Efficacy of In-utero Infusion of Autologous Platelet Rich Plasma Therapy in Women with Recurrent Implantation Failure: A Systematic Review and Meta-analysis of Randomised Controlled Trials

Abstract

Introduction: In-utero infusion of autologous Platelet Rich Plasma (PRP) is found to be a novel approach to address the thin, non receptive endometrium leading to recurrent implantation failure. Aim: To estimate the efficacy of intrauterine PRP infusion in subfertile females affected with recurrent implantation failure via the conduction of a systematic review and meta-analysis of the available Randomised Controlled Trials (RCTs). Materials and methods: A systematic literature search was done in electronic databases like Medline (through PubMed), Embase, Scopus, Web of Science, and Cochrane database from January 2000 to November 2020 using keywords like “In-vitro Fertilisation” OR “IVF” OR “Intracytoplasmic sperm injection” OR “ICSI” OR “Embryo transfer” AND “Platelet rich plasma” OR “PRP” OR “Autologous platelet rich plasma” OR “Platelet rich plasma” and “recurrent implantation failure”. The randomised controlled trials, comparing intrauterine infusion of PRP versus no intervention or placebo in a study population of subfertile women with recurrent implantation failure and having medically confirmed pregnancy outcomes like live birth, clinical pregnancy, chemical pregnancy, and miscarriage were included in this systematic review. Studies with inadequate details in the methodology or result section were excluded from this analysis. This meta-analysis involved a pooled data analysis of 335 participants (174 cases and 161 controls) from four RCTs. Results: Compared with the control group, patients in the PRP group were found to have more beneficial effects in terms of implantation rate (Relative risks: 1.51, 95% Confidence interval: 0.94, 2.44; Heterogeneity: Tau²=0.08; I²=44%; Test for overall effect: Z=1.69, p-value=0.09) and clinical pregnancy (Relative risk: 1.88, 95% CI: 1.17, 3.03; Heterogeneity: Tau²=0.12; I²=51%; Test for overall effect: Z=2.62; p-value=0.009). Conclusion: Intrauterine PRP infusion increases the implantation rate and clinical pregnancy rate in women undergoing the frozen embryo transfer cycle.