Intrauterine Platelet Rich Plasma Infusion
Intrauterine PRP Infusion has shown encouraging results in some recent studies and may be helpful in some cases to improve endometrial thickness. PRP infusion is now available at the Asherman’s surgical centre.
Why PRP?
Platelets contain multiple growth factors and other substances that can have a favourable impact on tissue growth and help improve the endometrial thickness.
What are the indications?
PRP infusion has been proposed to thicken the endometrium in cases where the endometrium is less than 7mm in thickness with peak estradiol levels. It has also been proposed to improve endometrial regeneration after surgical treatment of Asherman’s syndrome. It has also been reported to improve implantation rates in cases of recurrent implantation failure.
How/when is PRP used?
At the Asherman’s Surgical Centre we are using it to improve endometrial thickness in frozen embryo transfer cycles when the endometrial thickness (ET) is less than 7mm in spite of high levels of serum estradiol and maximal doses of oral and transdermal oestrogen supplementation. In these cases we offer PRP infusions every 72 hours from day 7 or 8 of oestrogen treatment.
Some women do not seem to respond to exogenous oestrogen and we also trial natural cycle FER in such cases.
In cases of recurrent implantation failure in spite of good endometrial development on scan we also offer a single infusion 2 days prior to embryo transfer.
Contraindications for PRP Infusion
- Previous adverse reaction to PRP
- Pt is pregnant or breastfeeding
- Diabetes
- Neoplastic Diseases
- Blood Diseases
- Cancer
- Chronic skin diseases
- Caution should be taken in patients with a history of heavy smoking, drug or alcohol use.
Pre-treatment instructions
Many commonly used supplements and drugs can interfere with the action of platelets. It is important not use any of the following for at least 4 days prior to treatment or for 7 days after treatment:
- Non-steroidal anti-inflammatory drugs (NSAID) such as aspirin, ibuprofen and diclofenac
- Gingko, garlic tablets, Vitamin E, Vitamin A, Flax oil and curcumin or turmeric
- Smoking and vaping
- Alcohol and caffeine
- Systemic steroids such as prednisolone should be stopped 2 weeks prior to treatment and 4 weeks after treatment
- Heparin and other anticoagulants should be stopped 1 week prior to treatment unless there is a strong medical indication to continue them. Please check with your doctor.
- Roaccutane should be stopped 6 months prior to PRP treatment
What does PRP involve?
A sample of your blood is taken and centrifuged to separate the red blood cells, platelets and plasma. The plasma and platelets are removed before a further centrifugation following which at least 2/3 of the plasma is discarded and the platelets resuspended in a much smaller volume of plasma. The platelet-rich plasma is then infused into the uterus using an IUI catheter. You should rest for 10 mins or so after infusion.
What are the risks?
There are very few risks associated with PRP infusion as you are being treated with your own blood. There is a small chance of infection but a careful attention to technique should eliminate this risk. If you do develop an unpleasant discharge after treatment please consult your doctor immediately and you will probably need to have antibiotics.
How much does it cost?
PRP Infusions are charged at £450 per infusion. Please allow 50 mins for the appointment, including processing the blood.
References
As this is still an experimental procedure it is important that you understand that no guarantee of success can be given. In an ideal world, we would await the outcome of prospective medical trials, but many of our patients do not want to wait what may be years before the results of such trials may be available.
The references below may help to inform your decision whether or not to have a PRP infusion. They are both recent meta-analyses of published RCTs that show encouraging improvements in implantation and clinical pregnancy rates with no difference in miscarriage raters compared to standard treatment.