The two hormones responsible for the preparation of the endometrium, are estrogen followed by progesterone. If the endometrium does not respond to estrogen then its thickness is affected. If the thickness of endometrium is insufficient then implantation fails.
This is the main cause of IVF cycle failure or postponement of embryo transfer. There can be several causes for thin endometrium.
Common causes of the thin endometrium:
- Uterine Infections and inflammations, pelvic infectious diseases lead to unresponsiveness to estrogens.
- Repetitive curettage causing damage to the basal layer of endometrium
- Asherman’s syndrome
- Low estrogen levels due to repetitive use of anti estrogenic treatment (clomiphene Citrate)
- Cancer treatments, such as radical surgery, chemotherapy and radiotherapy (RT) can permanently affect the uterus lining.
Endometrium thickness less than 7 mm is called thin endometrium and is considered responsible for cycle failure or frozen embryo transfer. Currently, there are reports in literature that infusion of PRP(Platelet Rich Plasma)in uterus, helps in improving the thickness of endometrium. This can be the basis of improving the receptivity of the endometrium to the implanting blastocyst.
“PRP contains activating platelets that stimulate action of cytokines and growth factors. They can regulate cell migration, attachment, proliferation and differentiation, and promote extracellular matrix accumulation. According to this theory, local infusion of PRP (that contains several growth factors and cytokines) may improve endometrial receptivity and implantation – Chang et. al. 2016. “
Data presented at the Annual meeting of American Society for Reproductive medicine (ASRM) in 2016 has shown that PRP not only causes endometrial cell proliferation in culture by acting on mesenchymal cells which help endogenous stem cells to increase endometrial cells. This is the basis of our use of PRP for management of endometrial thickening.
“EVIDENCE OF SUCCESS:
CHANG ET. AL. 2016
EVIDENCE OF SUCCESS, OF PRP THERAPY ON THE THIN ENDOMETRIAL LINING, HAS BEEN VERY ENCOURAGING AS ALL THE 5 PATIENTS WHO PARTICIPATED IN THIS STUDY RESPONDED WITH SUCCESSFUL THICKENING OF ENDOMETRIUM FOLLOWING INTRAUTERINE INFUSION OF PRP AND ALL OF THEM CONCEIVED.“
“NAZARI ET AL. ALSO SHOWED EVIDENCE, THAT PRP IS QUITE EFFECTIVE IN IMPROVING PREGNANCY OUTCOME IN PATIENTS WITH REPEATED IMPLANTATION FAILURE (RIF). 16 OUT OF THE TWENTY WOMEN WHO RECEIVED INTRA-UTERINE PRP TRANSFUSION 48 HOURS BEFORE TRANSFER WERE PREGNANT.“
- Done 48 hours before embryo transfer
- Patient has normal platelet count
- PRP is prepared from patients own blood (autologous), by collection of 10 ml blood from the vein
- PRP is prepared by double centrifugation as on the 10th day of ART cycle
- 8-10 ml of venous blood is drawn from the pre-filled syringe, and centrifuged at 1500g for 10 min.
- The Buffy coat along with some plasma is aspirated and centrifuged again at 1000g for 10 min.
- PRP is infused into the uterine cavity via a catheter (0.5–1 ml).
- Endometrial thickness is re-assessed 48–72 h later.
- Infusion of PRP can be performed 1-2 times more if the endometrial thickness is not satisfactory.
- Platelet count less than 105/μL,
- Hemoglobin level less than 10 g/dL,
Presence of metastatic disease or the blood tumour, and other associated infections.