermatogenesis. Optimization of methods of PRP preparation and dosage of testicular injections can enhance reproductive outcomes in assisted reproductive technologies.

Trial registration number

not applicable

Abstract

Purpose

To investigate the impact of a 3-month course of intracortical injections of autologous platelet-rich plasma (PRP) upon ovarian reserve markers versus no intervention in women with low ovarian reserve prior to undergoing assisted reproductive technology (ART).

Methods

Prospective controlled, non-randomized comparative study conducted in a private fertility clinic, in Venezuela. Women with abnormal ovarian reserve markers (FSH, AMH and AFC) who declined oocyte donation were allocated to one of the following groups according to patient choice: monthly intracortical ovarian PRP injections for three cycles, or no intervention. Primary outcomes were the change in FSH, AMH and AFC pre- and post-treatment. Secondary outcomes included the number of oocytes collected and fertilized, biochemical/clinical pregnancy rates and miscarriage and live birth rates.

Results

Eighty-three women were included, of which 46 received PRP treatment and 37 underwent no intervention. Overall median age was 41 years (IQR 39–44). There were no demographic differences between the study groups. At the 3-month follow-up, women treated with PRP experienced a significant improvement in FSH, AMH and AFC, whereas there was no change in the control group. Furthermore, overall rates of biochemical (26.1% versus 5.4%, P = 0.02) and clinical pregnancy (23.9% versus 5.4%, P = 0.03) were higher in the PRP group, while there was no difference in the rates of first trimester miscarriage and live birth between groups.

Conclusion

PRP injections are effective and safe to improve markers of low ovarian reserve prior to ART, although further evidence is required to evaluate the impact of PRP on pregnancy outcomes.

Despite the advancement in the healthcare sector, especially in gynecology, infertility among males has become more challenging to cure. One of the best-known treatments to cure infertility is PRP (Platelet-Rich-Plasma).