Clinical evaluation of autologous platelet-rich plasma therapy for intrauterine adhesions: a systematic review and meta-analysis

Ruonan Tang; Xifeng Xiao; Yunan He; Daner Qiu; Wanlin Zhang; Xiaohong Wang

doi:10.3389/fendo.2023.1183209

Clinical evaluation of autologous platelet-rich plasma therapy for intrauterine adhesions: a systematic review and meta-analysis

Front Endocrinol (Lausanne). 2023 Jul 6:14:1183209. doi: 10.3389/fendo.2023.1183209. eCollection 2023.

Authors

Ruonan Tang^{1

2

3}, Xifeng Xiao^{1

2}, Yunan He^{1

2}, Daner Qiu^{1

2}, Wanlin Zhang^{1

2}, Xiaohong Wang^{1

2}

Affiliations

¹ Reproductive Medicine Center, Department of Gynecology and Obstetrics, Tangdu Hospital, Air Force Medical University, Xi'an, Shaanxi, China.
² Clinical Research Center for Reproductive Medicine and Gynecological Endocrine Diseases of Shaanxi Province, Xi'an, Shaanxi, China.
³ Xi'an Medical University, Xi'an, Shaanxi, China.

Abstract

Objective: This meta-analysis aims to evaluate the efficacy and safety of autologous platelet-rich plasma (PRP) administration in reducing adhesion recurrence and improving pregnancy outcomes in patients with intrauterine adhesion (IUA).

Methods: We conducted a comprehensive search of Pubmed, Embase, the Cochrane Library, Web of Science, Scopus, and China National Knowledge Internet (CNKI) from inception to February 10, 2023, without any language or regional restrictions. We used random-effects models to assess odds ratios (OR) and weight mean differences (WMD) with 95% confidence intervals (CI).

Results: Our meta-analysis included a total of 730 patients from 10 clinical studies (6 RCTs and 4 non-RCTs). The results showed that PRP administration significantly increased endometrial thickness (WMD = 0.79, 95% CI: 0.40-1.19; P < 0.001; I² = 0.0%), menstrual volume (WMD = 2.96, 95% CI = 2.30-3.61; P < 0.001; I² = 0.0%), and days of menstruation (WMD = 1.13, 95% CI = 0.86-1.41; P < 0.001; I² = 0.0%). Additionally, the clinical pregnancy rate was also improved (OR = 1.82, 95% CI: 1.19-2.78; P = 0.006; I² = 0.0%). However, there was insufficient evidence to reach a conclusion regarding the effects of PRP on the recurrence rate of moderate to severe IUA, changes in AFS scores, miscarriage rate, and live birth rate.

Conclusions: Our analysis confirms that autologous PRP is an effective treatment for IUA. However, the limited sample size suggests that the results should be interpreted with caution. Therefore, larger and well-designed studies are necessary in the future to confirm these findings and explore the optimal PRP dosing regimens further.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO, identifier CRD42023391115.

Keywords: asherman’s syndrome; endometrial damage; endometrial thickness; safety; therapy.

Publication types

Meta-Analysis
Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Abortion, Spontaneous*
Female
Humans
Platelet-Rich Plasma*
Pregnancy
Pregnancy Outcome
Pregnancy Rate
Uterine Diseases*

Grants and funding

This research was granted by the National Natural Science Foundation of China (no. 82071717 to XW), the National Natural Science Foundation of China (no. 82271734 to XW), Health Scientific Research Fund Project of Shaanxi Province, China (no. 2021D022 to XX) and the Clinical Research Projects of the Second Affiliated Hospital, Air Force Medical University (no. 2021LCYJ035 to WZ).