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Journal ID : TMJ-02-09-2021-10615
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Title : Improving Endometrial Ultrasound Parameters and Enhancing Implantation in ICSI Patients: The Role of Autologous Platelet-Rich Plasma Intra-Uterine Infusion

Abstract :

Implantation is a complicated process that involves interactions between the endometrium and the blastocyst and involves adhesion molecules, cytokines, growth factors, lipids, and other components. Autologous platelet-rich plasma (PRP) is thought to be able to enhance endometrial development and improve pregnancy outcomes in ICSI patients by releasing granules containing growth factors including TGF-, PDGF, IGF-1, VEGF, and EGF, which drive the inflammatory cascade and healing process. The purpose of this study was to realize how intrauterine infusions of autologous platelet rich plasma (PRP) affected endometrial angiogenesis and vascularity on the day of ovulation trigger in women undergoing ICSI cycles, as measured by transvaginal ultrasonography and Power Doppler. Eighty-one women, all under the age of 40, were subjected to antagonist ovarian stimulation procedures based on their age, medical history, physical examination, and basal hormone level, and then oocytes were extracted using an ultrasound guidance and fertilized by sperm injection into the egg (Intra Cytoplasmic Sperm Injection). Forty-four of them (PRP group) received intrauterine autologous platelets rich plasma infusion produced from an individual's entire blood then centrifuged to remove red blood cells on the day of ovulation trigger, while the other 37 women did not (Non-PRP group). On the day of ovum pickup, all patients had their ultrasounds taken. In two-dimensional mode, power Doppler is used, electronically determined endometrial thickness, pulsatility index (PI), and resistance index (RI) of sub endometrial arteries. With highly significant deference between PRP and Non-PRP group for endometrial thickness =10.38 ±1.56 versus 9.31 ±1.36, respectively, P = 0.002, and resistance index = 0.49 ±0.08 versus 0.66 ±0.08, and pulsatility index= 0.78 ±0.55 versus 1.04 ±0.20, P = 0.009, respectively, the pregnancy rate in all enrolled infertile women was 18 out of 81 (22.2 %). The rate was higher in PRP group in comparison with Non-PRP group, 31.8 % versus 10.8 %, respectively and the difference was significant (p = 0.023). Autologous PRP intrauterine infusion on the day of ovulation trigger can improve implantation and clinical pregnancy rates in ICSI patients, according to this study. Ultrasonographical, sub-endometrial measures such as endometrial thickness, RI, and PI changed after PRP infusion, as the thickness increased while vascular resistance reduced, and were all used to predict endometrial receptivity.

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