The role of the use of platelet-rich plasma in reproductive medicine

Adamyan L.V.; Antonova A.A.; Pivazyan L.G.; Krylova E.I.

doi:https://doi.org/10.17116/repro20232903125

Close metadata

Recommended articles:

Modern view on the experimental creation of endometriosis in animal models (own data). Russian Journal of Human Reproduction. 2024;(6):55-60

Clinical case of successful pregnancy in a patient with ectopic ACTH syndrome after radical surgical treatment. Russian Journal of Human Reproduction. 2024;(6):118-123

Artificial intelligence in reproductive medicine and surgery. Russian Journal of Human Reproduction. 2025;(4):10-25

Radical cystectomy with fertility preservation for non-muscle invasive bladder cancer. P.A. Herzen Journal of Oncology. 2025;(2):76-82

The effect of sleep and other medical and social factors on a woman’s reproductive function. S.S. Korsakov Journal of Neurology and Psychiatry. 2025;(5-2):81-86

Abstract:

Advances in assisted reproductive technology (ART) have led to a significant increase in the number of pregnancies, but despite great progress in embryo selection and quality improvement, many patients still experience repeated implantation failures. Most studies use autologous platelet-rich plasma (PRP) in clinical cases of patients with thin endometrium, repeated implantation failure, chronic endometritis, and Asherman’s syndrome, since, unfortunately, there is still no effective remedy for these conditions. The lack of evidence-based treatments indicates the urgency of the problem. Recently, more and more data have appeared confirming the positive role of PRP in the treatment of the endometrium. A search was made in the PubMed, Cochrane library databases. As a result of using combinations of keywords: (PRP) AND (reproductive); 552 articles were identified. 47 papers were selected and their data included in the literature review. The article presents current data on the clinical use of platelet-rich plasma in the field of reproductive medicine. Given the complexity of platelet signaling and activation, the exact details of initiation of the full spectrum of platelet physiological effects remain unclear. The review describes the identified effects and possible mechanisms of action of plasma on ovarian and endometrial tissue. Available evidence suggests that PRP may be an effective alternative for women with poor ovarian reserve and may improve pregnancy outcomes in women with repeated implantation failure, suggesting a promising role for assisted reproductive technologies in these patients.

Keywords:

platelet-rich plasma

Asherman’s syndrome

thin endometrium

fertility

reproductive medicine

Authors:

Adamyan L.V.

Moscow State Medical and Dental University named after A.I. Evdokimov

SPIN RSCI: 9836-2713
Scopus AuthorID: 7006372422
ResearcherID: Q-1722-2018
ORCID: 0000-0002-3253-4512

Antonova A.A.

National Medical Research Center for Obstetrics, Gynecology and Perinatology Named After Academician V.I. Kulakov

ORCID: 0000-0002-6011-3889

Pivazyan L.G.

National medical research center for obstetrics, gynecology and perinatology named after academician V.I. Kulakov

ORCID: 0000-0002-6844-3321

Krylova E.I.

I.M. Sechenov First Moscow State Medical University (Sechenov University)

ORCID: 0000-0002-0220-0474

Received:

06.04.2023

Accepted:

10.04.2023

Close metadata

References:

Craciunas L, Gallos I, Chu J, Bourne T, Quenby S, Brosens JJ, Coomarasamy A. Conventional and Modern Markers of Endometrial Receptivity: A Systematic Review and Meta-Analysis. Human Reproduction Update. 2019;25(2):202-223. https://doi.org/10.1093/humupd/dmy044
Bos-Mikich A, de Oliveira R, Frantz N. Platelet-Rich Plasma Therapy and Reproductive Medicine. Journal of Assisted Reproduction and Genetics. 2018;35(5):753-756. https://doi.org/10.1007/s10815-018-1159-8
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 Meta-Analysis. Journal of Reproductive Immunology. 2020;137:103078. https://doi.org/10.1016/j.jri.2019.103078
Bos-Mikich A, Ferreira MO, de Oliveira R, Frantz N. Platelet-Rich Plasma or Blood-Derived Products to Improve Endometrial Receptivity? Journal of Assisted Reproduction and Genetics. 2019;36(4):613-620. https://doi.org/10.1007/s10815-018-1386-z
Zhu R, Gan L, Wang S, Duan H. A cohort study comparing the severity and outcome of intrauterine adhesiolysis for Asherman syndrome after first-or second-trimester termination of pregnancy. European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2019;238:49-53. https://doi.org/10.1016/j.ejogrb.2019.02.030
Khizrieva PM, Adamyan LV, Martynov SA. Modern methods of prevention and treatment of intrauterine synechiae (literature review). Ginekologiya. 2016;18(5)32-36. (In Russ.).
Puente Gonzalo E, Alonso Pacheco L, Vega Jiménez A, Vitale SG, Raffone A, Laganà AS. Intrauterine infusion of platelet-rich plasma for severe Asherman syndrome: a cutting-edge approach. Updates in Surgery. 2021;73(6):2355-2362. https://doi.org/10.1007/s13304-020-00828-0
Aghajanova L, Cedars M, Huddleston H. Platelet-rich plasma in the management of Asherman syndrome: case report. Journal of Assisted Reproduction and Genetics. 2018;35(5):771-775. https://doi.org/10.1007/s10815-018-1135-3
Jincharadze LG. The use of platelet-enriched plasma in gynecology. Akusherstvo i ginekologiya. 2020;5:150-155. (In Russ.). https://doi.org/10.18565/aig.2020.5.150-55
Albazee E, Al-Rshoud F, Almahmoud L, Al Omari B, Alnifise M, Baradwan S, Abu-Zaid A. Platelet-rich plasma for the management of intrauterine adhesions: A systematic review and meta-analysis of randomized controlled trials. Journal of Gynecology Obstetrics and Human Reproduction. 2022;51(2):102276. https://doi.org/10.1016/j.jogoh.2021.102276
Martynov SA, Adamyan LV, Arakelyan AS, Fedorova TA, Bystrov OV. Possibilities of using platelet-enriched autoplasm in the complex treatment of patients with intrauterine synechiae. Ginekologiya. 2021;23(3):250-254. (In Russ.). https://doi.org/10.26442/20795696.2021.3.200878
Marty’nov SA, Adamyan LV, Fedorova TA, By’stry’x OA., Arakelyan AS. Sposob lecheniya vnutrimatochny’x sinexij. Patent RF №RU 2741621 C1. Zayavitel’ i patentoobladatel’ FGBU «Nacional’ny’j medicinskij issledovatel’skij centr akusherstva, ginekologii i perinatologii imeni akademika V.I. Kulakova» Minzdrava Rossii. №2020131585; zayavl. 25.09.2020; opubl. 28.01.2021. Byul. №4. (In Russ.).
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. International Journal of Clinical and Experimental Medicine. 2015;8(1):1286-1290.
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. Taiwanese Journal of Obstetrics and Gynecology. 2018;57(6):810-813. Erratum in: Taiwan J Obstet Gynecol. 2021; 60(5):973. https://doi.org/10.1016/j.tjog.2018.10.007
Kim H, Shin JE, Koo HS, Kwon H, Choi DH, Kim JH. Effect of Autologous Platelet-Rich Plasma Treatment on Refractory Thin Endometrium during the Frozen Embryo Transfer Cycle: A Pilot Study. Frontiers in Endocrinology. 2019;10:61-61. https://doi.org/10.3389/fendo.2019.00061
Deng H, Wang S, Li Z, Xiao L, Ma L. Effect of intrauterine infusion of platelet-rich plasma for women with recurrent implantation failure: a systematic review and meta-analysis. Journal of Obstetrics and Gynaecology: the Journal of the Institute of Obstetrics and Gynaecology. 2023;43(1):2144177. https://doi.org/10.1080/01443615.2022.2144177
Wang X, Liu L, Mou S, Zhao H, Fang J, Xiang Y, Zhao T, Sha T, Ding J, Hao C. Investigation of Platelet-Rich Plasma in Increasing Proliferation and Migration of Endometrial Mesenchymal Stem Cells and Improving Pregnancy Outcome of Patients With Thin Endometrium. Journal of Cellular Biochemistry. 2018;120(5):7403-7411. https://doi.org/10.1002/jcb.28014
Aghajanova L, Houshdaran S, Balayan S, Manvelyan E, Irwin JC, Huddleston HG, Giudice LC. In Vitro Evidence That Platelet-Rich Plasma Stimulates Cellular Processes Involved in Endometrial Regeneration. Journal of Assisted Reproduction and Genetics. 2018; 35(5):757-770. https://doi.org/10.1007/s10815-018-1130-8
Marini MG, Perrini C, Esposti P, Corradetti B, Bizzaro D, Riccaboni P, Effects of Platelet-Rich Plasma in a Model of Bovine Endometrial Inflammation In Vitro. Reproductive Biology and Endocrinology. 2016;14(1):58. https://doi.org/10.1186/s12958-016-0195-4
Urman B, Boza A, Balaban B. Platelet-Rich Plasma Another Add-on Treatment Getting Out of Hand? How can Clinicians Preserve the Best Interest of Their Patients? Human Reproduction. 2019; 34(11):2099-2103. https://doi.org/10.1093/humrep/dez190
de Miguel-Gómez L, López-Martínez S, Campo H, Francés-Herrero E, Faus A, Díaz A, Pellicer A, Domínguez F, Cervelló I. Comparison of Different Sources of Platelet-Rich Plasma as Treatment Option for Infertility-Causing Endometrial Pathologies. Fertility and Sterility. 2020;115(2):490-500. https://doi.org/10.1016/j.fertnstert.2020.07.053
Chien LW, Au HK, Chen PL, Xiao J, Tzeng CR. Assessment of Uterine Receptivity by the Endometrial-Subendometrial Blood Flow Distribution Pattern in Women Undergoing In Vitro Fertilization-Embryo Transfer. Fertility and Sterility. 2002;78(2):245-251. https://doi.org/10.1016/s0015-0282(02)03223-5
Friedler S, Schenker JG, Herman A, Lewin A. The Role of Ultrasonography in the Evaluation of Endometrial Receptivity Following Assisted Reproductive Treatments: A Critical Review. Human Reproduction Update. 1996;2(4):323-335. https://doi.org/10.1093/humupd/2.4.323
Miwa I, Tamura H, Takasaki A, Yamagata Y, Shimamura K, Sugino N. Pathophysiologic Features of «Thin» Endometrium. Fertility and Sterility. 2009;91(4):998-1004. https://doi.org/10.1016/j.fertnstert.2008.01.029
Smith SK. Angiogenesis, Vascular Endothelial Growth Factor and the Endometrium. Human Reproduction Update. 1998;4(5):509-519. https://doi.org/10.1093/humupd/4.5.509
Smith SK. Angiogenesis and Implantation. Human Reproduction. 2000;15(suppl 6):59-66. https://doi.org/10.1007/s10815-007-9152-7
Kim JH, Park M, Paek JY, Lee WS, Song H, Lyu SW. Intrauterine Infusion of Human Platelet-Rich Plasma Improves Endometrial Regeneration and Pregnancy Outcomes in a Murine Model of Asherman’s Syndrome. Frontiers in Physiology. 2020;11:105. https://doi.org/10.3389/fphys.2020.00105
Jang HY, Myoung SM, Choe JM, Kim T, Cheon YP, Kim YM, Park H. Effects of Autologous Platelet-Rich Plasma on Regeneration of Damaged Endometrium in Female Rats. Yonsei Medical Journal. 2017;58(6):1195-1203. https://doi.org/10.3349/ymj.2017.58.6.1195
Caley MP, Martins VL, O’Toole EA. Metalloproteinases and Wound Healing. Advances in Wound Care. 2015;4(4):225-234. https://doi.org/10.1089/wound.2014.0581
White YA, Woods DC, Takai Y, Ishihara O, Seki H, Tilly JL. Oocyte formation by mitotically active germ cells purified from ovaries of reproductive-age women. Nature Medicine. 2012;18:413-421. https://doi.org/10.1038/nm.2669
Tilly JL, Telfer EE. Purification of germline stem cells from adult mammalian ovaries: a step closer towards control of the female biological clock? Molecular Human Reproduction. 2009;15(7):393-398. https://doi.org/10.1093/molehr/gap036
Atkinson L, Martin F, Sturmey RG. Intraovarian injection of platelet-rich plasma in assisted reproduction: too much too soon? Human Reproduction. 2021;36(7):1737-1750. https://doi.org/10.1093/humrep/deab106
Niikura Y, Niikura T, Tilly JL. Aged mouse ovaries possess rare premeiotic germ cells that can generate oocytes following transplantation into a young host environment. Aging. 2009;1(12):971-978. https://doi.org/10.18632/aging.100105
Cozzolino M, Marin D, Sisti G. New Frontiers in IVF: mtDNA and autologous germline mitochondrial energy transfer. Reproductive Biology and Endocrinology. 2019;17(1):55. https://doi.org/10.1186/s12958-019-0501-z
Labarta E, de Los Santos MJ, Escribá MJ, Pellicer A, Herraiz S. Mitochondria as a tool for oocyte rejuvenation. Fertility and Sterility. 2019;111(2):219-226. https://doi.org/10.1016/j.fertnstert.2018.10.036
Pantos K, Nitsos N, Kokkali G, Vaxevanoglou T, Markomichali C, Pantou A, Grammatis M, Lazaros L, Sfakianoudis K. P-401 ovarian rejuvenation and folliculogenesis reactivation in peri-menopausal women after autologous platelet-rich plasma treatment. Human Reproduction. 2016;31:310-311. https://doi.org/10.26226/morressier.573c1512d462b80296c98880
Farimani M, Heshmati S, Poorolajal J, Bahmanzadeh M. A report on three live births in women with poor ovarian response following intra-ovarian injection of platelet-rich plasma (PRP). Molecular Biology Reports. 2019;46(2):1611-1616. https://doi.org/10.1007/s11033-019-04609-w
Pantos K, Simopoulou M, Pantou A, Rapani A, Tsioulou P, Nitsos N, Syrkos S, Pappas A, Koutsilieris M, Sfakianoudis K. A Case Series on Natural Conceptions Resulting in Ongoing Pregnancies in Menopausal and Prematurely Menopausal Women Following Platelet-Rich Plasma Treatment. Cell Transplantation. 2019;28:1333-1340. https://doi.org/10.1177/0963689719859539
Melo P, Navarro C, Jones C, Coward K, Coleman L. The use of autologous platelet-rich plasma (PRP) versus no intervention in women with low ovarian reserve undergoing fertility treatment: a non-randomized interventional study. Journal of Assisted Reproduction and Genetics. 2020;37(4):855-863. https://doi.org/10.1007/s10815-020-01710-z
Kakudo N, Morimoto N, Kushida S, Ogawa T, Kusumoto K. Platelet-rich plasma releasate promotes angiogenesis in vitro and in vivo. Medical Molecular Morphology. 2014;47(2):83-89. https://doi.org/10.1007/s00795-013-0045-9
Gordon JD, Mesiano S, Zaloudek CJ, Jaffe RB. Vascular endothelial growth factor localization in human ovary and fallopian tubes: possible role in reproductive function and ovarian cyst formation. Journal of Clinical Endocrinology and Metabolism. 1996;81(1):353-359. https://doi.org/10.1210/jcem.81.1.8550777
Barboni B, Turriani M, Galeati G, Spinaci M, Bacci ML, Forni M, Mattioli M. Vascular endothelial growth factor production in growing pig antral follicles. Biology of Reproduction. 2000;63(3):858-864. https://doi.org/10.1095/biolreprod63.3.858
Danforth DR, Arbogast LK, Ghosh S, Dickerman A, Rofagha R, Friedman CI. Vascular endothelial growth factor stimulates preantral follicle growth in the rat ovary. Biology of Reproduction. 2003; 68(5):1736-1741. https://doi.org/10.1095/biolreprod.101.000679
Pauli SA, Tang H, Wang J, Bohlen P, Posser R, Hartman T, Sauer MV, Kitajewski J, Zimmermann RC. The vascular endothelial growth factor (VEGF)/VEGF receptor 2 pathway is critical for blood vessel survival in corpora lutea of pregnancy in the rodent. Endocrinology. 2005;146(3):1301-1311. https://doi.org/10.1210/en.2004-0765
Pascuali N, Scotti L, Abramovich D, Irusta G, Di Pietro M, Bas D, Tesone M, Parborell F. Inhibition of platelet-derived growth factor (PDGF) receptor affects follicular development and ovarian proliferation, apoptosis and angiogenesis in prepubertal eCG-treated rats. Molecular and Cellular Endocrinology. 2015;412:148-158. https://doi.org/10.1016/j.mce.2015.04.021
Callejo J, Salvador C, González-Nuñez S, Almeida L, Rodriguez L, Marqués L, Valls A, Lailla JM. Live birth in a woman without ovaries after autograft of frozen-thawed ovarian tissue combined with growth factors. Journal of Ovarian Research. 2013;6(1):33. https://doi.org/10.1186/1757-2215-6-33
Hosseini L, Shirazi A, Naderi MM, Shams-Esfandabadi N, Borjian Boroujeni S, Sarvari A, Sadeghnia S, Behzadi B, Akhondi MM. Platelet-rich plasma promotes the development of isolated human primordial and primary follicles to the preantral stage. Reproductive Biomedicine Online. 2017;35(4):343-350. https://doi.org/10.1016/j.rbmo.2017.04.007
Everts PA, Knape JT, Weibrich G, Schönberger JP, Hoffmann J, Overdevest EP, Box HA, van Zundert A. Platelet-rich plasma and platelet gel: a review. The Journal of ExtraCorporeal Technology. 2006;38(2):174-187.